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Halahleh K, Mustafa R, Sarhan D, Al Rimawi D, Abdelkhaleq H, Muradi I, Sultan I. The Impact of Graft CD3 + T-Cell Dose on the Outcome of T-Cell Replete Human Leukocyte Antigen-Mismatched Allogeneic Hematopoietic Peripheral Blood Stem Cells Transplantation. J Hematol 2023; 12:27-36. [PMID: 36895292 PMCID: PMC9990716 DOI: 10.14740/jh1071] [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: 10/24/2022] [Accepted: 12/16/2022] [Indexed: 02/26/2023] Open
Abstract
Background Data on whether the graft CD3-positive (CD3+) T-cell dose in T-cell-replete human leukocyte antigen (HLA)-mismatched allogeneic hematopoietic peripheral blood stem cells transplantation (PBSCT) influences post-transplant outcomes are controversial. Methods Using King Hussein Cancer Center (KHCC) Blood and Marrow Transplantation (BMT) Registry database, 52 adult subjects, receiving the first T-cell-replete HLA-mismatched allogeneic hematopoietic PBSCT for acute leukemias or myelodysplastic syndrome, were identified, from January 2017 to December 2020. The cutoff value of graft CD3+ T-cell dose was identified using the receiver operating characteristic (ROC) formula and Youden's analysis. Subjects were divided into two cohorts: cohort 1 with low CD3+ T-cell dose (n = 34) and cohort 2 with high CD3+ T-cell dose (n = 18). Correlative analyses were performed between CD3+ T-cell dose and the risk of graft-versus-host disease (GvHD), relapse, relapse-free survival (RFS), and overall survival (OS). P-values were two-sided and considered significant when P < 0.05. Results Subject covariates were displayed. Subject's characteristics were comparable, except for higher nucleated cells and more female donors in the high CD3+ T-cell cohort. The 100-day cumulative incidence of acute GvHD (aGvHD) was 45±7% and 3-year cumulative incidence of chronic GvHD (cGvHD) was 28±6.7%. There was no statistically significant difference between the two cohorts in aGvHD (50% vs. 39%, P = 0.4) or cGvHD (29% vs. 22%, P = 0.7). The 2-year cumulative incidence of relapse (CIR) was 67.5±16.3% for low compared with 14.3±6.8% for high CD3+ T-cell cohort (P = 0.018). Fifteen subjects relapsed and 24 have died, 13 due to disease relapse. There was an improvement in 2-year RFS (94% vs. 83%; P = 0.0022) and 2-year OS (91% vs. 89%; P = 0.025) in low CD3+ T-cell cohort compared with high CD3+ T-cell cohort. Graft CD3+ T-cell dose is the only significant risk factor for relapse (P = 002), and OS (P = 0.030) in univariate analysis which was maintained in multivariate for relapse (P = 0.003), but not for OS (P = 0.050). Conclusions Our data suggest that high graft CD3+ T-cell dose is associated with lower risk of relapse, and might improve long-term survival, but has no influence on the risk of developing aGvHD or cGvHD.
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Affiliation(s)
- Khalid Halahleh
- Hematology Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Rawan Mustafa
- Department of Internal Medicine, Hematology Oncology Section, King Hussein Cancer Center, Amman, Jordan
| | - Dania Sarhan
- Cell Therapy and Applied Genomics (CTAG Lab) laboratory, King Hussein Cancer Center, Amman, Jordan
| | - Dalia Al Rimawi
- Biostatistics Unit, Research Office, King Hussein Cancer Center, Amman, Jordan
| | - Hadeel Abdelkhaleq
- Biostatistics Unit, Research Office, King Hussein Cancer Center, Amman, Jordan
| | - Isra Muradi
- Department of Internal Medicine, University of Tripoli, Tripoli, Libya Jamahiriya
| | - Iyad Sultan
- Department of Pediatrics, Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan
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Xue E, Lorentino F, Lupo Stanghellini MT, Giglio F, Piemontese S, Clerici DT, Farina F, Mastaglio S, Bruno A, Campodonico E, Nitti R, Marcatti M, Assanelli A, Corti C, Ciceri F, Peccatori J, Greco R. Addition of a Single Low Dose of Anti T-Lymphocyte Globulin to Post-Transplant Cyclophosphamide after Allogeneic Hematopoietic Stem Cell Transplant: A Pilot Study. J Clin Med 2022; 11:jcm11041106. [PMID: 35207379 PMCID: PMC8879643 DOI: 10.3390/jcm11041106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 02/01/2023] Open
Abstract
Correlation between risk of graft-versus-host disease (GvHD) and CD3+ counts within the peripheral blood stem cell graft has recently been reported in the setting of post-transplant cyclophosphamide (PT-Cy). We aimed to investigate the benefit of the addition of a single dose of anti-T lymphocyte globulin (ATLG 5 mg/kg) to PT-Cy in this setting. Starting in 2019, all patients receiving PBSC transplant containing CD3+ counts above 300 × 106/kg (study group) received a post-transplant dose of ATLG in addition to standard PT-Cy. The study was designed as a real-life analysis and included all consecutive Hematopoietic Stem Cell Transplantation (HSCT) recipients according to the above-mentioned inclusion criterion (n = 21), excluding cord blood and bone marrow donors. Using a 1:2 matched-pair analysis, we compared the outcomes with a historical population who received PT-Cy only (control group). We found a delayed platelet engraftment (29% vs. 45% at 30 days, p = 0.03) and a non-significant trend toward higher risk of poor graft function (29% vs. 19%, p = 0.52). The addition of ATLG impacted long-term immune reconstitution on the CD4+ subsets, but this did not translate into higher rate of relapse or viral infection. Acute GvHD was not significantly impacted, but 1-year cumulative incidence of chronic GvHD was significantly lower in the study group (15% vs. 41%, p = 0.04). Survival outcomes were comparable. In conclusion PT-Cy and ATLG was overall safe and translated into a low rate of chronic GvHD incidence.
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Affiliation(s)
- Elisabetta Xue
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Francesca Lorentino
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
- PhD Program in Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Maria Teresa Lupo Stanghellini
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Fabio Giglio
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Simona Piemontese
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Daniela Teresa Clerici
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Francesca Farina
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Sara Mastaglio
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Alessandro Bruno
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Edoardo Campodonico
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Rosamaria Nitti
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Magda Marcatti
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Andrea Assanelli
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Consuelo Corti
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Fabio Ciceri
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Jacopo Peccatori
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
- Correspondence: (J.P.); (R.G.)
| | - Raffaella Greco
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
- Correspondence: (J.P.); (R.G.)
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Diesch-Furlanetto T, Gabriel M, Zajac-Spychala O, Cattoni A, Hoeben BAW, Balduzzi A. Late Effects After Haematopoietic Stem Cell Transplantation in ALL, Long-Term Follow-Up and Transition: A Step Into Adult Life. Front Pediatr 2021; 9:773895. [PMID: 34900873 PMCID: PMC8652149 DOI: 10.3389/fped.2021.773895] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022] Open
Abstract
Haematopoietic stem cell transplant (HSCT) can be a curative treatment for children and adolescents with very-high-risk acute lymphoblastic leukaemia (ALL). Improvements in supportive care and transplant techniques have led to increasing numbers of long-term survivors worldwide. However, conditioning regimens as well as transplant-related complications are associated with severe sequelae, impacting patients' quality of life. It is widely recognised that paediatric HSCT survivors must have timely access to life-long care and surveillance in order to prevent, ameliorate and manage all possible adverse late effects of HSCT. This is fundamentally important because it can both prevent ill health and optimise the quality and experience of survival following HSCT. Furthermore, it reduces the impact of preventable chronic illness on already under-resourced health services. In addition to late effects, survivors of paediatric ALL also have to deal with unique challenges associated with transition to adult services. In this review, we: (1) provide an overview of the potential late effects following HSCT for ALL in childhood and adolescence; (2) focus on the unique challenges of transition from paediatric care to adult services; and (3) provide a framework for long-term surveillance and medical care for survivors of paediatric ALL who have undergone HSCT.
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Affiliation(s)
- Tamara Diesch-Furlanetto
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel (UKB), University of Basel, Basel, Switzerland
| | - Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Alessandro Cattoni
- Clinica Pediatrica, University degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza, Italy
| | - Bianca A W Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Adriana Balduzzi
- Clinica Pediatrica, University degli Studi di Milano-Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), San Gerardo Hospital, Monza, Italy
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