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Dogliotti I, Levis M, Martin A, Bartoncini S, Felicetti F, Cavallin C, Maffini E, Cerrano M, Bruno B, Ricardi U, Giaccone L. Maintain Efficacy and Spare Toxicity: Traditional and New Radiation-Based Conditioning Regimens in Hematopoietic Stem Cell Transplantation. Cancers (Basel) 2024; 16:865. [PMID: 38473227 DOI: 10.3390/cancers16050865] [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: 01/31/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Novelty in total body irradiation (TBI) as part of pre-transplant conditioning regimens lacked until recently, despite the developments in the field of allogeneic stem cell transplants. Long-term toxicities have been one of the major concerns associated with TBI in this setting, although the impact of TBI is not so easy to discriminate from that of chemotherapy, especially in the adult population. More recently, lower-intensity TBI and different approaches to irradiation (namely, total marrow irradiation, TMI, and total marrow and lymphoid irradiation, TMLI) were implemented to keep the benefits of irradiation and limit potential harm. TMI/TMLI is an alternative to TBI that delivers more selective irradiation, with healthy tissues being better spared and the control of the radiation dose delivery. In this review, we discussed the potential radiation-associated long-term toxicities and their management, summarized the evidence regarding the current indications of traditional TBI, and focused on the technological advances in radiotherapy that have resulted in the development of TMLI. Finally, considering the most recent published trials, we postulate how the role of radiotherapy in the setting of allografting might change in the future.
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Affiliation(s)
- Irene Dogliotti
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Mario Levis
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Aurora Martin
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Sara Bartoncini
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Francesco Felicetti
- Division of Oncological Endocrinology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", 10126 Torino, Italy
| | - Chiara Cavallin
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Enrico Maffini
- Hematology Institute "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marco Cerrano
- Division of Hematology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", 10126 Torino, Italy
| | - Benedetto Bruno
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Umberto Ricardi
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Luisa Giaccone
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
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2
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Reilly M, Dandapani SV, Kumar KA, Constine L, Fogh SE, Roberts KB, Small W, Schechter NR. ACR-ARS Practice Parameter for the Performance of Total Body Irradiation. Am J Clin Oncol 2023; 46:185-192. [PMID: 36907934 DOI: 10.1097/coc.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVES This practice parameter was revised collaboratively by the American College of Radiology (ACR) and the American Radium Society (ARS). This practice parameter provides updated reference literature regarding both clinical-based conventional total body irradiation and evolving volumetric modulated total body irradiation. METHODS This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. RESULTS This practice parameter provides a comprehensive update to the reference literature regarding conventional total body irradiation and modulated total body irradiation. Dependence on dose rate remains an active area of ongoing investigation in both the conventional setting (where instantaneous dose rate can be varied) and in more modern rotational techniques, in which average dose rate is the relevant variable. The role of imaging during patient setup and the role of inhomogeneity corrections due to computer-based treatment planning systems are included as evolving areas of clinical interest notably surrounding the overall dose inhomogeneity. There is increasing emphasis on the importance of evaluating mean lung dose as it relates to toxicity during high-dose total body irradiation regimens. CONCLUSIONS This practice parameter can be used as an effective tool in designing and evaluating a total body irradiation program that successfully incorporates the close interaction and coordination among the radiation oncologists, medical physicists, dosimetrists, nurses, and radiation therapists.
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Affiliation(s)
| | | | - Kiran A Kumar
- UT Southwestern Medical Center 5323 Harry Hines Blvd, Dallas, TX
| | - Louis Constine
- University of Rochester Medical Center 601 Elmwood Ave, Rochester, NY
| | - Shannon E Fogh
- Department of Radiation Oncology, University of California San Francisco, CA
| | | | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago Loyola University Medical Center Department of Radiation Oncology Maguire Center - Room 2944 2160 S. 1st Ave. Maywood, IL
| | - Naomi R Schechter
- South Florida Proton Therapy Institute and Rakuten-Medical, Inc., Delray Beach, FL
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3
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Niederwieser D, Lang T, Krahl R, Heinicke T, Maschmeyer G, Al-Ali HK, Schwind S, Jentzsch M, Cross M, Kahl C, Wolf HH, Sayer H, Schulze A, Dreger P, Hegenbart U, Krämer A, Junghanss C, Mügge LO, Hähling D, Hirt C, Späth C, Peter N, Opitz B, Florschütz A, Reifenrath K, Zojer N, Scholl S, Pönisch W, Heyn S, Vucinic V, Hochhaus A, Aul C, Giagounidis A, Balleisen L, Oldenkott B, Staib P, Kiehl M, Schütte W, Naumann R, Eimermacher H, Dörken B, Sauerland C, Lengfelder E, Hiddemann W, Wörmann B, Müller-Tidow C, Serve H, Schliemann C, Hehlmann R, Berdel WE, Pfirrmann M, Krug U, Hoffmann VS. Different treatment strategies versus a common standard arm (CSA) in patients with newly diagnosed AML over the age of 60 years: a randomized German inter-group study. Ann Hematol 2023; 102:547-561. [PMID: 36695874 PMCID: PMC9977880 DOI: 10.1007/s00277-023-05087-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/01/2023] [Indexed: 01/26/2023]
Abstract
A randomized inter-group trial comparing more intensive treatment strategies to a common standard arm 3 + 7 (CSA) was conducted in patients with non-M3 AML. Untreated patients ≥ 60 years were allocated to the CSA (n = 132) or to the study group arms (n = 1154) of the AMLCG (TAD/HAM versus HAM/HAM ± G-CSF followed by TAD and maintenance) and the OSHO (intermediate-dose ara-C/mitoxantrone followed by ara-C/mitoxantrone). Median age of the 1147 eligible patients was 69 (range 60-87) years. CR/CRi status at 90 days was not significantly different between the CSA (54% (95%CI: 45-64)) and the study group arms (53% (95%CI: 47-60) and 59% (95%CI: 58-63)). The five-year event-free survival (EFS) probability (primary endpoint) was 6.2% (95%CI: 2.7-14.0) in the CSA, 7.6% (95%CI: 4.5-12.8) in study group A and 11.1% (95%CI: 9.0-13.7) in B. The 5-year OS was 17.2% (95%CI: 11.0-26.9), 17.0% (95%CI: 2.0-23.9), and 19.5% (95%CI: 16.7-22.8) in CSA, study group A and B, respectively. Neither study group differed significantly from the CSA regarding EFS, OS, or relapse-free survival. In multivariate analyses, allocation to the treatment strategy was not significantly associated with the time-to-event endpoints. The evaluation of more intensive treatment strategies did not show clinically relevant outcome differences when compared to CSA.
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Affiliation(s)
- Dietger Niederwieser
- University Leipzig, 04106, Leipzig, Germany. .,Lithuanian University of Health Sciences, Kaunas, Lithuania. .,Aichi Medical University, Nagakute, Japan.
| | - Thomas Lang
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| | | | - Thomas Heinicke
- Dept. Hematology and Oncology, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Georg Maschmeyer
- Dept. Hematology, Oncology and Palliative Care, Klinikum Ernst Von Bergmann, Potsdam, Germany
| | - Haifa Kathrin Al-Ali
- Department of Internal Medicine IV, Oncology/Hematology, Krukenberg Cancer-Center, University Hospital Halle (Saale), Halle, Germany
| | | | | | | | - Christoph Kahl
- Dept. Internal Medicine, Clinic III - Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany.,Dept. Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | | | - Herbert Sayer
- Medizinische Klinik (Hämatologie, Stammzelltransplantation, Onkologie), Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Peter Dreger
- Medical Department V, University Hospital, Heidelberg, Germany
| | - Ute Hegenbart
- Medical Department V, University Hospital, Heidelberg, Germany
| | - Alwin Krämer
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Dept. of Internal Medicine V, University, Heidelberg, Germany
| | - Christian Junghanss
- Department of Medicine, Clinic III (Hematology, Oncology, Palliative Medicine), Rostock University Medical Center, Rostock, Germany
| | - Lars-Olof Mügge
- Innere Medizin III (Hämatologie, Onkologie Und Palliativmedizin), Hospital Zwickau, Germany
| | - Detlev Hähling
- Dept. Hematology and Oncology, Klinikum Schwerin, Schwerin, Germany
| | - Carsten Hirt
- Innere Medizin C, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Christian Späth
- Innere Medizin C, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Norma Peter
- Medizinische Klinik, Carl-Thieme-Klinikum GmbH, Cottbus, Germany
| | - Bernhard Opitz
- St. Elisabeth Und St, Barbara Hospital Halle (Saale), Halle, Germany
| | | | | | - Niklas Zojer
- 1St Medical Department, Center for Oncology and Hematology & Palliative Care, Klinik Ottakring, Vienna, Austria
| | | | | | | | | | | | - Carlo Aul
- Klinik Für Hämatologie Und Onkologie, St. Johannes Hospital, Duisburg, Germany
| | - Aristoteles Giagounidis
- Klinik Für Hämatologie Und Onkologie, St. Johannes Hospital, Duisburg, Germany.,Dept. Oncology, Hematology and Palliative Care, Marienhospital Düsseldorf, Düsseldorf, Germany
| | | | - Bernd Oldenkott
- Dept. Hematology and Oncology, St. Hedwig Krankenhaus Berlin, Berlin, Germany
| | - Peter Staib
- Dept. Hematology/Oncology, St. Antonius Krankenhaus Eschweiler, Eschweiler, Germany
| | - Michael Kiehl
- Dept. Medicine I, Klinikum Frankfurt/Oder, FrankfurtOder, Germany
| | - Wolfgang Schütte
- Dept. Internal Medicine II, Krankenhaus Martha-Maria, Halle, Germany
| | - Ralph Naumann
- Dept. Hematology, Oncology and Palliative Care, St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - Hartmut Eimermacher
- Dept. Hematology and Oncology, Katholisches Krankenhaus Hagen, Hagen, Germany
| | - Bernd Dörken
- Dept. Hematology and Oncology, Charité Campus Virchow, Berlin, Germany
| | - Cristina Sauerland
- Institute of Biometry and Clinical Research, University Hospital Münster, Münster, Germany
| | - Eva Lengfelder
- IIIrd Medical Dept, University Hospital of Mannheim, Mannheim, Germany
| | | | - Bernhard Wörmann
- Division of Hematology, Oncology and Tumour Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie, Berlin, Germany
| | - Carsten Müller-Tidow
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Dept. of Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hubert Serve
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Department of Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | | | - Rüdiger Hehlmann
- Mannheim, University of Heidelberg, Mannheim, Germany.,European LeukemiaNet, Weinheim, Germany
| | - Wolfgang E Berdel
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| | - Utz Krug
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Dept. of Medicine 3, Klinikum Leverkusen, Leverkusen, Germany
| | - Verena S Hoffmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
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4
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Kwan ACF, Blosser N, Ghosh S, Leyshon C, Dersch-Mills D, Puckrin RP, Duggan P, Zepeda V, Savoie L, Stewart D, Storek J, Jamani K. Toward optimization of cyclosporine concentration target to prevent acute graft-vs-host disease following myeloablative allogeneic stem cell transplant. Clin Transplant 2022; 36:e14732. [PMID: 35606904 DOI: 10.1111/ctr.14732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/09/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
Despite the common use of cyclosporine (CsA) for acute graft-versus-host disease (aGVHD) prophylaxis following allogeneic stem cell transplant, the optimal CsA trough target remains unknown. Here, we report on outcomes of adult patients following myeloablative conditioning to identify an optimal CsA trough target and characterize the most relevant timeframe post-transplant for CsA trough targeting to minimize aGVHD. We retrospectively reviewed 399 consecutive patients who underwent first peripheral blood allogeneic stem cell transplant for hematological malignancies between January 2009 and December 2018. In the unadjusted and adjusted analyses, the incidence of grades 2-4 aGVHD was significantly higher among patients with an average CsA trough concentration <250 mcg/L compared to patients with an average CsA trough concentration ≥250 mcg/L during days 15-28 post-transplant (31.5% versus 18.8%, P = 0.037), with an odds ratio (OR) of 1.97 (95% confidence interval 1.04-3.71). In contrast, no correlations between CsA trough concentration and relapse, non-relapse mortality and overall survival was found. In conclusion, early post-transplant CsA trough concentrations are an important factor in the prophylaxis against aGVHD. Our findings suggest that CsA trough concentrations should be maximized between days 15-28 post-myeloablative transplant. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Nikki Blosser
- Alberta Blood & Marrow Transplant Program, Calgary, Alberta, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | | | | | - Peter Duggan
- Alberta Blood & Marrow Transplant Program, Calgary, Alberta, Canada
| | - Victor Zepeda
- Alberta Blood & Marrow Transplant Program, Calgary, Alberta, Canada
| | - Lynn Savoie
- Alberta Blood & Marrow Transplant Program, Calgary, Alberta, Canada
| | - Douglas Stewart
- Alberta Blood & Marrow Transplant Program, Calgary, Alberta, Canada
| | - Jan Storek
- Alberta Blood & Marrow Transplant Program, Calgary, Alberta, Canada
| | - Kareem Jamani
- Alberta Blood & Marrow Transplant Program, Calgary, Alberta, Canada
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5
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Maakaron JE, Zhang MJ, Chen K, Abhyankar S, Bhatt VR, Chhabra S, El Jurdi N, Farag SS, He F, Juckett M, de Lima M, Majhail N, van der Poel M, Saad A, Savani B, Ustun C, Waller EK, Litzow M, Kebriaei P, Hourigan CS, Saber W, Weisdorf D. Age is no barrier for adults undergoing HCT for AML in CR1: contemporary CIBMTR analysis. Bone Marrow Transplant 2022; 57:911-917. [PMID: 35368040 PMCID: PMC9232949 DOI: 10.1038/s41409-022-01650-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
Acute Myeloid Leukemia (AML) has a median age at diagnosis of 67 years. The most common curative therapy remains an allogeneic hematopoietic stem cell transplantation (HCT), yet it is complicated by treatment-related mortality (TRM) and ongoing morbidity including graft versus host disease (GVHD) that may impact survival, particularly in older patients. We examined the outcomes and predictors of success in 1,321 patients aged 60 years and older receiving a HCT for AML in first complete remission (CR1) from 2007–2017 and reported to the CIBMTR. Outcomes were compared in three age cohorts (60–64; 65–69; 70+). With median follow-up of nearly 3 years, patients aged 60–64 had modestly, though significantly better OS, DFS and lower TRM than those either 65–69 or 70+; cohorts with similar outcomes. Three-year OS for the 3 cohorts was 49.4%, 42.3%, and 44.7% respectively (p=0.026). TRM was higher with increasing age, cord blood as graft source and HCT-CI score of ≥ 3. Conditioning intensity was not a significant predictor of OS in the 60–69 cohort with 3-year OS of 46% for RIC and 49% for MAC (p=0.38); MAC was rarely used over age 70. There was no difference in the relapse rate, incidence of Grade III/IV acute GVHD, or moderate-severe chronic GVHD across the age cohorts. After adjusting for other predictors, age had a small effect on OS and TRM. High-risk features including poor cytogenetics and measurable residual disease (MRD) prior to HCT were each significantly associated with relapse and accounted for most of the adverse impact on OS and DFS. Age did not influence the incidence of either acute or chronic GVHD; while graft type and associated GVHD prophylaxis were most important. These data suggest that age alone is not a barrier to successful HCT for AML in CR1 and should not exclude patients from HCT. Efforts should focus on minimizing residual disease and better donor selection.
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6
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Cumulative incidence of subsequent malignancy after allo-HCT conditioned with or without low-dose total body irradiation. Blood Adv 2022; 6:767-773. [PMID: 34995342 PMCID: PMC8945311 DOI: 10.1182/bloodadvances.2020003910] [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: 11/30/2020] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Subsequent malignancies (SMs) present a significant burden of morbidity and are a common cause of late mortality in survivors of allogeneic hematopoietic cell transplant (allo-HCT). Previous studies have described total body irradiation (TBI) as a risk factor for the development of SMs in allo-HCT survivors. However, most studies of the association between TBI and SM have examined high-dose TBI regimens (typically ≥600 cGy), and thus little is known about the association between low-dose TBI regimens and risk of SMs. Our goal, therefore, was to compare the cumulative incidence of SMs in patients of Alberta, Canada, who received busulfan/fludarabine alone vs busulfan/fludarabine plus 400 cGy TBI. Of the 674 included patients, 49 developed a total of 56 malignancies at a median of 5.9 years' posttransplant. The cumulative incidence of SMs at 15 years' post-HCT in the entire cohort was 11.5% (95% confidence interval [CI], 8.5-15.6): 13.4% (95% CI, 9.1-19.3) in the no-TBI group and 10.8% (95% CI, 6.6-17.4) in the TBI group. In the multivariable model, TBI was not associated with SMs, whereas there was an association with number of pre-HCT cycles of chemotherapy. The standardized incidence ratio for the entire cohort, compared with the age-, sex-, and calendar year-matched general population, was 1.75. allo-HCT conditioning that includes low-dose TBI does not seem to increase risk of SMs compared with chemotherapy-alone conditioning.
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7
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Heinicke T, Krahl R, Kahl C, Cross M, Scholl S, Wolf HH, Hähling D, Hegenbart U, Peter N, Schulze A, Florschütz A, Schmidt V, Reifenrath K, Zojer N, Junghanss C, Sayer HG, Maschmeyer G, Späth C, Hochhaus A, Fischer T, Al-Ali HK, Niederwieser D. Allogeneic hematopoietic stem cell transplantation improves long-term outcome for relapsed AML patients across all ages: results from two East German Study Group Hematology and Oncology (OSHO) trials. Ann Hematol 2021; 100:2387-2398. [PMID: 34232360 PMCID: PMC8357692 DOI: 10.1007/s00277-021-04565-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/04/2021] [Indexed: 12/14/2022]
Abstract
Relapse of acute leukemia is a frequent complication with uncertain outcome and poorly defined risk factors. From 1621 patients entered into two prospective clinical trials (AML02; n = 740 and AML04; n = 881), 74.2% reached complete remission (CR) 1 after induction(s) and 59 patients after additional induction ± hematopoietic cell transplantation (HCT). Of the non-refractory patients, 48.4% with a median age of 63 (range 17-85) years relapsed. Relapses occurred within 6 months after CR in 46.5%, between 7 and 18 months in 38.7%, and after 18 months in 14.8% of patients. Relapse treatment resulted in CR2 in 39% of patients depending upon age (54.5% of ≤ 60 and 28.6% of > 60 years), duration of CR1, and treatment of relapse. Overall survival (OS) was 10.9 (7.4-16.2) %, but OS after HCT ± intensive chemotherapy (ICT) was 39.3% (31.8-48.6) at 5 years and not different in younger and older patients. Donor lymphocyte infusion ± chemotherapy and ICT alone resulted only in OS of 15.4% and of 5%, respectively. Independent favorable factors for OS were long CR1 duration, and HCT, while non-monosomal disease was beneficial for OS in elderly patients. Leukemia-free survival [LFS; 24.9 (19.5-31.7) % at 10 years] was affected by similar risk factors. In a competing risk model, the relapse incidence at 5 years was 53.5 ± 3.5% and the non-relapse mortality rate 21.7 ± 2.9%. Lower relapse incidence was observed in patents with HCT, long CR1 duration, and female gender. Risk factors for non-relapse mortality were HCT in younger and type of AML in elderly patients. In conclusion, allogeneic HCT ± IC improved the results in relapsed AML in younger and elderly patients. Increasing CR2 rates and HCT frequency will be the challenge for the next years. Relapse of the disease remains the major problem.
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Affiliation(s)
- Thomas Heinicke
- Department of Hematology and Oncology, University of Magdeburg, Magdeburg, Germany
| | - Rainer Krahl
- University Hospital Leipzig, 04106, Leipzig, Germany
| | - Christoph Kahl
- Department of Hematology and Oncology, Hospital Magdeburg, Magdeburg, Germany
| | - Michael Cross
- University Hospital Leipzig, 04106, Leipzig, Germany
| | - Sebastian Scholl
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Hans-Heinrich Wolf
- Department of Hematology and Oncology, University Hospital, Halle, Germany
| | - Detlev Hähling
- Department of Hematology and Oncology, Klinikum Schwerin, Schwerin, Germany
| | - Ute Hegenbart
- Departement of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Norma Peter
- Medizinische Klinik, Carl-Thieme-Klinikum GmbH, Cottbus, Germany
| | - Antje Schulze
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Volker Schmidt
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Niklas Zojer
- Department of Medicine I, Wilhelminen Cancer Research Institute, Wilhelminenhospital, , Vienna, Austria
| | - Christian Junghanss
- Hematology, Oncology, Palliative Medicine, University of Rostock, Rostock, Germany
| | - Herbert G Sayer
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst Von Bergmann Hospital, Potsdam, Germany
| | - Christian Späth
- Hematology and Oncology, University of Greifswald, Greifswald, Germany
| | - Andreas Hochhaus
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Thomas Fischer
- Department of Hematology and Oncology, University of Magdeburg, Magdeburg, Germany
| | | | - Dietger Niederwieser
- University Hospital Leipzig, 04106, Leipzig, Germany.
- Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Aichi Medical University, Nagakute, Japan.
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8
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Prognostic impact of the ELN2017 risk classification in patients with AML receiving allogeneic transplantation. Blood Adv 2021; 4:3864-3874. [PMID: 32810221 DOI: 10.1182/bloodadvances.2020001904] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/29/2020] [Indexed: 12/11/2022] Open
Abstract
In 2017, an updated European LeukemiaNet (ELN) risk classification was published allocating patients with acute myeloid leukemia (AML) to 3 risk groups on the basis of certain cytogenetic and molecular aberrations. To date, studies of the prognostic significance of the ELN2017 risk classification in the context of an allogeneic hematopoietic stem cell transplantation (HSCT) are lacking. We performed risk stratification according to the ELN2017 classification in 234 patients with AML who underwent allogeneic HSCT as a consolidation therapy. In our cohort, the risk of 39.7% of the patients was classified as favorable, that of 12.8% as intermediate, and that of 47.4% as adverse. In the context of allogeneic HSCT, the assignment to the 3 ELN2017 risk groups retained its prognostic significance, with patients with favorable risk having the best prognosis and those with adverse risk having the worst one. Subgroup analyses showed that patients with a monosomal karyotype or TP53 mutation had considerably increased relapse rates, even in the adverse-risk group. When we analyzed the impact of digital droplet PCR-based measurable residual disease (MRD) before allogeneic HSCT, MRD+ patients had impaired prognoses, with cumulative incidence of relapse and overall survival comparable to those of patients classified as having an ELN2017 adverse genetic risk. This study is the first to demonstrate that the ELN2017 classification distinguishes the 3 risk groups with significantly distinct prognoses, even after allogeneic HSCT, and emphasizes the dismal prognosis of patients with AML with TP53 mutations, monosomal karyotype, or MRD positivity after allogeneic HSCT.
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Ringdén O, Remberger M, Törlén J, Finnbogadottir S, Svahn BM, Sadeghi B. Cytokine levels following allogeneic hematopoietic cell transplantation: a match-pair analysis of home care versus hospital care. Int J Hematol 2021; 113:712-722. [PMID: 33544322 DOI: 10.1007/s12185-021-03087-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/16/2022]
Abstract
Following allogeneic hematopoietic cell transplantation (HCT), patients living near the hospital were treated at home instead of in isolation in the hospital. We analyzed cytokines using Luminex assays for the first 3 weeks after HCT and compared patients treated at home (n = 42) with matched patients isolated in the hospital (n = 37). In the multivariate analysis, patients treated at home had decreased GM-CSF, IFN-γ (p < 0.01), IL-13, IL-5 (p < 0.05), and IL-2 (p < 0.07). Bloodstream infections, anti-thymocyte globulin, G-CSF treatment, immunosuppression, reduced-intensity conditioning (RIC), related vs. unrelated donors, and graft source affected various cytokine levels. When patients with RIC were analyzed separately, home care patients had reduced G-CSF (p = 0.04) and increased vascular endothelial growth factor (VEGF, p = 0.001) at 3 weeks compared with hospital care patients. Patients with low GM-CSF (p < 0.036) and low IFNγ (p = 0.07) had improved survival. Acute GVHD grades III-IV was seen in 7% and 16% of home care and hospital care patients, respectively. One-year transplantation-related mortality was 7% and 16% and survival at 5 years was 69% and 57% in the two groups, respectively. To conclude, patients treated in the hospital showed varying increased levels of GM-CSF, IFN-γ, IL-13, G-CSF, IL-5, and IL-2 and decreased VEGF, which may contribute to acute GVHD.
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Affiliation(s)
- Olle Ringdén
- Translational Cell Therapy Research Group (TCR), Department of Pediatrics, CLINTEC, Karolinska Institutet, Kliniskt Forskningscentrum, KFC, NOVUM Plan 6, Hälsovägen 7-9, 141 57, Huddinge, Sweden.
| | - Mats Remberger
- Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Törlén
- Cell Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Sigrun Finnbogadottir
- Cell Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Britt-Marie Svahn
- Translational Cell Therapy Research Group (TCR), Department of Pediatrics, CLINTEC, Karolinska Institutet, Kliniskt Forskningscentrum, KFC, NOVUM Plan 6, Hälsovägen 7-9, 141 57, Huddinge, Sweden
| | - Behnam Sadeghi
- Translational Cell Therapy Research Group (TCR), Department of Pediatrics, CLINTEC, Karolinska Institutet, Kliniskt Forskningscentrum, KFC, NOVUM Plan 6, Hälsovägen 7-9, 141 57, Huddinge, Sweden
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10
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Outcomes of Older Patients with NPM1 Mutated and FLT3-ITD Negative Acute Myeloid Leukemia Receiving Allogeneic Transplantation. Hemasphere 2020; 4:e326. [PMID: 32072142 PMCID: PMC7000468 DOI: 10.1097/hs9.0000000000000326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/25/2022] Open
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11
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Jentzsch M, Döhring C, Linke R, Hille A, Grimm J, Pönisch W, Vucinic V, Franke G, Behre G, Niederwieser D, Schwind S. Comparison of non-myeloablative and reduced-intensity allogeneic stem cell transplantation in older patients with myelodysplastic syndromes. Am J Hematol 2019; 94:1344-1352. [PMID: 31495933 DOI: 10.1002/ajh.25636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 11/07/2022]
Abstract
Allogeneic stem cell transplantation (HSCT) remains the only curative treatment for myelodysplastic syndromes (MDS) or myelodysplastic/myeloproliferative neoplasms (MDS/MPN) patients. The introduction of reduced intensity (RIC) and non-myeloablative (NMA) conditioning enabled HSCT in older or comorbid individuals representing the majority of patients. Studies comparing RIC and NMA conditioning are limited. We retrospectively analyzed 151 MDS or MDS/MPN patients older than 50 years who received NMA- or RIC-HSCT. Patients younger or older than 65 years at HSCT were analyzed separately. Patients receiving RIC-HSCT or NMA-HSCT were balanced in factors reflecting disease aggressiveness and the HCT-CI comorbidity score. The NMA conditioned patients had a higher incidence of graft rejection and chronic graft-vs-host disease. Cumulative incidence of relapse (CIR), non-relapse mortality (NRM) and overall survival (OS), did not differ significantly with regard to the conditioning regime in the whole cohort. In patients <65 years at HSCT, NMA conditioning associated with higher NRM and shorter OS by trend, while CIR was similar in both groups. In multivariable analyzes, the conditioning regimen remained a prognostic factor for NRM and OS in patients <65 years at HSCT. In MDS patients NMA and RIC conditioning result in similar disease control, but especially patients <65 years may benefit from RIC-HSCT.
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Affiliation(s)
- Madlen Jentzsch
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Christine Döhring
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Richard Linke
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Andrea Hille
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Juliane Grimm
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Wolfram Pönisch
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Vladan Vucinic
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Georg‐Nikolaus Franke
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Gerhard Behre
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Dietger Niederwieser
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
| | - Sebastian Schwind
- Department of Hematology and Clinical Oncology University of Leipzig Leipzig Germany
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12
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Fludarabine/busulfan versus fludarabine/total-body-irradiation (2 Gy) as conditioning prior to allogeneic stem cell transplantation in patients (≥60 years) with acute myelogenous leukemia: a study of the acute leukemia working party of the EBMT. Bone Marrow Transplant 2019; 55:729-739. [PMID: 31645668 DOI: 10.1038/s41409-019-0720-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022]
Abstract
Nonmyeloablative (NMA) conditioning regimens facilitate allogeneic stem cell transplantation (alloSCT) in elderly patients and/or in those with comorbidities. The acute leukemia working party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT) compared the outcomes of patients ≥60 years with AML in first complete remission (CR1), that had received an alloSCT following NMA conditioning, i.e. either fludarabine/busulfan (FB2) or fludarabine/total-body-irradiation-2Gy (FluTBI2Gy). A total of 1088 patients were included (median age 65 years). Donors were matched siblings (MSD) and matched unrelated donors (MUD) in 47% and 53%, respectively. In vivo T-cell depletion (TCD) was applied to 79% and none (0%) of patients in the FB2 and FluTBI2Gy groups, respectively. In the MSD group we found a trend for less extensive cGVHD in patients receiving FB2 with in vivo TCD, HR: 0.49, p = 0.08, and in those without worse NRM, HR: 2.14, p = 0.04, and a trend for more total cGVHD, HR: 1.61, p = 0.09. Patients transplanted from MUDs had a significantly higher incidence of total cGVHD, extensive cGVHD and a worse GRFS with FluTBI2Gy in comparison to FB2, HR: 2.44; p < 0.0001; HR 4.59; p < 0.00001 and HR: 1.35; p = 0.03, respectively. No differences were observed with respect to LFS, OS, RI, NRM, and aGVHD.
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13
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Shah NA. Allogeneic Hematopoietic Cell Transplantation in the Outpatient Setting. Biol Blood Marrow Transplant 2019; 25:e319-e320. [PMID: 31585166 DOI: 10.1016/j.bbmt.2019.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Nilay A Shah
- Atrium Health, Levine Cancer Institute, Charlotte, North Carolina.
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14
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Salas MQ, Prem S, Atenafu EG, Law AD, Lam W, Al-Shaibani Z, Loach D, Kim DDH, Michelis FV, Lipton JH, Kumar R, Mattsson J, Viswabandya A. Reduced intensity allogeneic stem cell transplant with anti-thymocyte globulin and post-transplant cyclophosphamide in acute myeloid leukemia. Eur J Haematol 2019; 103:510-518. [PMID: 31449699 DOI: 10.1111/ejh.13321] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We aimed to study the efficacy of reduced intensity conditioning (RIC) allo-HSCT combined with anti-thymocyte globulin (ATG) and post-transplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis in AML. METHODS One hundred forty-seven patients were included. All patients underwent unmanipulated peripheral blood stem cell RIC allo-HSCT. Median follow-up was 12.8 months (range 0.5-39). RESULTS Median age was 58 years. Twenty-nine (20%) recipients received 10/10 MRD grafts, 69 (47%) 10/10 MUD grafts, 20 (13.6%) 9/10 MMUD, and 29 (20%) haploidentical grafts. The cumulative incidence of grade II-IV and III-IV acute GVHD at day +100, and moderate/severe chronic GVHD at 1-year were as follow: 14.3%, 1.4%, and 8.3%. There were no significant differences according to donor type (P = .46) and cumulative incidence of GVHD. One-year overall survival (OS), relapse-free survival (RFS), non-relapse mortality, and GVHD-free/Relapse-free survival were as follows: 66.9% (95% CI 58.4-74), 59.9%, and 18.7% and 53.7%. KPS ≤ 80 was predictive of worst OS (P = .04). Those recipients who received MUD transplants had better RFS (P = .01). CONCLUSIONS RIC allo-HSCT combined with ATG and PTCy is safe and a potentially curative strategy and it is associated with impressive GRFS in AML.
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Affiliation(s)
- Maria Queralt Salas
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shruti Prem
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princes Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Arjun Datt Law
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wilson Lam
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zeyad Al-Shaibani
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David Loach
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Fotios V Michelis
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey Howard Lipton
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rajat Kumar
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonas Mattsson
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Auro Viswabandya
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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15
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Granot N, Storer BE, Cooper JP, Flowers ME, Sandmaier BM, Storb R. Allogeneic Hematopoietic Cell Transplantation in the Outpatient Setting. Biol Blood Marrow Transplant 2019; 25:2152-2159. [PMID: 31255743 DOI: 10.1016/j.bbmt.2019.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
Conditioning with fludarabine and low-dose total-body irradiation before allogeneic hematopoietic cell transplantation (HCT) enabled treating older or medically infirm patients with advanced hematologic malignancies in the outpatient setting. Between December 1997 and June 2017, 1037 patients with hematologic malignancies received peripheral blood stem cell (PBSC) grafts from HLA-matched or 1 HLA antigen/allele-mismatched related or unrelated donors. Median age was 58 (range, 18 to 80) years. Serious comorbidities with Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) scores ≥3 were present in 52% of patients. We found that 47% of patients were either never hospitalized or only had an overnight hospital stay for infusion of late-arriving PBSCs while 53% were admitted for a median of 6 days. Main reasons for admission were infection, fever, graft-versus-host disease, and regimen-related toxicity. Two thirds of admissions occurred within 3 weeks of HCT. The 5-year risk of nonrelapse mortality (NRM) was 26% among hospitalized patients and 13% among nonhospitalized patients. Significant risk factors for hospitalization included unrelated transplants, 1 HLA antigen-mismatched transplant, high HCT-CI scores, and diagnosis of nonmyeloma malignancies. Significant risk factors for NRM were hospitalization, older age, unrelated transplants, and high HCT-CI scores. Ambulatory allogeneic HCT is feasible and safe.
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Affiliation(s)
- Noa Granot
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Barry E Storer
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington
| | - Jason P Cooper
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Brenda M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Rainer Storb
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
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16
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de Kort EA, de Lil HS, Bremmers MEJ, van Groningen LFJ, Blijlevens NMA, Huls G, Brüggemann RJM, van Dorp S, van der Velden WJFM. Cyclosporine A trough concentrations are associated with acute GvHD after non-myeloablative allogeneic hematopoietic cell transplantation. PLoS One 2019; 14:e0213913. [PMID: 30897127 PMCID: PMC6428294 DOI: 10.1371/journal.pone.0213913] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/04/2019] [Indexed: 01/08/2023] Open
Abstract
Low plasma CsA concentrations (<300–350 ng/mL) early following allogeneic hematopoietic stem cell transplantation (HSCT) is associated with an increased risk of developing acute graft-versus-host disease (aGvHD). Nevertheless, the current optimal target trough concentration for CsA following HSCT is considered to be 200–400 ng/mL. Here, we performed a retrospective analysis of a homogeneous group of 129 patients who received HSCT after non-myeloablative conditioning, and we analyzed the impact of CsA trough concentration measured during the first four weeks (CsA W1-4) on the incidence aGvHD, relapse-free survival (RFS), non-relapse mortality (NRM), overall survival (OS), and toxicity. The 180-day incidence of grade II-IV aGvHD was 25% (32/129 patients). In multivariate analysis the incidence of grade II-IV aGvHD was significantly lower among patients with a CsA W1-4 concentration ≥350 ng/mL compared to patients with a concentration <350 ng/mL (18% versus 38%, respectively; P = 0.007), with a hazard ration (HR) of 0.38 (95% CI: 0.19–0.77). In contrast, we found no correlation between CsA trough concentration and RFS, NRM, or OS. Moreover, we found an increased incidence of hypomagnesemia at higher CsA concentrations, but no difference in the incidence of acute renal toxicity, hepatic toxicity, or electrolyte imbalance. Interestingly, 30% of patients experienced hyponatremia with no apparent cause other than the use of CsA, with urinalysis suggesting SIADH as the underlying cause. Our findings suggest that a CsA trough concentration of 350–500 ng/mL might be more appropriate in the first month following non-myeloablative HSCT.
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Affiliation(s)
- Elizabeth A. de Kort
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heleen S. de Lil
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Manita E. J. Bremmers
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Gerwin Huls
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Suzanne van Dorp
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Prognostic Impact of Blood MN1 Copy Numbers Before Allogeneic Stem Cell Transplantation in Patients With Acute Myeloid Leukemia. Hemasphere 2019; 3:e167. [PMID: 31723806 PMCID: PMC6745933 DOI: 10.1097/hs9.0000000000000167] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/27/2018] [Indexed: 01/02/2023] Open
Abstract
High expression of the leukemia-associated gene meningioma-1 (MN1) is frequently found at diagnosis of acute myeloid leukemia (AML) and associates with adverse outcomes. The presence of measurable residual disease (MRD) in complete remission (CR) indicates high risk of relapse and worse outcome in AML patients. However, the prognostic impact of MN1 expression levels as MRD marker has not been evaluated. Digital droplet polymerase chain reaction (ddPCR) is a novel technique allowing sensitive and specific absolute gene expression quantification. We retrospectively analyzed 124 AML patients who received allogeneic hematopoietic stem cell transplantation (HSCT) in CR or CR with incomplete peripheral recovery. Absolute MN1 copy numbers in peripheral blood were assessed prior to HSCT (median 7; range 0-29 days) using ddPCR. High pre-HSCT MN1/Abelson murine leukemia viral oncogene homolog 1 gene (ABL1) copy numbers associated with a higher cumulative incidence of relapse after HSCT and-in relapsing patients-shorter time to relapse. In multivariable analysis, high pre-HSCT MN1/ABL1 copy numbers remained an independent prognosticator for relapse after HSCT. Patients with the highest pre-HSCT MN1/ABL1 copy numbers also had the highest risk of relapse. MN1 copy number assessment also added prognostic information to nucleophosmin 1 gene (NPM1) mutation- and brain and acute leukemia, cytoplasmic (BAALC) and Wilm's tumor gene 1 (WT1) expression-based MRD evaluation. Our study demonstrates the feasibility of the novel ddPCR technique for MN1/ABL1 copy number assessment as a marker for MRD. Evaluation of MN1/ABL1 copy numbers allows the identification of patients at high risk of relapse, independently of other diagnostic risk factors and MRD markers.
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18
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Grimm J, Bill M, Jentzsch M, Beinicke S, Häntschel J, Goldmann K, Schulz J, Cross M, Franke G, Behre G, Vucinic V, Pönisch W, Lange T, Niederwieser D, Schwind S. Clinical impact of clonal hematopoiesis in acute myeloid leukemia patients receiving allogeneic transplantation. Bone Marrow Transplant 2018; 54:1189-1197. [DOI: 10.1038/s41409-018-0413-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 12/21/2022]
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19
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Yeh AC, Khan MA, Harlow J, Biswas AR, Akter M, Ferdous J, Ara T, Islam M, Caron M, Barron AM, Moran J, Brezina M, Nazneen H, Kamruzzaman M, Saha A, Marshall A, Afrose S, Stowell C, Preffer F, Bangsberg D, Goodman A, Attar E, McAfee S, Spitzer TR, Dey BR. Hematopoietic Stem-Cell Transplantation in the Resource-Limited Setting: Establishing the First Bone Marrow Transplantation Unit in Bangladesh. J Glob Oncol 2018; 4:1-10. [PMID: 30241180 PMCID: PMC6223381 DOI: 10.1200/jgo.2016.006460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Treatment of malignant and nonmalignant hematologic diseases with hematopoietic stem-cell transplantation (HSCT) was first described almost 60 years ago, and its use has expanded significantly over the last 20 years. Whereas HSCT has become the standard of care for many patients in developed countries, the significant economic investment, infrastructure, and health care provider training that are required to provide such a service have prohibited it from being widely adopted, particularly in developing countries. METHODS Over the past two decades, however, efforts to bring HSCT to the developing world have increased, and several institutions have described their efforts to establish such a program. We aim to provide an overview of the current challenges and applications of HSCT in developing countries as well as to describe our experience in developing an HSCT program at Dhaka Medical College and Hospital in Bangladesh via a partnership with health care providers at Massachusetts General Hospital. RESULTS AND CONCLUSION We discuss key steps of the program, including the formation of a collaborative partnership, infrastructure development, human resource capacity building, and financial considerations.
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Affiliation(s)
- Albert C Yeh
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Mohiuddin A Khan
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Jason Harlow
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Akhil R Biswas
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Mafruha Akter
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Jannatul Ferdous
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Tasneem Ara
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Manirul Islam
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Martin Caron
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Anne-Marie Barron
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Jenna Moran
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Mark Brezina
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Humayra Nazneen
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Md Kamruzzaman
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Anup Saha
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Ariela Marshall
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Salma Afrose
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Christopher Stowell
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Frederic Preffer
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - David Bangsberg
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Annekathryn Goodman
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Eyal Attar
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Steven McAfee
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Thomas R Spitzer
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Bimalangshu R Dey
- Albert C. Yeh, Christopher Stowell, Frederic Preffer, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital; Jason Harlow and David Bangsberg, Massachusetts General Hospital Center for Global Health; Martin Caron, Jenna Moran, Mark Brezina, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Anne-Marie Barron, Simmons College School of Nursing and Health Science; Annekathryn Goodman, Eyal Attar, Steven McAfee, Thomas R. Spitzer, and Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; Ariela Marshall, Mayo Clinic, Rochester, MN; and Mohiuddin A. Khan, Akhil R. Biswas, Mafruha Akter, Jannatul Ferdous, Tasneem Ara, Manirul Islam, Humayra Nazneen, Md Kamruzzaman, Anup Saha, and Salma Afrose, Dhaka Medical College and Hospital, Dhaka, Bangladesh
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Sheth V, Labopin M, Canaani J, Volin L, Brecht A, Ganser A, Mayer J, Labussière-Wallet H, Bittenbring J, Shouval R, Savani B, Mohty M, Nagler A. Comparison of FLAMSA-based reduced intensity conditioning with treosulfan/fludarabine conditioning for patients with acute myeloid leukemia: an ALWP/EBMT analysis. Bone Marrow Transplant 2018; 54:531-539. [DOI: 10.1038/s41409-018-0288-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 11/09/2022]
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Wong JY, Filippi AR, Dabaja BS, Yahalom J, Specht L. Total Body Irradiation: Guidelines from the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys 2018; 101:521-529. [DOI: 10.1016/j.ijrobp.2018.04.071] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/09/2018] [Accepted: 04/23/2018] [Indexed: 01/04/2023]
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Bill M, Grimm J, Jentzsch M, Kloss L, Goldmann K, Schulz J, Beinicke S, Häntschel J, Cross M, Vucinic V, Pönisch W, Behre G, Franke GN, Lange T, Niederwieser D, Schwind S. Digital droplet PCR-based absolute quantification of pre-transplant NPM1 mutation burden predicts relapse in acute myeloid leukemia patients. Ann Hematol 2018; 97:1757-1765. [DOI: 10.1007/s00277-018-3373-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/12/2018] [Indexed: 12/24/2022]
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Maples KT, Sabo RT, McCarty JM, Toor AA, Hawks KG. Maintenance azacitidine after myeloablative allogeneic hematopoietic cell transplantation for myeloid malignancies. Leuk Lymphoma 2018; 59:2836-2841. [DOI: 10.1080/10428194.2018.1443334] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kathryn T. Maples
- Department of Pharmacy Services, VCU School of Pharmacy, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Roy T. Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - John M. McCarty
- Bone Marrow Transplant Program, Massey Cancer Center, Department of Internal Medicine, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Amir A. Toor
- Bone Marrow Transplant Program, Massey Cancer Center, Department of Internal Medicine, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Kelly G. Hawks
- Department of Pharmacy Services, VCU School of Pharmacy, Virginia Commonwealth University Health, Richmond, VA, USA
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Schmalbrock LK, Bonifacio L, Bill M, Jentzsch M, Schubert K, Grimm J, Cross M, Lange T, Vucinic V, Pönisch W, Behre G, Franke GN, Niederwieser D, Schwind S. Prognostic relevance of DNMT3A R882 mutations in AML patients undergoing non-myeloablative conditioning hematopoietic stem cell transplantation. Bone Marrow Transplant 2018; 53:640-643. [PMID: 29335621 DOI: 10.1038/s41409-017-0060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/15/2017] [Accepted: 11/09/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Laura K Schmalbrock
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Lynn Bonifacio
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Marius Bill
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Madlen Jentzsch
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Karoline Schubert
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Juliane Grimm
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Michael Cross
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Thoralf Lange
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Vladan Vucinic
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Wolfram Pönisch
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Gerhard Behre
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | | | | | - Sebastian Schwind
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany.
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Jentzsch M, Bill M, Grimm J, Schulz J, Goldmann K, Beinicke S, Häntschel J, Pönisch W, Franke GN, Vucinic V, Behre G, Lange T, Niederwieser D, Schwind S. High BAALC copy numbers in peripheral blood prior to allogeneic transplantation predict early relapse in acute myeloid leukemia patients. Oncotarget 2017; 8:87944-87954. [PMID: 29152132 PMCID: PMC5675684 DOI: 10.18632/oncotarget.21322] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/17/2017] [Indexed: 12/15/2022] Open
Abstract
High BAALC expression levels at acute myeloid leukemia diagnosis have been linked to adverse outcomes. Recent data indicate that high BAALC expression levels may also be used as marker for residual disease following acute myeloid leukemia treatment. Allogeneic hematopoietic stem cell transplantation (HSCT) offers a curative treatment for acute myeloid leukemia patients. However, disease recurrence remains a major clinical challenge and identification of high-risk patients prior to HSCT is crucial to improve outcomes. We performed absolute quantification of BAALC copy numbers in peripheral blood prior (median 7 days) to HSCT in complete remission (CR) or CR with incomplete peripheral recovery in 82 acute myeloid leukemia patients using digital droplet PCR (ddPCR) technology. An optimal cut-off of 0.14 BAALC/ABL1 copy numbers was determined and applied to define patients with high or low BAALC/ABL1 copy numbers. High pre-HSCT BAALC/ABL1 copy numbers significantly associated with higher cumulative incidence of relapse and shorter overall survival in univariable and multivariable models. Patients with high pre-HSCT BAALC/ABL1 copy numbers were more likely to experience relapse within 100 days after HSCT. Evaluation of pre-HSCT BAALC/ABL1 copy numbers in peripheral blood by ddPCR represents a feasible and rapid way to identify acute myeloid leukemia patients at high risk of early relapse after HSCT. The prognostic impact was also observed independently of other known clinical, genetic, and molecular prognosticators. In the future, prospective studies should evaluate whether acute myeloid leukemia patients with high pre-HSCT BAALC/ABL1 copy numbers benefit from additional treatment before or early intervention after HSCT.
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Affiliation(s)
- Madlen Jentzsch
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Marius Bill
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Juliane Grimm
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Julia Schulz
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Karoline Goldmann
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Stefanie Beinicke
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Janine Häntschel
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Wolfram Pönisch
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | | | - Vladan Vucinic
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Gerhard Behre
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Thoralf Lange
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | | | - Sebastian Schwind
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
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26
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Spitzer B, Jakubowski AA, Papadopoulos EB, Fuller K, Hilden PD, Young JW, Barker JN, Koehne G, Perales MA, Hsu KC, van den Brink MR, Kernan NA, Prockop SE, Scaradavou A, Castro-Malaspina H, O'Reilly RJ, Boulad F. A Chemotherapy-Only Regimen of Busulfan, Melphalan, and Fludarabine, and Rabbit Antithymocyte Globulin Followed by Allogeneic T-Cell Depleted Hematopoietic Stem Cell Transplantations for the Treatment of Myeloid Malignancies. Biol Blood Marrow Transplant 2017; 23:2088-2095. [PMID: 28711727 DOI: 10.1016/j.bbmt.2017.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/07/2017] [Indexed: 12/27/2022]
Abstract
We sought to develop a myeloablative chemotherapeutic regimen to secure consistent engraftment of T-cell depleted (TCD) hematopoietic stem cell transplantations (HSCT) without the need for total body irradiation, thereby reducing toxicity while maintaining low rates of graft-versus-host disease (GVHD) and without increasing relapse. We investigated the myeloablative combination of busulfan (Bu) and melphalan (Mel), with the immunosuppressive agents fludarabine (Flu) and rabbit antithymocyte globulin (r-ATG) as cytoreduction before a TCD HSCT. No post-transplantation immunosuppression was administered. Between April 2001 and May 2008, 102 patients (median age, 55 years) with a diagnosis of primary or secondary myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) underwent cytoreduction with Bu/Mel/Flu, followed by TCD grafts. TCD was accomplished by CD34+-selection followed by E-rosette depletion for peripheral blood stem cell grafts and, for bone marrow grafts, by soybean agglutination followed by E-rosette depletion. Donors included matched and mismatched, related and unrelated donors. Risk stratification was by American Society for Blood and Marrow Transplantation risk categorization for patients with primary disease. For patients with secondary/treatment-related MDS/AML, those in complete remission (CR) 1 or with refractory anemia were classified as intermediate risk, and all other patients were considered high risk. Neutrophil engraftment occurred at a median of 11 days in 100 of 101 evaluable patients. The cumulative incidences of grades II to IV acute and chronic GVHD at 1 year were 8.8% and 5.9%, respectively. Overall- and disease-free survival (DFS) rates at 5 years were 50.0% and 46.1%, respectively, and the cumulative incidences of relapse and treatment-related mortality were 23.5% and 28.4%, respectively. Stratification by risk group demonstrated superior DFS for low-risk patients (61.5% at 5 years) compared with intermediate- or high-risk (34.2% and 40.0%, respectively, P = .021). For patients with AML, those in CR1 had superior 5-year DFS compared with those in ≥CR2 (60% and 30.6%, respectively, P = .01), without a significant difference in incidence of relapse (17.1% and 30.6%, respectively, P = .209). There were no differences in DFS for other patient, donor, or disease characteristics. In summary, cytoreduction with Bu/Mel/Flu and r-ATG secured consistent engraftment of TCD transplantations. The incidences of acute/chronic GVHD and disease relapse were low, with favorable outcomes in this patient population with high-risk myeloid malignancies.
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Affiliation(s)
- Barbara Spitzer
- Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York.
| | - Ann A Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Esperanza B Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Kirsten Fuller
- Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Patrick D Hilden
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James W Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Juliet N Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Guenther Koehne
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Katharine C Hsu
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Marcel R van den Brink
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Nancy A Kernan
- Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Susan E Prockop
- Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Andromachi Scaradavou
- Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Hugo Castro-Malaspina
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Richard J O'Reilly
- Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Farid Boulad
- Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
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27
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Conditioning regimens for allogeneic hematopoietic stem cell transplants in acute myeloid leukemia. Bone Marrow Transplant 2017; 52:1504-1511. [DOI: 10.1038/bmt.2017.83] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/06/2017] [Accepted: 02/24/2017] [Indexed: 12/24/2022]
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28
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Prognostic impact of the European LeukemiaNet standardized reporting system in older AML patients receiving stem cell transplantation after non-myeloablative conditioning. Bone Marrow Transplant 2017; 52:932-935. [DOI: 10.1038/bmt.2017.42] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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29
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Jentzsch M, Bill M, Nicolet D, Leiblein S, Schubert K, Pless M, Bergmann U, Wildenberger K, Schuhmann L, Cross M, Pönisch W, Franke GN, Vucinic V, Lange T, Behre G, Mrózek K, Bloomfield CD, Niederwieser D, Schwind S. Prognostic impact of the CD34+/CD38- cell burden in patients with acute myeloid leukemia receiving allogeneic stem cell transplantation. Am J Hematol 2017; 92:388-396. [PMID: 28133783 DOI: 10.1002/ajh.24663] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 01/09/2023]
Abstract
In acute myeloid leukemia (AML), leukemia-initiating cells exist within the CD34+/CD38- cell compartment. They are assumed to be more resistant to chemotherapy, enriched in minimal residual disease cell populations, and responsible for relapse. Here we evaluated clinical and biological associations and the prognostic impact of a high diagnostic CD34+/CD38- cell burden in 169 AML patients receiving an allogeneic stem cell transplantation in complete remission. Here, the therapeutic approach is mainly based on immunological graft-versus-leukemia effects. Percentage of bone marrow CD34+/CD38- cell burden at diagnosis was measured using flow cytometry and was highly variable (median 0.5%, range 0%-89% of all mononuclear cells). A high CD34+/CD38- cell burden at diagnosis associated with worse genetic risk and secondary AML. Patients with a high CD34+/CD38- cell burden had shorter relapse-free and overall survival which may be mediated by residual leukemia-initiating cells in the CD34+/CD38- cell population, escaping the graft-versus-leukemia effect after allogeneic transplantation. Evaluating the CD34+/CD38- cell burden at diagnosis may help to identify patients at high risk of relapse after allogeneic transplantation. Further studies to understand leukemia-initiating cell biology and develop targeting therapies to improve outcomes of AML patients are needed.
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Affiliation(s)
- Madlen Jentzsch
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Marius Bill
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center; Columbus Ohio USA
| | - Sabine Leiblein
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Karoline Schubert
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Martina Pless
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Ulrike Bergmann
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Kathrin Wildenberger
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Luba Schuhmann
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Michael Cross
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Wolfram Pönisch
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Georg-Nikolaus Franke
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Vladan Vucinic
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Thoralf Lange
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Gerhard Behre
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center; Columbus Ohio USA
| | | | - Dietger Niederwieser
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
| | - Sebastian Schwind
- Department of Hematology; Oncology and Hemostaseology, University of Leipzig; Leipzig Germany
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30
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Role of reduced-intensity conditioning allogeneic hematopoietic cell transplantation in older patients with de novo acute myeloid leukemia. Ann Hematol 2016; 96:289-297. [PMID: 27838773 DOI: 10.1007/s00277-016-2872-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
Reduced-intensity conditioning (RIC) regimens extend the therapeutic use of allogeneic hematopoietic cell transplantation (HCT) to older patients. The survival trend in 2325 patients aged >50 years presenting with de novo acute myeloid leukemia (AML) who underwent first reduced-intensity HCT (RIC-HCT) was assessed by retrospectively analyzing outcomes between 2000 and 2013. The annual number of RIC-HCTs in Japan was higher in the 2008-2013 period (n = 205/year [1229/6 years]) than in the 2000-2007 period (n = 137/year [1096/8 years]). Overall and disease-free survival were higher in the 2008-2013 period (P < 0.001) because of the improvement in transplant-related mortality (TRM). Survival regarding RIC-HCT for AML has improved over time, with an increased number of RIC-HCTs in patients with a Karnofsky performance status (KPS) ≥80. However, TRM remains high and the relapse rate has not improved over time. Multivariate analyses showed that a KPS ≥80 and complete remission at HCT were associated with less TRM and relapse, and better survival regardless of age ≥65 years. Accurate timing and prospective identification of patients at risk of TRM may aid the development of risk-adapted strategies for RIC-HCT in AML patients regardless of age.
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31
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Kim H, Lee JH, Joo YD, Bae SH, Lee SM, Jo JC, Choi Y, Lee JH, Kim DY, Ryoo HM, Lee KH. Comparable Allogeneic Hematopoietic Cell Transplantation Outcome of a Haplo-Identical Family Donor with an Alternative Donor in Adult Aplastic Anemia. Acta Haematol 2016; 136:129-39. [PMID: 27409595 DOI: 10.1159/000445820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/27/2016] [Indexed: 11/19/2022]
Abstract
We performed a study on allogeneic hematopoietic cell transplantation (alloHCT) from an HLA-haplo-identical familial donor (haploFD) using a busulfan-fludarabine-antithymocyte globulin conditioning regimen for severe aplastic anemia (sAA) and hypoplastic myelodysplastic syndrome. For the comparison between a haploFD and an alternative donor (AD; matched unrelated or partially matched donor) for sAA in adults, we collected haploFD data retrospectively and prospectively. Forty-eight AD cases were selected for the comparison with 16 haploFD cases. All transplantation outcomes except for extensive chronic graft versus host disease (GvHD) were similar. The frequencies of hepatic sinusoidal obstruction syndrome (p = 1.000), acute GvHD (p = 0.769), grade 3/4 acute GvHD (p = 0.258), chronic GvHD (p = 0.173), extensive chronic GvHD (p = 0.099), primary neutrophil engraftment failure (p = 1.000), secondary graft failure (p = 1.000) and platelet engraftment failure (p = 0.505) were similar. Time to neutrophil engraftment was faster in haploFD (p = 0.003), while the cumulative incidence of platelet engraftment was similar (p = 0.505). Overall survival was also similar between AD and haploFD (p = 0.730). In conclusion, alloHCT from haploFD in sAA was comparable with alloHCT from AD, but extensive chronic GvHD seemed frequent in haploFD. Therefore alloHCT from haploFD could be an alternative approach for alloHCT from AD in adult sAA.
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Affiliation(s)
- Hawk Kim
- Division of Hematology and Cellular Therapy, Ulsan University Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
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32
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Goyal G, Gundabolu K, Vallabhajosyula S, Silberstein PT, Bhatt VR. Reduced-intensity conditioning allogeneic hematopoietic-cell transplantation for older patients with acute myeloid leukemia. Ther Adv Hematol 2016; 7:131-41. [PMID: 27247754 PMCID: PMC4872178 DOI: 10.1177/2040620716643493] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Elderly patients (>60 years) with acute myeloid leukemia have a poor prognosis with a chemotherapy-alone approach. Allogeneic hematopoietic-cell transplantation (HCT) can improve overall survival (OS). However, myeloablative regimens can have unacceptably high transplant-related mortality (TRM) in an unselected group of older patients. Reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning regimens preserve the graft-versus-leukemia effects but reduce TRM. NMA regimens result in minimal cytopenia and may not require stem cell support for restoring hematopoiesis. RIC regimens, intermediate in intensity between NMA and myeloablative regimens, can cause prolonged myelosuppresion and usually require stem cell support. A few retrospective and prospective studies suggest a possibility of lower risk of relapse with myeloablative HCT in fit older patients with lower HCT comorbidity index; however, RIC and NMA HCTs have an important role in less-fit patients and those with significant comorbidities because of lower TRM. Whether early tapering of immunosuppression, monitoring of minimal residual disease, and post-transplant maintenance therapy can improve the outcomes of RIC and NMA HCT in elderly patients will require prospective trials.
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Affiliation(s)
- Gaurav Goyal
- Creighton University Medical Center, 601 North 30th Street, Ste 5850, Omaha, NE 68131, USA
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33
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Hematopoietic stem cell transplantation for patients with AML in first complete remission. Blood 2016; 127:62-70. [DOI: 10.1182/blood-2015-07-604546] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/07/2015] [Indexed: 12/31/2022] Open
Abstract
Abstract
Postremission therapy in patients with acute myeloid leukemia (AML) may consist of continuing chemotherapy or transplantation using either autologous or allogeneic stem cells. Patients with favorable subtypes of AML generally receive chemotherapeutic consolidation, although recent studies have also suggested favorable outcome after hematopoietic stem cell transplantation (HSCT). Although allogeneic HSCT (alloHSCT) is considered the preferred type of postremission therapy in poor- and very-poor-risk AML, the place of alloHSCT in intermediate-risk AML is being debated, and autologous HSCT is considered a valuable alternative that may be preferred in patients without minimal residual disease after induction chemotherapy. Here, we review postremission transplantation strategies using either autologous or allogeneic stem cells. Recent developments in the field of alternative donors, including cord blood and haploidentical donors, are highlighted, and we discuss reduced-intensity alloHSCT in older AML recipients who represent the predominant category of patients with AML who have a high risk of relapse in first remission.
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34
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Craddock C, Jilani N, Siddique S, Yap C, Khan J, Nagra S, Ward J, Ferguson P, Hazlewood P, Buka R, Vyas P, Goodyear O, Tholouli E, Crawley C, Russell N, Byrne J, Malladi R, Snowden J, Dennis M. Tolerability and Clinical Activity of Post-Transplantation Azacitidine in Patients Allografted for Acute Myeloid Leukemia Treated on the RICAZA Trial. Biol Blood Marrow Transplant 2015; 22:385-390. [PMID: 26363443 PMCID: PMC4728172 DOI: 10.1016/j.bbmt.2015.09.004] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 09/02/2015] [Indexed: 01/08/2023]
Abstract
Disease relapse is the major causes of treatment failure after allogeneic stem cell transplantation (SCT) in patients with acute myeloid leukemia (AML). As well as demonstrating significant clinical activity in AML, azacitidine (AZA) upregulates putative tumor antigens, inducing a CD8(+) T cell response with the potential to augment a graft-versus-leukemia effect. We, therefore, studied the feasibility and clinical sequelae of the administration of AZA during the first year after transplantation in 51 patients with AML undergoing allogeneic SCT. Fourteen patients did not commence AZA either because of transplantation complications or withdrawal of consent. Thirty-seven patients commenced AZA at a median of 54 days (range, 40 to 194 days) after transplantation, which was well tolerated in the majority of patients. Thirty-one patients completed 3 or more cycles of AZA. Sixteen patients relapsed at a median time of 8 months after transplantation. No patient developed extensive chronic graft-versus-host disease. The induction of a post-transplantation CD8(+) T cell response to 1 or more tumor-specific peptides was studied in 28 patients. Induction of a CD8(+) T cell response was associated with a reduced risk of disease relapse (hazard ratio [HR], .30; 95% confidence interval [CI], .10 to .85; P = .02) and improved relapse-free survival (HR, .29; 95% CI, .10 to .83; P = .02) taking into account death as a competing risk. In conclusion, AZA is well tolerated after transplantation and appears to have the capacity to reduce the relapse risk in patients who demonstrate a CD8(+) T cell response to tumor antigens. These observations require confirmation in a prospective clinical trial.
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Affiliation(s)
- Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom; Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Nadira Jilani
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom; Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shamyla Siddique
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom; Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christina Yap
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom; Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Josephine Khan
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sandeep Nagra
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Janice Ward
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Paul Ferguson
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom; Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Peter Hazlewood
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom; Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Richard Buka
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Paresh Vyas
- MRC Molecular Haematology Unit and Department of Haematology, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Oliver Goodyear
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Eleni Tholouli
- Department of Clinical Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Charles Crawley
- Cambridge Cancer Trials Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Nigel Russell
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jenny Byrne
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Ram Malladi
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom; Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Trust and Department of Oncology, University of Sheffield, United Kingdom
| | - Mike Dennis
- Haematology and Transplant Unit, The Christie NHS Foundation Trust, Manchester, United Kingdom
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35
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Pingali SR, Champlin RE. Pushing the envelope-nonmyeloablative and reduced intensity preparative regimens for allogeneic hematopoietic transplantation. Bone Marrow Transplant 2015; 50:1157-67. [PMID: 25985053 PMCID: PMC4809137 DOI: 10.1038/bmt.2015.61] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 12/30/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) was originally developed to allow delivery of myeloablative doses of chemotherapy and radiotherapy. With better understanding of disease pathophysiology, the graft vs malignancy (GVM) effect of allogeneic hematopoietic transplantation and toxicities associated with myeloablative conditioning (MAC) regimens, the focus shifted to developing less toxic conditioning regimens to reduce treatment-related morbidity without compromising survival. Although HCT with MAC is preferred to reduced intensity conditioning (RIC) for most patients ⩽60 years with AML/myelodysplastic syndrome and ALL, RIC and nonmyeloablative (NMA) regimens allow HCT for many otherwise ineligible patients. Reduced intensity preparative regimens have produced high rates of PFS for diagnoses, which are highly sensitive to GVM. Relapse of the malignancy is the major cause of treatment failure with RIC/NMA HCT. Incorporation of novel agents like bortezomib or lenalidomide, addition of cellular immunotherapy and use of targeted radiation therapies could further improve outcome. In this review, we discuss commonly used RIC/NMA regimens and promising novel regimens.
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Affiliation(s)
- S R Pingali
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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36
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Meyer C, Walker J, Dewane J, Engelmann F, Laub W, Pillai S, Thomas CR, Messaoudi I. Impact of irradiation and immunosuppressive agents on immune system homeostasis in rhesus macaques. Clin Exp Immunol 2015; 181:491-510. [PMID: 25902927 DOI: 10.1111/cei.12646] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2015] [Indexed: 12/30/2022] Open
Abstract
In this study we examined the effects of non-myeloablative total body irradiation (TBI) in combination with immunosuppressive chemotherapy on immune homeostasis in rhesus macaques. Our results show that the administration of cyclosporin A or tacrolimus without radiotherapy did not result in lymphopenia. The addition of TBI to the regimen resulted in lymphopenia as well as alterations in the memory/naive ratio following reconstitution of lymphocyte populations. Dendritic cell (DC) numbers in whole blood were largely unaffected, while the monocyte population was altered by immunosuppressive treatment. Irradiation also resulted in increased levels of circulating cytokines and chemokines that correlated with T cell proliferative bursts and with the shift towards memory T cells. We also report that anti-thymocyte globulin (ATG) treatment and CD3 immunotoxin administration resulted in a selective and rapid depletion of naive CD4 and CD8 T cells and increased frequency of memory T cells. We also examined the impact of these treatments on reactivation of latent simian varicella virus (SVV) infection as a model of varicella zoster virus (VZV) infection of humans. None of the treatments resulted in overt SVV reactivation; however, select animals had transient increases in SVV-specific T cell responses following immunosuppression, suggestive of subclinical reactivation. Overall, we provide detailed observations into immune modulation by TBI and chemotherapeutic agents in rhesus macaques, an important research model of human disease.
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Affiliation(s)
- C Meyer
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Beaverton, OR, USA
| | - J Walker
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - J Dewane
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Beaverton, OR, USA
| | - F Engelmann
- Division of Biomedical Sciences, University of California-Riverside, Riverside, CA, USA
| | - W Laub
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - S Pillai
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - I Messaoudi
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Beaverton, OR, USA.,Division of Biomedical Sciences, University of California-Riverside, Riverside, CA, USA
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Gifford G, Wong K, Kerridge I, Stevenson W, Arthur C, Fay K, Greenwood M. Addition of low dose total body irradiation to fludarabine melphalan reduced intensity conditioning is feasible, tolerable, and may improve outcomes in patients with high-risk acute myeloid leukaemia and other high risk myeloid malignancies. Am J Hematol 2015; 90:E97-100. [PMID: 25683457 DOI: 10.1002/ajh.23974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/09/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Grace Gifford
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Kelly Wong
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Ian Kerridge
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
| | - William Stevenson
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Chris Arthur
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Keith Fay
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
- Haematology Department; St Vincent's Hospital; Sydney, New South Wales Australia
| | - Matthew Greenwood
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
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Hobbs GS, Perales MA. Effects of T-Cell Depletion on Allogeneic Hematopoietic Stem Cell Transplantation Outcomes in AML Patients. J Clin Med 2015; 4:488-503. [PMID: 26239251 PMCID: PMC4470141 DOI: 10.3390/jcm4030488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 01/19/2015] [Accepted: 01/19/2015] [Indexed: 01/25/2023] Open
Abstract
Graft versus host disease (GVHD) remains one of the leading causes of morbidity and mortality associated with conventional allogeneic hematopoietic stem cell transplantation (HCT). The use of T-cell depletion significantly reduces this complication. Recent prospective and retrospective data suggest that, in patients with AML in first complete remission, CD34+ selected grafts afford overall and relapse-free survival comparable to those observed in recipients of conventional grafts, while significantly decreasing GVHD. In addition, CD34+ selected grafts allow older patients, and those with medical comorbidities or with only HLA-mismatched donors to successfully undergo transplantation. Prospective data are needed to further define which groups of patients with AML are most likely to benefit from CD34+ selected grafts. Here we review the history of T-cell depletion in AML, and techniques used. We then summarize the contemporary literature using CD34+ selection in recipients of matched or partially mismatched donors (7/8 or 8/8 HLA-matched), and provide a summary of the risks and benefits of using T-cell depletion.
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Affiliation(s)
- Gabriela Soriano Hobbs
- Adult Leukemia Service, Massachusetts General Hospital, Boston, MA 02114, USA.
- Harvard Medical School, Boston, MA 02115, USA.
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
- Weill Cornell Medical College, New York, NY 10065, USA.
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Lekakis LJ, Cooper BW, de Lima MG. Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: are we closer to knowing who needs it? Curr Hematol Malig Rep 2015; 9:128-37. [PMID: 24664820 DOI: 10.1007/s11899-014-0207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Acute myeloid leukemia (AML) is a very heterogeneous disease. Prognosis is related not only to intrinsic characteristics such as cytogenetics and molecular markers, but also the patient's ability to tolerate therapy, and treatment response. Allogeneic stem cell transplantation (allo-HCT) has been traditionally indicated for poor-risk disease in first complete remission (CR1) or for treatment of relapsed or refractory AML. 'Poor-risk' disease is now better defined due to genetic subtyping, particularly in chromosomally normal AML. In addition, the presence of comorbid conditions should be included in the decision-making process. Improvements in supportive care and the use of modern conditioning regimens have been associated with improved outcomes, mostly due to a reduction in treatment-related mortality. Therefore, a significant proportion of patients with AML-CR1 can potentially benefit from allo-HCT. We give general guidelines on how to incorporate cytogenetic and molecular risk factors, donor selection, and patient characteristics in order to determine when allo-HCT should be indicated in CR1.
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Federmann B, Faul C, Meisner C, Vogel W, Kanz L, Bethge WA. Influence of age on outcome after allogeneic hematopoietic cell transplantation: a single center study in patients aged ⩾60. Bone Marrow Transplant 2015; 50:427-31. [DOI: 10.1038/bmt.2014.292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 10/17/2014] [Accepted: 10/21/2014] [Indexed: 11/09/2022]
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41
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Cornelissen JJ, Versluis J, Passweg JR, van Putten WLJ, Manz MG, Maertens J, Beverloo HB, Valk PJM, van Marwijk Kooy M, Wijermans PW, Schaafsma MR, Biemond BJ, Vekemans MC, Breems DA, Verdonck LF, Fey MF, Jongen-Lavrencic M, Janssen JJWM, Huls G, Kuball J, Pabst T, Graux C, Schouten HC, Gratwohl A, Vellenga E, Ossenkoppele G, Löwenberg B. Comparative therapeutic value of post-remission approaches in patients with acute myeloid leukemia aged 40–60 years. Leukemia 2014; 29:1041-50. [DOI: 10.1038/leu.2014.332] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/06/2014] [Accepted: 11/14/2014] [Indexed: 12/27/2022]
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42
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A comparative assessment of the curative potential of reduced intensity allografts in acute myeloid leukaemia. Leukemia 2014; 29:1478-84. [DOI: 10.1038/leu.2014.319] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/11/2014] [Accepted: 10/07/2014] [Indexed: 11/08/2022]
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43
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Ringdén O, Brazauskas R, Wang Z, Ahmed I, Atsuta Y, Buchbinder D, Burns LJ, Cahn JY, Duncan C, Hale GA, Halter J, Hayashi RJ, Hsu JW, Jacobsohn DA, Kamble RT, Kamani NR, Kasow KA, Khera N, Lazarus HM, Loren AW, Marks DI, Myers KC, Ramanathan M, Saber W, Savani BN, Schouten HC, Socie G, Sorror ML, Steinberg A, Popat U, Wingard JR, Mattsson J, Majhail NS. Second solid cancers after allogeneic hematopoietic cell transplantation using reduced-intensity conditioning. Biol Blood Marrow Transplant 2014; 20:1777-84. [PMID: 25042734 PMCID: PMC4194257 DOI: 10.1016/j.bbmt.2014.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/07/2014] [Indexed: 12/21/2022]
Abstract
We examined risk of second solid cancers after allogeneic hematopoietic cell transplantation (AHCT) using reduced-intensity/nonmyeloablative conditioning (RIC/NMC). RIC/NMC recipients with leukemia/myelodysplastic syndrome (MDS) (n = 2833) and lymphoma (n = 1436) between 1995 and 2006 were included. In addition, RIC/NMC recipients 40 to 60 years of age (n = 2138) were compared with patients of the same age receiving myeloablative conditioning (MAC, n = 6428). The cumulative incidence of solid cancers was 3.35% at 10 years. There was no increase in overall cancer risk compared with the general population (leukemia/MDS: standardized incidence ratio [SIR] .99, P = 1.00; lymphoma: SIR .92, P = .75). However, risks were significantly increased in leukemia/MDS patients for cancers of lip (SIR 14.28), tonsil (SIR 8.66), oropharynx (SIR 46.70), bone (SIR 23.53), soft tissue (SIR 12.92), and vulva (SIR 18.55) and skin melanoma (SIR 3.04). Lymphoma patients had significantly higher risks of oropharyngeal cancer (SIR 67.35) and skin melanoma (SIR 3.52). Among RIC/NMC recipients, age >50 years was the only independent risk factor for solid cancers (hazard ratio [HR] 3.02, P < .001). Among patients ages 40 to 60 years, when adjusted for other factors, there was no difference in cancer risks between RIC/NMC and MAC in leukemia/MDS patients (HR .98, P = .905). In lymphoma patients, risks were lower after RIC/NMC (HR .51, P = .047). In conclusion, the overall risks of second solid cancers in RIC/NMC recipients are similar to the general population, although there is an increased risk of cancer at some sites. Studies with longer follow-up are needed to realize the complete risks of solid cancers after RIC/NMC AHCT.
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Affiliation(s)
- Olle Ringdén
- Center for Allogeneic Stem Cell Transplantation, Karolinka University Hospital, Stockholm, Sweden
| | - Ruta Brazauskas
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhiwei Wang
- Center for International Bone and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ibrahim Ahmed
- Department of Pediatric Hematology & Oncology, University of New Mexico, Albuquerque, New Mexico
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, California
| | - Linda J Burns
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Jean-Yves Cahn
- Clinique Universitaire d'Hématologie, University Hospital, Grenoble, France
| | - Christine Duncan
- Pediatric Stem Cell Transplantation Program, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Gregory A Hale
- Department of Hematology Oncology, All Children's Hospital, St. Petersburg, Florida
| | - Joerg Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Washington University, St. Louis Children's Hospital, St. Louis, Missouri
| | - Jack W Hsu
- Division of Hematology & Oncology, Shands HealthCare, University of Florida, Gainesville, Florida
| | - David A Jacobsohn
- Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC
| | - Rammurti T Kamble
- Center for Gene Therapy, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas
| | | | - Kimberly A Kasow
- Pediatric Bone Marrow Transplantation Program, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Hillard M Lazarus
- Division of Hematology and Oncology, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Alison W Loren
- Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David I Marks
- Adult BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom
| | - Kasiani C Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Muthalagu Ramanathan
- Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Wael Saber
- Center for International Bone and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harry C Schouten
- Department of Medicine and Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Gérard Socie
- Service d'Hematologie-Greffe de Moelle, Hopital Saint Louis, Paris, France
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Amir Steinberg
- Department of Hematology and Medical Oncology, Mount Sinai Medical Center, Los Angeles, California
| | - Uday Popat
- Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas
| | - John R Wingard
- Division of Hematology & Oncology, Shands HealthCare, University of Florida, Gainesville, Florida
| | - Jonas Mattsson
- Center for Allogeneic Stem Cell Transplantation, Karolinka University Hospital, Stockholm, Sweden
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
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44
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[Current indications of allogeneic stem cell transplant in adults with acute myeloid leukemia]. Bull Cancer 2014; 101:856-65. [PMID: 25296413 DOI: 10.1684/bdc.2014.1944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Allogeneic stem cell transplantation (SCT) is an increasingly important therapeutic option for the treatment of adult patients with acute myeloid leukemia. Here we review the current indications of SCT in this disease. While patients with favorable cytogenetics should receive consolidation chemotherapy, patients with unfavorable karyotype are prime candidates for SCT or new approaches to SCT (which should be done in first complete remission). Patients with intermediate prognoses should also receive SCT in first complete remission. In the absence of a suitable matched related donor, most patients will be able to find an alternative donor to proceed to a potentially curative allogeneic transplantation. The use of reduced-intensity conditioning regimens before SCT has allowed patients in the sixth or seventh decades of life to be routinely transplanted. Despite major differences among transplant centers in the intensity and composition of the conditioning regimen and immunosuppression, choice of graft source, postgraft immune-modulation, and supportive care, there has been a dramatic improvement in terms of tolerance. Although it is presumed to be a curative strategy, major complications of SCT remain graft-versus-host disease, delayed immune recovery, multiple comorbidities, and relapse after transplant.
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45
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Yanada M. Allogeneic hematopoietic cell transplantation for acute myeloid leukemia during first complete remission: a clinical perspective. Int J Hematol 2014; 101:243-54. [PMID: 25212675 DOI: 10.1007/s12185-014-1657-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 12/28/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is the most potent therapy for preventing relapse of acute myeloid leukemia (AML). Although its efficacy is compromised by a high risk of treatment-related morbidity and mortality, an accumulating body of evidence has led to the general recommendation favoring allogeneic HCT from a matched sibling donor during first complete remission (CR1) for younger patients with cytogenetically intermediate- or high-risk AML. Over the past few decades, this field has seen a great many advancements. The indications for allogeneic HCT have been refined by taking into account the molecular profiles of leukemic cells and the degree of comorbidities. The introduction of high-resolution human leukocyte antigen-typing technology and advances in immunosuppressive therapy and supportive care measures have improved outcomes in alternative donor transplantation, while the parallel growth of unrelated donor registries and greater use of umbilical cord blood and haploidentical donors have considerably improved the chance of finding an alternative donor. The development of reduced-intensity and non-myeloablative conditioning has made it possible to receive allogeneic HCT for patients who might once have been considered ineligible due to advanced age or comorbidities. Thanks to these advances, the role of allogeneic HCT during CR1 has become progressively more important in the treatment of AML.
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Affiliation(s)
- Masamitsu Yanada
- Department of Hematology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan,
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Oudin C, Chevallier P, Furst S, Guillaume T, El Cheikh J, Delaunay J, Castagna L, Faucher C, Granata A, Devillier R, Chabannon C, Esterni B, Vey N, Mohty M, Blaise D. Reduced-toxicity conditioning prior to allogeneic stem cell transplantation improves outcome in patients with myeloid malignancies. Haematologica 2014; 99:1762-8. [PMID: 25085356 DOI: 10.3324/haematol.2014.105981] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The introduction of reduced intensity/toxicity conditioning regimens has allowed allogeneic hematopoietic cell transplantation to be performed in patients who were previously considered too old or otherwise unfit. Although it led to a reduction in non-relapse mortality, disease control remains a major challenge. We studied the outcome of 165 patients with acute myeloid leukemia (n=124) or myelodysplastic syndrome (n=41) transplanted after conditioning with fludarabine (30 mg/m(2)/day for 5 days), intravenous busulfan (either 260 mg/m(2): reduced intensity conditioning, or 390-520 mg/m(2): reduced toxicity conditioning), and rabbit anti-thymoglobulin (2.5 mg/kg/day for 2 days). The median age of the patients at transplantation was 56.8 years. The 2-year relapse incidence was 29% (23% versus 39% for patients transplanted in first complete remission and those transplanted beyond first complete remission, respectively; P=0.008). The 2-year progression-free survival rate was 57% (95% CI: 49.9-65). It was higher in the groups with favorable or intermediate cytogenetics than in the group with unfavorable cytogenetics (72.7%, 60.5%, and 45.7%, respectively; P=0.03). The cumulative incidence of grades 2-4 and 3-4 acute graft-versus-host disease at day 100 was 19.3% and 7.9%, respectively. The cumulative incidence of chronic graft-versus-host disease at 1 year was 21.6% (severe forms: 7.8%). Non-relapse mortality at 1 year reached 11%. The 2-year overall survival rate was 61.8% (95% CI: 54.8-69.7). Unfavorable karyotype and disease status beyond first complete remission were associated with a poorer survival. This well-tolerated conditioning platform can lead to long-term disease control and offers possibilities of modulation according to disease stage or further development.
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Affiliation(s)
- Claire Oudin
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Aix-Marseille University, Marseille, France
| | - Patrice Chevallier
- Centre Hospitalier Universitaire de Nantes, Service d'Hématologie Clinique, France
| | - Sabine Furst
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Thierry Guillaume
- Centre Hospitalier Universitaire de Nantes, Service d'Hématologie Clinique, France
| | - Jean El Cheikh
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Jacques Delaunay
- Centre Hospitalier Universitaire de Nantes, Service d'Hématologie Clinique, France
| | - Luca Castagna
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Humanitas Cancer Center, Hematology Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy
| | - Catherine Faucher
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Angela Granata
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Raynier Devillier
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Aix-Marseille University, Marseille, France Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
| | - Christian Chabannon
- Aix-Marseille University, Marseille, France Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France Cell Therapy Unit, Institut Paoli Calmettes, Marseille, France
| | - Benjamin Esterni
- Unité de Biostatistiques, Institut Paoli Calmettes, Marseille, France
| | - Norbert Vey
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Aix-Marseille University, Marseille, France Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
| | - Mohamad Mohty
- Centre Hospitalier Universitaire de Nantes, Service d'Hématologie Clinique, France Université de Nantes, Faculté de Médecine, France INSERM CRNCA UMR 892, Nantes, France Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France Université Pierre et Marie Curie, Paris, France INSERM, UMRs 938, Paris, France
| | - Didier Blaise
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Aix-Marseille University, Marseille, France Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
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Solomon SR, Sanacore M, Zhang X, Brown S, Holland K, Morris LE, Bashey A. Calcineurin inhibitor--free graft-versus-host disease prophylaxis with post-transplantation cyclophosphamide and brief-course sirolimus following reduced-intensity peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 2014; 20:1828-34. [PMID: 25064745 DOI: 10.1016/j.bbmt.2014.07.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/15/2014] [Indexed: 12/26/2022]
Abstract
Calcineurin inhibitors (CNIs) form the foundation of current graft-versus-host disease (GVHD) prophylaxis regimens. We hypothesized that a CNI-free regimen consisting of post-transplantation cyclophosphamide (PTCy) and brief-course sirolimus would reduce chronic GVHD and nonrelapse mortality (NRM) after reduced-intensity conditioning allogeneic peripheral blood stem cell transplantation (PBSCT). Twenty-six patients (median age, 61 years) underwent unmanipulated PBSCT from an 8/8 locus-matched donor (matched related donor, n = 17; natched unrelated donor, n = 9). GVHD prophylaxis consisted of PTCy and brief-course sirolimus. Donor engraftment occurred in all patients. The cumulative incidence (CI) of grade II-IV acute GVHD, grade III-IV acute GVHD, and chronic GVHD was 46%, 15%, and 31% respectively. One-year NRM was 4%. The median time to immunosuppression discontinuation was day +138. With a median follow-up of 20 months, the estimated 2-year overall survival was 71%, estimated disease-free survival was 64%, and estimated relapse incidence was 32%. In patients with a lymphoid malignancy (eg, chronic lymphoblastic leukemia, non-Hodgkin lymphoma, Hodgkin disease), 2-year disease-free survival was 100%, and there were no relapses. Good immune reconstitution was evidenced by low cytomegalovirus reactivation rate of 21% (4 of 19 at-risk patients). GVHD prophylaxis with PTCy and sirolimus achieves consistent donor engraftment, low rates of chronic GVHD and NRM, and excellent outcomes in recipients of HLA-identical related and unrelated donor allogeneic PBSCT.
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Affiliation(s)
- Scott R Solomon
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia.
| | - Melissa Sanacore
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Xu Zhang
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia
| | - Stacey Brown
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Kent Holland
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Lawrence E Morris
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Asad Bashey
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
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Kanate AS, Pasquini MC, Hari PN, Hamadani M. Allogeneic hematopoietic cell transplant for acute myeloid leukemia: Current state in 2013 and future directions. World J Stem Cells 2014; 6:69-81. [PMID: 24772235 PMCID: PMC3999783 DOI: 10.4252/wjsc.v6.i2.69] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/03/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Acute myeloid leukemia (AML) represents a heterogeneous group of high-grade myeloid neoplasms of the elderly with variable outcomes. Though remission-induction is an important first step in the management of AML, additional treatment strategies are essential to ensure long-term disease-free survival. Recent pivotal advances in understanding the genetics and molecular biology of AML have allowed for a risk-adapted approach in its management based on relapse-risk. Allogeneic hematopoietic cell transplantation (allo-HCT) represents an effective therapeutic strategy in AML providing the possibility of cure with potent graft-versus-leukemia reactions, with a demonstrable survival advantage in younger patients with intermediate- or poor-risk cytogenetics. Herein we review the published data regarding the role of allo-HCT in adults with AML. We searched MEDLINE/PubMed and EMBASE/Ovid. In addition, we searched reference lists of relevant articles, conference proceedings and ongoing trial databases. We discuss the role of allo-HCT in AML patients stratified by cytogenetic- and molecular-risk in first complete remission, as well as allo-HCT as an option in relapsed/refractory AML. Besides the conventional sibling and unrelated donor allografts, we review the available data and recent advances for alternative donor sources such as haploidentical grafts and umbilical cord blood. We also discuss conditioning regimens, including reduced intensity conditioning which has broadened the applicability of allo-HCT. Finally we explore recent advances and future possibilities and directions of allo-HCT in AML. Practical therapeutic recommendations have been made where possible based on available data and expert opinion.
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Devic I, Shi M, Schubert MM, Lloid M, Izutsu KT, Pan C, Missaghi M, Morton TH, Mancl LA, Zhang J, Presland RB. Proteomic analysis of saliva from patients with oral chronic graft-versus-host disease. Biol Blood Marrow Transplant 2014; 20:1048-55. [PMID: 24704387 DOI: 10.1016/j.bbmt.2014.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/26/2014] [Indexed: 12/13/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) is an immune-mediated disorder and is the major long-term complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). The oral mucosa, including the salivary glands, is affected in the majority of patients with cGVHD; however, at present there is only a limited understanding of disease pathobiology. In this study, we performed a quantitative proteomic analysis of saliva pooled from patients with and without oral cGVHD-cGVHD(+) and cGVHD(-), respectively-using isobaric tags for relative and absolute quantification labeling, followed by tandem mass spectrometry. Among 249 salivary proteins identified by tandem mass spectrometry, 82 exhibited altered expression in the oral cGVHD(+) group compared with the cGVHD(-) group. Many of the identified proteins function in innate or acquired immunity, or are associated with tissue maintenance functions, such as proteolysis or the cytoskeleton. Using ELISA immunoassays, we further confirmed that 2 of these proteins, IL-1 receptor antagonist and cystatin B, showed decreased expression in patients with active oral cGVHD (P < .003). Receiver operating curve characteristic analysis revealed that these 2 markers were able to distinguish oral cGVHD with a sensitivity of 85% and specificity of 60%, and showed slightly better discrimination in newly diagnosed patients evaluated within 12 months of allo-HSCT (sensitivity, 92%; specificity 73%). In addition to identifying novel potential salivary cGVHD biomarkers, our study demonstrates that there is coordinated regulation of protein families involved in inflammation, antimicrobial defense, and tissue protection in oral cGVHD that also may reflect changes in salivary gland function and damage to the oral mucosa.
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Affiliation(s)
- Ivana Devic
- Department of Pathology, University of Washington, Seattle, Washington
| | - Min Shi
- Department of Pathology, University of Washington, Seattle, Washington
| | - Mark M Schubert
- Department of Oral Medicine, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michele Lloid
- Department of Oral Medicine, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Kenneth T Izutsu
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - Catherine Pan
- Department of Pathology, University of Washington, Seattle, Washington
| | - Melody Missaghi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - Thomas H Morton
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - Lloyd A Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - Jing Zhang
- Department of Pathology, University of Washington, Seattle, Washington
| | - Richard B Presland
- Department of Oral Health Sciences, University of Washington, Seattle, Washington; Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington.
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Abstract
Acute myeloid leukemia carries a dismal prognosis in patients over 60 years of age and, despite many clinical trials of both novel and conventional agents, there has been no significant improvement in overall survival during the last 30 years. Combinations of anthracyclines and cytarabine remain the cornerstone of therapy and produce complete remission in 45-55% of older patients, with a median survival of only 8-12 months. These statistics become even worse in patients over 70 years and those with unfavorable cytogenetics and/or poor performance status. Deciding which older acute myeloid leukemia patients would benefit from intensive chemotherapy is difficult and efforts are underway to improve existing risk-assessment tools. Many new agents are under development, including signal transduction inhibitors, farnesyl transferase inhibitors, antibodies and novel chemotherapeutics. To date, small-molecule inhibitors and targeted therapies have had limited single-agent efficacy and have required combination with chemotherapy. The role of hematopoietic stem cell transplantation in older patients is under investigation. All patients over 60 years of age with acute myeloid leukemia should be encouraged to participate in a clinical trial if possible.
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Affiliation(s)
- Gail J Roboz
- Weill Medical College of Cornell University and The New York Presbyterian Hospital, 520 East 70th Street, Starr 340A, New York, NY 10021, USA.
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