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Pestana I, Pedro J, Simões C, Ferreira CN, da Mata S, Claro I. Transjugular Liver Biopsy: The Key to a Rare Etiology of Cholestatic Hepatitis after Bone Marrow Transplantation. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:437-442. [PMID: 39633904 PMCID: PMC11614426 DOI: 10.1159/000536535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/30/2023] [Indexed: 12/07/2024]
Abstract
Introduction Hematopoietic stem cell transplantation (HSCT) is associated with multiple complications, such as sinusoidal obstruction syndrome (SOS) (hepatomegaly, ascites, jaundice, and thrombocytopenia) and graft-versus-host disease (GVHD) (with the skin, gastrointestinal tract, and liver being the main targets). These entities may present overlapping clinical findings, being considered differential diagnoses, but their coexistence is rare. Case Presentation A 29-year-old male with acute myeloid leukemia underwent HSCT. On day (D)+20, he developed hyperbilirubinemia, pleural effusion, ascites, and painful hepatomegaly. Abdominal ultrasound was suggestive of SOS, and defibrotide was initiated. On D+44, acute cutaneous, intestinal, and hepatic GVHD developed which improved after treatment with methylprednisolone. On D+132, there was worsening cholestasis and abdominal pain. MRCP revealed strictures in several segments of the intrahepatic bile ducts and irregularity of the main bile duct. Due to aggravation of liver enzyme changes and clinical worsening, he was admitted to the Intensive Care Unit. Due to persistence of severe hyperbilirubinemia (30 mg/dL) and thrombocytopenia (30,000 cell/uL), he underwent a hepatic hemodynamic study which revealed a hepatic venous pressure gradient of 10 mm Hg. The transjugular liver biopsy revealed canalicular hepatic cholestasis, bile duct injury, and focal hepatocellular necrosis suggestive of GVHD as well as injury to centrilobular veins and centrilobular necrosis compatible with possible SOS. Mycophenolate mofetil was started, but on D+195, the patient died of septic shock. Discussion/Conclusion This case is notable for its complexity and for demonstrating the rare coexistence of histological features of SOS and GVHD. Although the clinical and laboratory findings may be sufficient for the diagnosis, it is important to highlight the importance of liver hemodynamic study and transjugular liver biopsy in these patients who often have severe thrombocytopenia, for the characterization and histological confirmation of cholestatic hepatitis, especially when the etiology may be multifactorial.
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Affiliation(s)
- Inês Pestana
- Serviço de Gastrenterologia, Hospital Amato Lusitano ULSCB, Castelo Branco, Portugal
| | - Juliana Pedro
- Serviço de Gastrenterologia e Hepatologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Carolina Simões
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Carlos Noronha Ferreira
- Serviço de Gastrenterologia e Hepatologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- Clínica Universitária de Gastrenterologia, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Sara da Mata
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Isabel Claro
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Braidotti S, Curci D, Zanon D, Maestro A, Longo A, De Vita N, Maximova N. Impact of Body Mass Index on Outcomes in Pediatric Allogeneic Hematopoietic Stem Cell Transplantation Recipients: A Single-Center Retrospective Study. Nutrients 2024; 16:3638. [PMID: 39519471 PMCID: PMC11547439 DOI: 10.3390/nu16213638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 10/21/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) face several risk factors influencing transplantation success, including nutritional status as measured by body mass index (BMI). METHODS This study analyzed BMI data collected from patients transplanted between 2003 and 2023, and aimed to evaluate whether deviations from normal BMI are associated with poorer clinical outcomes. BMI levels assessed before and after first-line treatment and pre-transplantation were analyzed retrospectively to determine a correlation with survival and post-transplant complications. RESULTS Underweight patients had significantly lower 12- and 36-month overall survival rates compared to normal-weight and overweight patients (p = 1.22 × 10-8 and p = 8.88 × 10-8, respectively). Event-free survival was also lower for underweight patients at all time points. A higher pre-transplant BMI increases the risk of acute graft-versus-host disease (GVHD, p = 0.00068). Otherwise, pre-transplant BMI was not significantly correlated with early TRCs and cGVHD. As secondary objectives, this study identified differences in BMI across primary disease groups, with solid tumor patients having the highest BMI and myelodysplastic syndrome patients having the lowest. BMI cut-offs were identified to predict or protect against serious outcomes, including delayed engraftment, TRCs, and acute and chronic GVHD. CONCLUSIONS This study highlights the importance of nutritional assessment and management in pediatric patients undergoing allo-HSCT to optimize post-transplant outcomes, as deviations from a normal BMI can significantly impact post-transplant health. These findings underscore the importance of integrating BMI assessment throughout the entire pre-HSCT therapeutic course to identify patients at higher risk for complications and to define more effective nutritional management strategies.
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Affiliation(s)
- Stefania Braidotti
- Department of Pediatrics, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (S.B.); (A.L.); (N.D.V.)
| | - Debora Curci
- Advanced Translational Diagnostic Laboratory, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology Department, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (D.Z.); (A.M.)
| | - Alessandra Maestro
- Pharmacy and Clinical Pharmacology Department, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (D.Z.); (A.M.)
| | - Antonella Longo
- Department of Pediatrics, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (S.B.); (A.L.); (N.D.V.)
| | - Nicole De Vita
- Department of Pediatrics, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (S.B.); (A.L.); (N.D.V.)
| | - Natalia Maximova
- Department of Pediatrics, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (S.B.); (A.L.); (N.D.V.)
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Gavriilaki E, Demosthenous C, Evangelidis P, Bousiou Z, Batsis I, Vardi A, Mallouri D, Koravou EE, Spyridis N, Panteliadou A, Karavalakis G, Masmanidou M, Touloumenidou T, Papalexandri A, Poziopoulos C, Yannaki E, Sakellari I, Politou M, Papassotiriou I. Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR), Growth Differentiation Factor-15 (GDF-15), and Soluble C5b-9 (sC5b-9) Levels Are Significantly Associated with Endothelial Injury Indices in CAR-T Cell Recipients. Int J Mol Sci 2024; 25:11028. [PMID: 39456810 PMCID: PMC11507105 DOI: 10.3390/ijms252011028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 10/09/2024] [Accepted: 10/13/2024] [Indexed: 10/28/2024] Open
Abstract
Endothelial injury indices, such as Endothelial Activation and Stress Index (EASIX), modified EASIX (m-EASIX), and simplified EASIX (s-EASIX) scores, have been previously associated with chimeric antigen receptor-T (CAR-T) cell immunotherapy complications. Soluble urokinase-type plasminogen activator receptor (suPAR), growth differentiation factor-15 (GDF-15), and soluble C5b-9 (sC5b-9) have been described as markers of endothelial injury post-hematopoietic stem cell transplantation. In the current study, we examined whether suPAR, GDF-15, and sC5b-9 levels were associated with endothelial injury indices in adult CAR-T cell recipients. The levels of these markers were measured in patients before CAR-T cell infusion and in healthy individuals with immunoenzymatic methods. We studied 45 CAR-T cell recipients and 20 healthy individuals as the control group. SuPAR, GDF-15, and sC5b-9 levels were significantly higher in the patients' group compared to the healthy control group (p < 0.001, in all comparisons). SuPAR levels at baseline were associated with the m-EASIX scores calculated at the same time point (p = 0.020), while suPAR and GDF-15 concentrations were correlated with EASIX scores at day 14 post-infusion (p < 0.001 in both comparisons). Moreover, sC5b-9 levels were correlated with the s-EASIX scores at infusion (p = 0.008) and the EASIX scores at day 14 (p = 0.005). In our study, sC5b9, suPAR, and GDF-15 levels were found to reflect endothelial injury in CAR-T cell recipients.
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Affiliation(s)
- Eleni Gavriilaki
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Christos Demosthenous
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Paschalis Evangelidis
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Zoi Bousiou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Ioannis Batsis
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Anna Vardi
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Despina Mallouri
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Eudoxia-Evaggelia Koravou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Nikolaos Spyridis
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Alkistis Panteliadou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Georgios Karavalakis
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Marianna Masmanidou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Tasoula Touloumenidou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Apostolia Papalexandri
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | | | - Evangelia Yannaki
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Ioanna Sakellari
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (C.D.); (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (N.S.); (A.P.); (G.K.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Marianna Politou
- Thrombosis–Bleeding–Transfusion Medicine Postgraduate Studies, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
- Hematology Laboratory-Blood Bank, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ioannis Papassotiriou
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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Larue M, Labopin M, Brissot E, Alaskar AS, Aljurf M, Arat M, Baron F, Bazarbachi A, Ciceri F, Corbacioglu S, Dignan FL, Kenyon M, Malard F, Nagler A, Pagliuca A, Ruggeri A, Yakoub-Agha I, Ye Y, Duarte RF, Ruutu T, Carreras E, Peric Z, Mohty M. An international survey to better understand the current incidence, severity, and management of VOD/SOS. Bone Marrow Transplant 2024:10.1038/s41409-024-02434-9. [PMID: 39375526 DOI: 10.1038/s41409-024-02434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/13/2024] [Accepted: 10/02/2024] [Indexed: 10/09/2024]
Abstract
This international questionnaire survey aimed to explore the current incidence, diagnostic policies, management, and outcomes of veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) among healthcare providers involved in the management of these patients. A questionnaire was e-mailed to practitioners with an interest in allogeneic hematopoietic cell transplantation (allo-HCT). Of the respondents, 144 of 215 (67.0%) felt that early detection or diagnosis of VOD/SOS was difficult. Regarding diagnostic criteria, 142 (66.1%) already declared using the 2023 EBMT refined criteria. Most respondents (163/215, 75.8%) found these recent refined EBMT criteria useful for diagnosis, and 193 (89.8%) found the severity criteria easy to use. The major risk factors identified for VOD/SOS were a second allo-HCT (41.4%), pre-existing liver disease (54.9%), and prior use of antibody-drug conjugates (49.8%). Preferences for starting VOD/SOS treatment varied, with 61 (28.4%) preferring initiating therapy at a mild stage, and 122 (56.7%) preferring the moderate stage. In summary, this survey provided valuable insight into the challenges and opportunities of the identification and management of VOD/SOS. By improving current knowledge and increasing collaboration among healthcare professionals, early detection, management, and clinical outcomes for patients with this potentially serious complication can also be improved.
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Affiliation(s)
- Marion Larue
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
| | - Myriam Labopin
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Eolia Brissot
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Ahmed S Alaskar
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center Riyadh, Riyadh, Saudi Arabia
| | - Mutlu Arat
- F Sisli Florence Nightingale Hospital, HSCT Unit, Istanbul, Turkey
| | | | - Ali Bazarbachi
- BMT program, department of internal medicine, American University of Beirut, Beirut, Lebanon
| | - Fabio Ciceri
- San Raffaele Scientific Institute, Hematology and Bone marrow Transplantation Unit, Milan, Italy
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Fiona L Dignan
- Department of clinical haematology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Kenyon
- Department of Haematology, King's College Hospital, London, UK
| | - Florent Malard
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical center, Tel-Hashomer, Israel
| | | | - Annalisa Ruggeri
- San Raffaele Scientific Institute, Hematology and Bone marrow Transplantation Unit, Milan, Italy
| | - Ibrahim Yakoub-Agha
- CHU de Lille, université de Lille, Infinite, Inserm U1286, 59000, Lille, France
| | - Yishan Ye
- Bone Marrow Transplantation Center, Zhejiang University School of Medicine, Hangzhou, China
| | - Rafael F Duarte
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Tapani Ruutu
- Clinical Research Institute and Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Enric Carreras
- Josep Carreras Foundation & Leukemia Research Institute, Barcelona, Spain
| | - Zinaida Peric
- Department of Hematology, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mohamad Mohty
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
- EBMT ALWP office, Hôpital Saint-Antoine, Paris, France
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5
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Gavriilaki E, Papchianou E, Karavalakis G, Batsis I, Panteliadou A, Lazaridou A, Mallouri D, Constantinou V, Karvouni P, Evangelidis P, Papakonstantinou A, Papalexandri A, Kaloyannidis P, Spyridis N, Bousiou Z, Vardi A, Yannaki E, Sotiropoulos D, Sakellari I. Safety and Efficacy of Extracorporeal Photopheresis for Acute and Chronic Graft-versus-Host Disease. Pharmaceuticals (Basel) 2024; 17:1279. [PMID: 39458920 PMCID: PMC11510389 DOI: 10.3390/ph17101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 09/25/2024] [Accepted: 09/25/2024] [Indexed: 10/28/2024] Open
Abstract
Background/Objectives: Despite novel biological agents, steroid-dependent or -refractory graft-versus-host disease (GvHD) remains a severe complication of allogeneic hematopoietic cell transplantation (allo-HCT). Extracorporeal photopheresis (ECP) is an alternative, non-immunosuppressive treatment for patients with acute (aGvHD) or chronic (cGvHD) GvHD. The aim of this study was to investigate the safety and efficacy of ECP in the treatment of acute and chronic GvHD; Methods: We prospectively studied 112 patients with cGvHD who received one or more previous lines of treatment and 28 patients with steroid-dependent or refractory grade II-IV aGvHD post-alloHSCT. Results: In terms of severe aGvHD, most of the patients (19/28) responded to ECP treatment, while the five-year overall survival (OS) was 34%. After adjustment for several confounder factors, the reduction in immunosuppression (p = 0.026) and number of ECP sessions (p < 0.001) were associated with improved OS. Regarding chronic GvHD, only 19 patients failed to respond to ECP treatment; though significantly lower rates of response were presented in patients with visceral involvement (p = 0.037) and earlier post-transplant GVHD diagnosis (p = 0.001). Over a follow-up period of 45.2 [interquartile range (IQR): 5.6-345.1] months, the 5-year cumulative incidence (CI) of cGvHD-related mortality was 21.2% and was significantly reduced in patients with ECP response (p < 0.001), while the 5-year OS was 65.3%. Conclusions: Our results confirm the safety and efficacy of ECP in patients with GvHD and provide sufficient data for further investigation and the best combination drugs needed such that GvHD will not be the major barrier of allo-HCT in the near future.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Eleni Papchianou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Giorgos Karavalakis
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Ioannis Batsis
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Alkistis Panteliadou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Andriana Lazaridou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Despina Mallouri
- Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.M.); (P.K.); (A.P.)
| | - Varnavas Constantinou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Paraskevi Karvouni
- Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.M.); (P.K.); (A.P.)
| | - Paschalis Evangelidis
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Anna Papakonstantinou
- Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.M.); (P.K.); (A.P.)
| | - Apostolia Papalexandri
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Panayotis Kaloyannidis
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Nikolaos Spyridis
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Zoi Bousiou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Anna Vardi
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Evangelia Yannaki
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Damianos Sotiropoulos
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
| | - Ioanna Sakellari
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (E.P.); (G.K.); (I.B.); (A.P.); (A.L.); (V.C.); (A.P.); (P.K.); (N.S.); (Z.B.); (A.V.); (E.Y.); (D.S.); (I.S.)
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6
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Harris AC, Ganjaei K, Vilela C, Geyer A. Late-Onset Noninfectious Pulmonary Complications after Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2024; 30:S585-S596. [PMID: 39370238 DOI: 10.1016/j.jtct.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 10/08/2024]
Affiliation(s)
- Andrew C Harris
- Pediatric Transplantation and Cellular Therapy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kimia Ganjaei
- Pulmonary Service. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Camila Vilela
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander Geyer
- Division of Pulmonary, Critical Care and Sleep Medicine, Lenox Hill Hospital, Northwell Health, New York, New York.
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Fageräng B, Cyranka L, Schjalm C, McAdam KE, Larsen CS, Heinzelbecker J, Gedde-Dahl T, Würzner R, Espevik T, Tjønnfjord GE, Garred P, Barratt-Due A, Tvedt THA, Mollnes TE. The function of the complement system remains fully intact throughout the course of allogeneic stem cell transplantation. Front Immunol 2024; 15:1422370. [PMID: 38938578 PMCID: PMC11208304 DOI: 10.3389/fimmu.2024.1422370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction Hematopoietic stem cell transplantation (HSCT) is associated with immune complications and endothelial dysfunction due to intricate donor-recipient interactions, conditioning regimens, and inflammatory responses. Methods This study investigated the role of the complement system during HSCT and its interaction with the cytokine network. Seventeen acute myeloid leukemia patients undergoing HSCT were monitored, including blood sampling from the start of the conditioning regimen until four weeks post-transplant. Clinical follow-up was 200 days. Results Total complement functional activity was measured by WIELISA and the degree of complement activation by ELISA measurement of sC5b-9. Cytokine release was measured using a 27-multiplex immuno-assay. At all time-points during HSCT complement functional activity remained comparable to healthy controls. Complement activation was continuously stable except for two patients demonstrating increased activation, consistent with severe endotheliopathy and infections. In vitro experiments with post-HSCT whole blood challenged with Escherichia coli, revealed a hyperinflammatory cytokine response with increased TNF, IL-1β, IL-6 and IL-8 formation. Complement C3 inhibition markedly reduced the cytokine response induced by Staphylococcus aureus, Aspergillus fumigatus, and cholesterol crystals. Discussion In conclusion, HSCT patients generally retained a fully functional complement system, whereas activation occurred in patients with severe complications. The complement-cytokine interaction indicates the potential for new complement-targeting therapeutic strategies in HSCT.
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Affiliation(s)
- Beatrice Fageräng
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Clinical Immunology, Laboratory of Molecular Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Leon Cyranka
- Department of Clinical Immunology, Laboratory of Molecular Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Camilla Schjalm
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Karin Ekholt McAdam
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - Julia Heinzelbecker
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Tobias Gedde-Dahl
- Department of Hematology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Reinhard Würzner
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Terje Espevik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Erland Tjønnfjord
- Department of Hematology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Garred
- Department of Clinical Immunology, Laboratory of Molecular Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas Barratt-Due
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | - Tom Eirik Mollnes
- Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Research Laboratory, Nordland Hospital, Bodø, Norway
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8
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Farina M, Scaini MC, Facchinetti A, Leoni A, Bernardi S, Catoni C, Morello E, Radici V, Frioni F, Campodonico E, Traverso G, Cavallaro G, Olivieri A, Galieni P, Renzo ND, Patriarca F, Carluccio P, Skert C, Maffini E, Pellizzeri S, Campisi G, Re F, Benedetti E, Rosato A, Almici C, Chiusolo P, Peccatori J, Malagola M, Poggiana C, Russo D. Evaluation of Circulating Endothelial Cells as Direct Marker of Endothelial Damage in Allo-Transplant Recipients at High Risk of Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome. Transplant Cell Ther 2024; 30:580.e1-580.e14. [PMID: 38582286 DOI: 10.1016/j.jtct.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
Sinusoidal obstruction syndrome (SOS), also known as veno-occlusive disease (VOD), is a rare but potentially fatal complication following allogenic hematopoietic cell transplantation (allo-HCT). Timely identification of SOS/VOD to allow for prompt treatment is critical, but identifying a VOD-predictive biomarker remains challenging. Given the pivotal role of endothelial dysfunction in SOS/VOD pathophysiology, the CECinVOD study prospectively evaluated levels of circulating endothelial cells (CECs) in patients undergoing allo-HCT with a myeloablative conditioning (MAC) regimen to investigate the potential of CEC level in predicting and diagnosing SOS/VOD. A total of 150 patients from 11 Italian bone marrow transplantation units were enrolled. All participants were age >18 years and received a MAC regimen, putting them at elevated risk of developing SOS/VOD. Overall, 6 cases of SOS/VOD (4%) were recorded. CECs were detected using the Food and Drug Administration-approved CellSearch system, an immunomagnetic selection-based platform incorporating ferrofluid nanoparticles and fluorescent-labeled antibodies, and were defined as CD146+, CD105+, DAPI+, or CD45-. Blood samples were collected at the following time points: before (T0) and at the end of conditioning treatment (T1), at neutrophil engraftment (T2), and at 7 to 10 days postengraftment (T3). For patients who developed VOD, additional samples were collected at any suspected or proven VOD onset (T4) and weekly during defibrotide treatment (T5 to T8). A baseline CEC count >17/mL was associated with an elevated risk of SOS/VOD (P = .04), along with bilirubin level >1.5 mg/mL and a haploidentical donor hematopoietic stem cell source. Postconditioning regimen (T1) CEC levels were elevated (P = .02), and levels were further increased at engraftment (P < .0001). Additionally, patients developing SOS/VOD after engraftment, especially those with late-onset SOS/VOD, showed a markedly higher relative increase (>150%) in CEC count. Multivariate analysis supported these findings, along with a high Endothelial Activation and Stress Index (EASIX) score at engraftment (T2). Finally, CEC kinetics corresponded with defibrotide treatment. After the start of therapy (T4), CEC levels showed an initial increase in the first week (T5), followed by a progressive decrease during VOD treatment (T6 and T7) and a return to pre-SOS/VOD onset levels at resolution of the complication. This prospective multicenter study reveals a low incidence of SOS/VOD in high-risk patients compared to historical data, in line with recent reports. The results from the CECinVOD study collectively confirm the endothelial injury in allo-HCT and its role in in the development of SOS/VOD, suggesting that CEC level can be a valuable biomarker for diagnosing SOS/VOD and identifying patients at greater risk of this complication, especially late-onset SOS/VOD. Furthermore, CEC kinetics may support treatment strategies by providing insight into the optimal timing for discontinuing defibrotide treatment.
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Affiliation(s)
- Mirko Farina
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.
| | - Maria Chiara Scaini
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Antonella Facchinetti
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35128 Padua, Italy
| | - Alessandro Leoni
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Simona Bernardi
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Catoni
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy.
| | - Enrico Morello
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Vera Radici
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Filippo Frioni
- Hematology Section, Department of Radiologic and Hematologic Sciences, Università Cattolica del Sacro Cuore, Rome; Department of Diagnostic Imaging, Radiotherapy, Oncology, and Hematology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Edoardo Campodonico
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ginevra Traverso
- Hematology Unit, Azienda Ospedaliero Universitana Pisana, Pisa, Italy
| | - Gianluca Cavallaro
- Hematology and Bone Marrow Transplantation Unit, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Attilio Olivieri
- Clinica di Ematologia e Clinica Medica, Università Politecnica delle Marche, Ancona, Italy
| | - Piero Galieni
- UOC Ematologia e Terapia cellulare, Ospedale C. e G. Mazzoni, Ascoli Piceno, Italy
| | | | - Francesca Patriarca
- Hematology and Bone Marrow Transplantation Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Paola Carluccio
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
| | - Cristina Skert
- Unit of Haematology and Bone Marrow Transplantation, "Ospedale Dell'Angelo", Venezia Mestre, Italy
| | - Enrico Maffini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna; Istituto "L. e A. Seràgnoli", Bologna, Italy
| | - Simone Pellizzeri
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giovanni Campisi
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Federica Re
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Edoardo Benedetti
- Hematology Unit, Azienda Ospedaliero Universitana Pisana, Pisa, Italy
| | - Antonio Rosato
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35128 Padua, Italy
| | - Camillo Almici
- Laboratory for Stem Cells Manipulation and Cryopreservation, Department of Transfusion Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Chiusolo
- Hematology Section, Department of Radiologic and Hematologic Sciences, Università Cattolica del Sacro Cuore, Rome; Department of Diagnostic Imaging, Radiotherapy, Oncology, and Hematology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Jacopo Peccatori
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele Malagola
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Poggiana
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Domenico Russo
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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9
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Tazoe K, Harada N, Makuuchi Y, Kuno M, Takakuwa T, Okamura H, Hirose A, Nakamae M, Nishimoto M, Nakashima Y, Koh H, Hino M, Nakamae H. Systemic inflammatory autoimmune disease before allogeneic hematopoietic stem cell transplantation is a risk factor for death in patients with myelodysplastic syndrome or chronic myelomonocytic leukemia. Ann Hematol 2024; 103:2059-2072. [PMID: 38662207 DOI: 10.1007/s00277-024-05772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/20/2024] [Indexed: 04/26/2024]
Abstract
Myelodysplastic syndrome (MDS) is well known to be complicated by systemic inflammatory autoimmune disease (SIADs). However, it remains unclear how the prognosis after allogenic hematopoietic stem cell transplantation (allo-HSCT) in patients with MDS is impacted by SIADs that occur before allo-HSCT. Therefore, we hypothesized that SIADs before allo-HSCT may be a risk factor for negative outcomes after allo-HSCT in patients with MDS. We conducted a single-center, retrospective, observational study of sixty-nine patients with MDS or chronic myelomonocytic leukemia who underwent their first allo-HCT. Fourteen of the patients had SIADs before allo-HSCT. In multivariate analysis, the presence of SIADs before allo-HSCT was an independent risk factor for overall survival (HR, 3.36, 95% confidence interval: 1.34-8.42, p = 0.009). Endothelial dysfunction syndrome was identified in five of 14 patients with SIADs who required immunosuppressive therapy or intensive chemotherapy, and notably, all patients with uncontrollable SIADs at allo-HSCT developed serious endothelial dysfunction syndrome and died in the early phase after allo-HSCT. The development of SIADs in the context of MDS is thought to reflect the degree of dysfunction of hematopoietic cells in MDS and suggests a higher risk of disease progression. In addition, MDS patients with SIADs before allo-HSCT are considered to be at higher risk of endothelial dysfunction syndrome because of preexisting vascular endothelial dysfunction due to SIADs. In conclusion, SIADs before allo-HSCT constitute an independent risk factor for death in MDS patients undergoing allo-HSCT.
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Affiliation(s)
- Kumiyo Tazoe
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Hematology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Naonori Harada
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
- Department of Hematology, Fuchu Hospital, Osaka, Japan.
| | - Yosuke Makuuchi
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masatomo Kuno
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Teruhito Takakuwa
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Okamura
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Asao Hirose
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Mika Nakamae
- Department of Clinical Laboratory, Osaka Metropolitan University Hospital, Osaka, Japan
- Department of Laboratory Medicine and Medical Informatics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Mitsutaka Nishimoto
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Nakashima
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hideo Koh
- Department of Preventive Medicine and Environmental Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Hino
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hirohisa Nakamae
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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10
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Gavriilaki E, Bousiou Z, Batsis I, Vardi A, Mallouri D, Koravou EE, Konstantinidou G, Spyridis N, Karavalakis G, Noli F, Patriarcheas V, Masmanidou M, Touloumenidou T, Papalexandri A, Poziopoulos C, Yannaki E, Sakellari I, Politou M, Papassotiriou I. Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) and Growth Differentiation Factor-15 (GDF-15) Levels Are Significantly Associated with Endothelial Injury Indices in Adult Allogeneic Hematopoietic Cell Transplantation Recipients. Int J Mol Sci 2023; 25:231. [PMID: 38203404 PMCID: PMC10778584 DOI: 10.3390/ijms25010231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (HSCT-TMA) and graft-versus-host disease (GvHD) represent life-threatening syndromes after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In both conditions, endothelial dysfunction is a common denominator, and development of relevant biomarkers is of high importance for both diagnosis and prognosis. Despite the fact that soluble urokinase plasminogen activator receptor (suPAR) and growth differentiation factor-15 (GDF-15) have been determined as endothelial injury indices in various clinical settings, their role in HSCT-related complications remains unexplored. In this context, we used immunoenzymatic methods to measure suPAR and GDF-15 levels in HSCT-TMA, acute and/or chronic GVHD, control HSCT recipients, and apparently healthy individuals of similar age and gender. We found considerably greater SuPAR and GDF-15 levels in HSCT-TMA and GVHD patients compared to allo-HSCT and healthy patients. Both GDF-15 and suPAR concentrations were linked to EASIX at day 100 and last follow-up. SuPAR was associated with creatinine and platelets at day 100 and last follow-up, while GDF-15 was associated only with platelets, suggesting that laboratory values do not drive EASIX. SuPAR, but not GDF-15, was related to soluble C5b-9 levels, a sign of increased HSCT-TMA risk. Our study shows for the first time that suPAR and GDF-15 indicate endothelial damage in allo-HSCT recipients. Rigorous validation of these biomarkers in many cohorts may provide utility for their usefulness in identifying and stratifying allo-HSCT recipients with endothelial cell impairment.
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Affiliation(s)
- Eleni Gavriilaki
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Zoi Bousiou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Ioannis Batsis
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Anna Vardi
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Despina Mallouri
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Evaggelia-Evdoxia Koravou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Georgia Konstantinidou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Nikolaos Spyridis
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Georgios Karavalakis
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Foteini Noli
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Vasileios Patriarcheas
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Marianna Masmanidou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Tasoula Touloumenidou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Apostolia Papalexandri
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Christos Poziopoulos
- Department of Hematology, Metropolitan Hospital, Neo Faliro, 18547 Athens, Greece;
| | - Evangelia Yannaki
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Ioanna Sakellari
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Marianna Politou
- Hematology Laboratory-Blood Bank, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Ioannis Papassotiriou
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
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11
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Vythoulkas D, Lazana I, Kroupis C, Gavriilaki E, Konstantellos I, Bousiou Z, Chondropoulos S, Griniezaki M, Vardi A, Gkirkas K, Karagiannidou A, Batsis I, Stamouli M, Sakellari I, Tsirigotis P. Endothelial Injury Syndromes after Allogeneic Hematopoietic Stem Cell Transplantation: Angiopetin-2 as a Novel Predictor of the Outcome and the Role of Functional Autoantibodies against Angiotensin II Type 1 and Endothelin A Receptor. Int J Mol Sci 2023; 24:ijms24086960. [PMID: 37108124 PMCID: PMC10138628 DOI: 10.3390/ijms24086960] [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: 02/27/2023] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Transplant-associated thrombotic microangiopathy (TMA) occurs in a significant percentage of patients after allogeneic stem cell transplantation (allo-SCT) and is associated with significant morbidity and mortality. The aim of the present study was to examine the association of serum angiopoetin-2 (Ang2) levels and the presence of antibodies against angiotensin II type 1 (AT1R) and ndothelin A Recreptor (ETAR) with the outcome of patients with TMA and/or graft-versus-host disease (GVHD) after allo-SCT. Analysis of our data showed that elevated serum Ang2 levels at the time of TMA diagnosis are significantly associated with increased non-relapse mortality and decreased overall survival. To our knowledge, this is the first study demonstrating an association between raised Ang2 levels and poor outcomes in patients with TMA. Antibodies against AT1R (AT1R-Abs) and ETAR (ETAR-Abs) were detected in 27% and 23% of the patients, respectively, but there was no association between the presence of autoantibodies and the outcome of patients with TMA. However, a significant finding was the strong positive correlation between the presence of AT1R-Abs with the occurrence of chronic fibrotic GVHD, such as scleroderma and cryptogenic organizing pneumonia, raising the possibility of the contribution of autoantibodies in the pathogenesis of fibrotic GVHD manifestations.
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Affiliation(s)
- Dionysios Vythoulkas
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioanna Lazana
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Christos Kroupis
- Clinical Biochemistry and Molecular Diagnostics, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Eleni Gavriilaki
- Hematology and Bone Marrow Transplantation Department, "G. Papanikolaou" General Hospital, 57010 Thessaloniki, Greece
| | - Ioannis Konstantellos
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Zoi Bousiou
- Hematology and Bone Marrow Transplantation Department, "G. Papanikolaou" General Hospital, 57010 Thessaloniki, Greece
| | - Spiros Chondropoulos
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Marianna Griniezaki
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anna Vardi
- Hematology and Bone Marrow Transplantation Department, "G. Papanikolaou" General Hospital, 57010 Thessaloniki, Greece
| | - Konstantinos Gkirkas
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Aggeliki Karagiannidou
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioannis Batsis
- Hematology and Bone Marrow Transplantation Department, "G. Papanikolaou" General Hospital, 57010 Thessaloniki, Greece
| | - Maria Stamouli
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioanna Sakellari
- Hematology and Bone Marrow Transplantation Department, "G. Papanikolaou" General Hospital, 57010 Thessaloniki, Greece
| | - Panagiotis Tsirigotis
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
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12
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Nomura S, Ichikawa J, Shimizu T, Ishiura Y, Okada M, Ishii K, Ito T. Association of High Mobility Group Box-Protein 1 and Platelet Microparticles in Patients After Hematopoietic Stem Cell Transplantation. Clin Appl Thromb Hemost 2023; 29:10760296231193398. [PMID: 37563884 PMCID: PMC10422918 DOI: 10.1177/10760296231193398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
Thrombotic complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT) significantly impact transplant outcomes. We focused on high mobility group box-protein (HMGB)1, one causative agent of thrombotic lesions in allo-HSCT, and investigated its association with platelets. We statistically analyzed available data from 172 patients with hematopoietic malignancies receiving allo-HSCT. A significant enhancement of monocyte-chemotactant protein-1, HMGB1, and platelet-derived microparticle (PDMP) levels was observed at day 0 after transplantation as compared to pre-transplantation. Multivariate analysis of the association among HMGB1 and 16 factors on day 0 revealed a significant correlation of HMGB1 levels with thrombin-antithrombin complex, interleukin-6, and PDMPs. High mobility group box-protein 1-induced procoagulant platelet induction and PDMP generation were performed in vitro using healthy platelets. High mobility group box-protein 1-induced PDMP generation was suppressed by toll-like receptor inhibitors and recombinant thrombomodulin. These results suggest that HMGB1 contributes to platelet activation in patients after allo-HSCT and is associated with PDMP-related thrombotic complications.
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Affiliation(s)
- Shosaku Nomura
- Center of Thrombosis and Hemostasis, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Jun Ichikawa
- First Department of Internal Medicine, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Toshiki Shimizu
- First Department of Internal Medicine, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Yoshihisa Ishiura
- First Department of Internal Medicine, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Masaya Okada
- First Department of Internal Medicine, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Kazuyoshi Ishii
- First Department of Internal Medicine, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
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