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Nishiwaki S, Sugiura I, Sato T, Kobayashi M, Osaki M, Sawa M, Adachi Y, Okabe M, Saito S, Morishita T, Kohno A, Nishiyama T, Iida H, Kurahashi S, Kuwatsuka Y, Sugiyama D, Ito S, Nishikawa H, Kiyoi H. Autologous peripheral blood stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia is safe but poses challenges for long-term maintenance of molecular remission: Results of the Auto-Ph17 study. EJHAEM 2023; 4:358-369. [PMID: 37206256 PMCID: PMC10188459 DOI: 10.1002/jha2.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 05/21/2023]
Abstract
Autologous hematopoietic stem cell transplantation (SCT) is not a standard treatment option for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL); however, its position has been reassessed since the introduction of tyrosine kinase inhibitors (TKIs). We prospectively analyzed the efficacy and safety of autologous peripheral blood SCT (auto-PBSCT) for Ph+ALL patients aged between 55 and 70 years who had achieved complete molecular remission. Melphalan, cyclophosphamide, etoposide, and dexamethasone were used for conditioning. A total of 12 courses of maintenance therapy, including dasatinib, were performed. The required number of CD34+ cells was harvested in all five patients. No patient died within 100 days after auto-PBSCT, and no unexpected serious adverse events were observed. Although 1-year event-free survival was 100%, hematological relapse was observed in three patients at a median of 801 days (range, 389-1088 days) after auto-PBSCT. Molecular progressive disease was observed in the other two patients, although they maintained their first hematological remission at the last visit. Auto-PBSCT can be safely performed for Ph+ALL with TKIs. A limitation of auto-PBSCT was suggested, despite the increase in the intensity of a single treatment. The development of long-term therapeutic strategies by including new molecular targeted drugs is warranted to maintain long-term molecular remission.
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Affiliation(s)
- Satoshi Nishiwaki
- Department of Advanced MedicineNagoya University HospitalNagoyaJapan
| | - Isamu Sugiura
- Division of Hematology and OncologyToyohashi Municipal HospitalToyohashiJapan
| | - Takahiko Sato
- Department of ImmunologyNagoya University Graduate School of MedicineNagoyaJapan
- Department of Hematology and OncologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Miki Kobayashi
- Department of Hematology and OncologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Masahide Osaki
- Department of HematologyJapanese Red Cross Aichi Medical Center Nagoya Daiichi HospitalNagoyaJapan
| | - Masashi Sawa
- Department of Hematology and OncologyAnjo Kosei HospitalAnjoJapan
| | - Yoshitaka Adachi
- Department of Hematology and OncologyJA Aichi Konan Kosei HospitalKonanJapan
| | - Motohito Okabe
- Department of HematologyJapanese Red Cross Aichi Medical Center Nagoya Daiichi HospitalNagoyaJapan
| | - Shigeki Saito
- Department of Hematology and OncologyJapanese Red Cross Aichi Medical Center Nagoya Daini HospitalNagoyaJapan
| | - Takanobu Morishita
- Department of HematologyJapanese Red Cross Aichi Medical Center Nagoya Daiichi HospitalNagoyaJapan
| | - Akio Kohno
- Department of Hematology and OncologyJA Aichi Konan Kosei HospitalKonanJapan
| | | | - Hiroatsu Iida
- Department of HematologyNational Hospital Organization Nagoya Medical CenterNagoyaJapan
| | - Shingo Kurahashi
- Division of Hematology and OncologyToyohashi Municipal HospitalToyohashiJapan
| | - Yachiyo Kuwatsuka
- Department of Advanced MedicineNagoya University HospitalNagoyaJapan
| | - Daisuke Sugiyama
- Department of ImmunologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Sachiko Ito
- Department of ImmunologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Hiroyoshi Nishikawa
- Department of ImmunologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Hitoshi Kiyoi
- Department of Hematology and OncologyNagoya University Graduate School of MedicineNagoyaJapan
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Sumransub N, Cao Q, Wangen R, Brunstein C, Miller JS, Bachanova V. High Proliferating Regulatory T cells Post-transplant are Associated with Poor Survival in Lymphoma Patients Treated with Autologous Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2022; 28:184.e1-184.e8. [DOI: 10.1016/j.jtct.2022.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 01/02/2023]
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Derman BA, Zha Y, Zimmerman TM, Malloy R, Jakubowiak A, Bishop MR, Kline J. Regulatory T-cell depletion in the setting of autologous stem cell transplantation for multiple myeloma: pilot study. J Immunother Cancer 2021; 8:jitc-2019-000286. [PMID: 31940591 PMCID: PMC7057425 DOI: 10.1136/jitc-2019-000286] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Progression after high-dose melphalan with autologous stem cell transplantation (ASCT) in multiple myeloma (MM) may be due in part to immune dysfunction. Regulatory T (Treg) cells reconstitute rapidly after ASCT and inhibit immune responses against myeloma cells. METHODS We performed a randomized study to evaluate two methods of Treg depletion in patients with MM undergoing ASCT. No Treg depletion was performed in the control ASCT arm. An anti-CD25 monoclonal antibody (basiliximab 20 mg IV) was administered on day +1 post-ASCT in the in vivo Treg depletion (IVTRD) arm. Tregs were depleted from autologous stem cell (ASC) grafts with anti-CD25 microbeads and the CliniMACS device in the ex vivo Treg depletion (EVTRD) arm. RESULTS Fifteen patients were enrolled, five in each arm. The conditioning regimen was melphalan 200 mg/m2. Primary objectives included assessments of efficiency of IVTRD/EVTRD, kinetics of Treg depletion and recovery following ASCT, and safety. EVTRD removed 90% of CD4+CD25+ cells from ASC grafts. IVTRD and EVTRD led to reductions in Treg frequency between days +7 and +90 post-transplant compared with the control (p=0.007 and p<0.001, respectively). CONCLUSIONS IVTRD and EVTRD are feasible and significantly reduce and delay Treg recovery post-ASCT for MM, and serve as a platform for using post-transplant immunotherapies to improve post-ASCT outcomes. TRIAL REGISTRATION NUMBER NCT01526096.
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Affiliation(s)
- Benjamin A Derman
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Yuanyuan Zha
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
| | | | - Rebecca Malloy
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Andrzej Jakubowiak
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Michael R Bishop
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Justin Kline
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
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Safety and Efficacy of Consolidation Therapy with Ipilimumab Plus Nivolumab after Autologous Stem Cell Transplantation. Transplant Cell Ther 2020; 27:391-403. [PMID: 33965177 DOI: 10.1016/j.jtct.2020.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/10/2020] [Accepted: 12/27/2020] [Indexed: 12/24/2022]
Abstract
Autologous hematopoietic stem cell transplantation (ASCT) is a standard-of-care treatment for many hematologic malignancies. Progression of disease after ASCT is the primary cause of treatment failure. In this Phase Ib trial, we studied the safety and clinical effect of combined checkpoint inhibition therapy (CPIT) with ipilimumab and nivolumab as a consolidation strategy after ASCT for patients with high-risk diffuse large B cell lymphoma (DLBCL), mature T cell lymphoma (TCL), and multiple myeloma (MM). Starting at 14 to 28 days after ASCT, patients received ipilimumab (1 mg/kg i.v. on day 1 of weeks 1, 4, 7, 10, 16, and 22) and nivolumab (3 mg/kg i.v. on day 1 of weeks 1, 4, 7, 10, 12, 14, 16, 18, 20, 22, 24, and 26). Patients received a median of 5 doses of ipilimumab and 8 doses of nivolumab. Thirty-five patients were included in the intent-to-treat population. Ninety-four percent of the patients experienced immune-related adverse events (irAEs) of any grade. Ninety-seven percent of irAEs resolved spontaneously or after holding study drugs and instituting high-dose corticosteroid therapy. Progression-free and overall survival at 18 months post-ASCT for each disease cohort were 85.7% and 100% for primary refractory DLBCL, 28.6% and 57.1% for relapsed DLBCL, not evaluable and 80% for frontline TCL, 25% and 75% for relapsed TCL, 57.1% and 87% for high-risk transplant-naïve MM, and 40% and 100% for MM relapsed within 3 years of first ASCT. We conclude that combined CPIT appears to be tolerable as a consolidation strategy after ASCT and in addition to the potential clinical efficacy observed in some subsets of disease, T cell receptor repertoire, T regulatory cell phenotype, and gut microbiota profiles provide a biologic rationale warranting further study of this approach.
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Batorov EV, Aristova TA, Sergeevicheva VV, Sizikova SA, Ushakova GY, Pronkina NV, Shishkova IV, Shevela EY, Ostanin AA, Chernykh ER. Quantitative and functional characteristics of circulating and bone marrow PD-1- and TIM-3-positive T cells in treated multiple myeloma patients. Sci Rep 2020; 10:20846. [PMID: 33257767 PMCID: PMC7704628 DOI: 10.1038/s41598-020-77941-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/17/2020] [Indexed: 12/17/2022] Open
Abstract
The aim of the present work was to evaluate counts and functional properties of PD-1+ and TIM-3+ T cells in peripheral blood (PB) and bone marrow (BM) of multiple myeloma (MM) patients following the induction therapy. Sixty patients were enrolled in the study, CD4+ and CD8+ T cells expressing PD-1 and TIM-3, intracellular production of IFNγ and intracellular expression of Granzyme B were assessed. Relative counts of the majority of circulating PD-1+, TIM-3+ and PD-1+TIM-3+ T cells were higher in MM patients with disease progression compared with individuals in remission. Frequencies of almost all evaluated PD-1+ and TIM-3+ T cell subsets were higher in BM samples compared with PB; circulating CD4+PD-1+, CD8+PD-1+, CD8+TIM-3+, CD8+PD-1+TIM-3+ T cells positively correlated with the same BM subsets. Circulating CD4+ T cells, expressing PD-1 and TIM-3 (including co-expressing subset), as well as CD8+PD-1+TIM-3+ T cells, and BM CD8+PD-1+ T cells correlated with serum B2-M levels. Sufficient frequencies of GrB+ and IFNγ+ subsets in PD-1-expressing T cells indicated their retained functional properties. TIM-3-expressing T cells and double positive PD-1+TIM-3+ populations showed diminished cytotoxic and cytokine-producing ability and therefore might be attributed to the exhausted compartment. To identify T cell exhaustion, it is necessary to evaluate T cells co-expressing PD-1, TIM-3 and other inhibitory signal molecules and to study their functional properties. Sustained functionality of PD-1-positive T cells may explain low efficacy and frequent immune-mediated adverse events during anti-PD-1 therapy in MM.
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Affiliation(s)
- Egor V Batorov
- Laboratory of Cellular Immunotherapy, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation.
| | - Tatiana A Aristova
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Vera V Sergeevicheva
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Svetlana A Sizikova
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Galina Y Ushakova
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Natalia V Pronkina
- Laboratory of Clinical Immunology, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Irina V Shishkova
- Laboratory of Clinical Immunology, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Ekaterina Y Shevela
- Laboratory of Cellular Immunotherapy, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Alexander A Ostanin
- Laboratory of Cellular Immunotherapy, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Elena R Chernykh
- Laboratory of Cellular Immunotherapy, Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
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Batorov EV, Pronkina NV, Tikhonova MA, Kryuchkova IV, Sergeevicheva VV, Sizikova SA, Ushakova GY, Aristova TA, Batorova DS, Shishkova IV, Gilevich AV, Shevela EY, Ostanin AA, Chernykh ER. Increased circulating CD3 + T cells are associated with early relapse following autologous hematopoietic stem cell transplantation in patients with classical Hodgkin lymphoma. Leuk Lymphoma 2019; 60:2488-2497. [PMID: 31609150 DOI: 10.1080/10428194.2019.1581934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Non-malignant host immune cells are the main substrate in classical Hodgkin lymphoma (HL) microenvironment. Reconstitution of lymphocyte populations following the high-dose chemotherapy (HDC) with autologous hematopoietic stem cell transplantation (auto-HSCT) can support tumor growth in HL patients. We investigated recovery dynamics of circulating CD3+, CD4+, CD8+, CD16+/CD56+, CD19+, CD4+FOXP3+ lymphocytes following auto-HSCT in 79 HL patients and assessed relationship between these populations and the development of early relapse. Studied populations were not statistically significant between patients with high or standard/intermediate risk of relapse. CD3+ T cells at the time of engraftment were increased in patients with the early relapse of HL compared to non-relapsed patients (PU = 0.0028). Area under the curve was 0.76 (р = .0037). In logistic regression models, CD3+ T cell count was associated with early relapse/progression as a trend. These findings elucidate several interactions between early systemic T cell recovery and tumor progression following HDC with auto-HSCT.
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Affiliation(s)
- Egor V Batorov
- Laboratory of Cellular Immunotherapy, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Natalia V Pronkina
- Laboratory of Clinical Immunology, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Marina A Tikhonova
- Laboratory of Cellular Immunotherapy, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Irina V Kryuchkova
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Vera V Sergeevicheva
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Svetlana A Sizikova
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Galina Y Ushakova
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Tatiana A Aristova
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Dariya S Batorova
- Department of Hematology and Bone Marrow Transplantation, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Irina V Shishkova
- Laboratory of Clinical Immunology, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Andrey V Gilevich
- Intensive Care Unit, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Ekaterina Y Shevela
- Laboratory of Cellular Immunotherapy, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Alexander A Ostanin
- Laboratory of Cellular Immunotherapy, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Elena R Chernykh
- Laboratory of Cellular Immunotherapy, Research Institute of Fundamental and Clinical Immunology , Novosibirsk , Russia
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