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Lindemans CA, Te Boome LCJ, Admiraal R, Jol-van der Zijde EC, Wensing AM, Versluijs AB, Bierings MB, Kuball J, Boelens JJ. Sufficient Immunosuppression with Thymoglobulin Is Essential for a Successful Haplo-Myeloid Bridge in Haploidentical-Cord Blood Transplantation. Biol Blood Marrow Transplant 2015; 21:1839-45. [PMID: 26119367 DOI: 10.1016/j.bbmt.2015.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/04/2015] [Indexed: 12/25/2022]
Abstract
In haploidentical (haplo)-cord blood (CB) transplantations, early haplo donor engraftment serves as a myeloid bridge to sustainable CB engraftment and is associated with early neutrophil recovery. The conditioning regimens as published for haplo-cord protocols usually contain serotherapy, such as rabbit antithymocyte globulin (ATG) (Thymoglobulin, Genzyme, Cambridge, MA). However, reducing or omitting serotherapy is an important strategy to improve early immune reconstitution after transplantation. The need for serotherapy in successful haplo-cord transplantation, defined as having a haplo-derived myeloid bridge to CB engraftment, has not been investigated before. Two consecutive cohorts of patients underwent transplantation with haplo-CB. The first group underwent transplantation with haplo-CB for active infection and/or an underlying condition with expected difficult engraftment without a conventional donor available. They received a single unit (s) CB and haplo donor cells (CD34(+) selected, 5 × 10(6) CD34(+)/kg). The second cohort included patients with poor-risk malignancies, not eligible for other treatment protocols. They received a sCB and haplo donor cells (CD19/αβTCR-depleted; 5 × 10(6) CD34(+)/kg). Retrospectively in both cohorts, active ATG (Thymoglobulin) levels were measured and post-hematopoietic cell transplantation area under the curve (AUC) was calculated. The influence of ATG exposure for having a successful haplo-myeloid bridge (early haplo donor engraftment before CB engraftment and no secondary neutropenia) and transplantation-related mortality (TRM) were analyzed as primary endpoints. Twenty patients were included (16 in the first cohort and 4 in the second cohort). In 58% of evaluable patients, there was no successful haplo-derived myeloid bridge to CB engraftment, for which a low post-transplantation ATG exposure appeared to be a predictor (P <.001). TRM in the unsuccessful haplo-bridge group was 70% ± 16% versus 12% ± 12% in the successful haplo-bridge group (P = .012). In conclusion, sufficient in vivo T depletion with ATG is required for a successful haplo-myeloid bridge to CB engraftment.
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Affiliation(s)
- Caroline A Lindemans
- Pediatric Blood and Bone Marrow Program, University Medical Center Utrecht, The Netherlands.
| | - Liane C J Te Boome
- Department of Hematology, University Medical Center Utrecht, The Netherlands; Tumorimmunology, Lab Translational Immunology, University Medical Center Utrecht, The Netherlands
| | - Rick Admiraal
- Pediatric Blood and Bone Marrow Program, University Medical Center Utrecht, The Netherlands; Tumorimmunology, Lab Translational Immunology, University Medical Center Utrecht, The Netherlands; Department of Pediatrics, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Department of Pharmacology, Leiden Academic center for Drug Research, University of Leiden, The Netherlands
| | | | - Anne M Wensing
- Virology, Deptartment of Medical Microbiology, University Medical Center Utrecht, The Netherlands
| | - A Birgitta Versluijs
- Pediatric Blood and Bone Marrow Program, University Medical Center Utrecht, The Netherlands
| | - Marc B Bierings
- Pediatric Blood and Bone Marrow Program, University Medical Center Utrecht, The Netherlands
| | - Jürgen Kuball
- Department of Hematology, University Medical Center Utrecht, The Netherlands; Tumorimmunology, Lab Translational Immunology, University Medical Center Utrecht, The Netherlands
| | - Jaap J Boelens
- Pediatric Blood and Bone Marrow Program, University Medical Center Utrecht, The Netherlands; Tumorimmunology, Lab Translational Immunology, University Medical Center Utrecht, The Netherlands
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Kuzmina Z, Gounden V, Curtis L, Avila D, RNP TT, Baruffaldi J, Cowen EW, Naik HB, Hasni SA, Mays JW, Mitchell S, Baird K, Steinberg SM, Pavletic SZ. Clinical significance of autoantibodies in a large cohort of patients with chronic graft-versus-host disease defined by NIH criteria. Am J Hematol 2015; 90:114-9. [PMID: 25363867 DOI: 10.1002/ajh.23885] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/22/2014] [Accepted: 10/27/2014] [Indexed: 12/26/2022]
Abstract
There is an unmet need for identifying new clinical biomarkers in chronic Graft-versus-Host-disease (cGVHD) suitable for diagnosis and disease monitoring. Circulating autoantibodies represent an ongoing immune response and suggest a pathogenic role for B cells in cGVHD. Autoantibodies could be useful markers of cGVHD disease activity, severity, or organ specificity; however, their clinical utility is not established. The focus of this study was to determine the incidence and associations of a broad array of clinical autoantibodies with cGVHD manifestations in a large patient cohort characterized by NIH criteria. A panel of 21 circulating antibodies commonly used in clinical medicine was tested in 280 cGVHD patients (70% severe) enrolled in a cross-sectional prospective natural history study. Median cGVHD duration was two years. Patients with circulating autoantibodies (62%) had significantly higher levels of IgM (P < 0.0001), IgG (P < 0.0001), and IgA (P = 0.001), elevated uric acid (P = 0.008) and total protein (P = 0.0004), and higher numbers of CD3+ (P = 0.002), CD4+ (P = 0.001), CD8+ (P = 0.023) T cells, and CD19+ B cells (P < 0.0001). Multiple antibodies were detected in 35% of patients. Prior rituximab therapy (n = 66) was associated with reduced presence of autoantibodies (48 vs. 66% P = 0.01). Only oral cGVHD was significantly associated with presence of autoantibodies in this study (P = 0.028). No significant associations were found between cGVHD activity and severity, and presence of autoantibodies. Circulating autoantibodies are common in patients with advanced cGVHD. Their presence is associated with better quantitative immunologic reconstitution but does not have utility as a clinical biomarker of cGVHD.
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Affiliation(s)
- Zoya Kuzmina
- Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute NCI, National Institutes of Health; Bethesda Maryland
- Internal Medicine Department; Evangelical Hospital; Vienna Austria
| | - Verena Gounden
- Department of Laboratory Medicine; Clinical Center, National Cancer Institute NCI, National Institutes of Health
| | - Lauren Curtis
- Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute NCI, National Institutes of Health; Bethesda Maryland
| | - Daniele Avila
- Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute NCI, National Institutes of Health; Bethesda Maryland
| | - Tiffani Taylor RNP
- Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute NCI, National Institutes of Health; Bethesda Maryland
| | - Judy Baruffaldi
- Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute NCI, National Institutes of Health; Bethesda Maryland
| | - Edward W. Cowen
- Dermatology Branch, National Cancer Institute NCI, National Institutes of Health
| | - Haley B. Naik
- Dermatology Branch, National Cancer Institute NCI, National Institutes of Health
| | - Sarfaraz A. Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Cancer Institute NCI, National Institutes of Health
| | | | - Sandra Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences NIH
| | - Kristin Baird
- Pediatric Oncology Branch, National Cancer Institute NCI, National Institutes of Health
| | - Seth M. Steinberg
- Biostatistics and Data Management Section NIH, Center for Cancer Research
| | - Steven Z. Pavletic
- Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute NCI, National Institutes of Health; Bethesda Maryland
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Peng Y, Chen X, Liu Q, Xu D, Zheng H, Liu L, Liu Q, Liu M, Fan Z, Sun J, Li X, Zou R, Xiang AP. Alteration of naïve and memory B-cell subset in chronic graft-versus-host disease patients after treatment with mesenchymal stromal cells. Stem Cells Transl Med 2014; 3:1023-31. [PMID: 25015640 DOI: 10.5966/sctm.2014-0001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although mesenchymal stromal cells (MSCs) possess immunomodulatory properties and exhibit promising efficacy against chronic graft-versus-host disease (cGVHD), little is known about the immune changes by which MSCs ameliorate cGVHD in vivo. Recent studies have suggested that B lymphocytes might play an important role in the pathogenesis of cGVHD. In this study, we investigated changes in the numbers, phenotypes, and subpopulations of B lymphocytes in cGVHD patients who showed a complete response (CR), partial response (PR), or no response (NR) after MSC treatment. We found that the frequencies and numbers of CD27+ memory and pre-germinal center B lymphocytes were significantly increased in the CR and PR cGVHD patients after MSC treatment but decreased in the NR patients. A further analysis of CR/PR cGVHD patients showed that MSC treatment led to a decrease in the plasma levels of B cell-activating factor (BAFF) and increased expression of the BAFF receptor (BAFF-R) on peripheral B lymphocytes but no changes in plasma BAFF levels or BAFF-R expression on B lymphocytes in NR patients. Overall, our findings imply that MSCs might exert therapeutic effects in cGVHD patients, accompanied by alteration of naïve and memory B-cell subsets, modulating plasma BAFF levels and BAFF-R expression on B lymphocytes.
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Affiliation(s)
- Yanwen Peng
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoyong Chen
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qifa Liu
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Dijing Xu
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Haiqing Zheng
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Longshan Liu
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qiuli Liu
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Muyun Liu
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhiping Fan
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jing Sun
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaobo Li
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ruifeng Zou
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Andy Peng Xiang
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Medical Science Experimentation Center, and Department of Biochemistry, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China; Department of Rehabilitation Medicine Science and Cell-Gene Therapy Translational Medicine Research Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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