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Wei Y, Qian K, Le N, Wang L, Li F, Luan S, Wang L, Jin X, Peng B, Wang N, Dou L, Liu D. Addition of ruxolitinib and decitabine to modified busulfan/cyclophosphamide conditioning regimen for prophylaxis relapse in high-risk acute myeloid leukemia: the phase 2 prospective study. Ann Hematol 2024:10.1007/s00277-024-05972-w. [PMID: 39243311 DOI: 10.1007/s00277-024-05972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 08/23/2024] [Indexed: 09/09/2024]
Abstract
The prognosis of patients with high-risk acute myeloid leukemia (AML) is dismal even after allogeneic stem cell transplantation (allo-HSCT), with relapse remaining the leading cause of treatment failure. Here, we investigated whether ruxolitinib and decitabine plus modified busulfan-cyclophosphamide (mBu/Cy) conditioning could reduce relapse in high-risk AML after allo-HSCT. This prospective, single-arm, phase II trial enrolled 37 patients who received allo-HSCT between September 2020 and March 2022 at the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital. Eligible patients (10-62 years) had relapsed/refractory, positive measurable residual disease (MRD) prior to conditioning or adverse genetic abnormalities. Ruxolitinib (35 mg twice daily, days - 15 to - 10) and decitabine (20 mg/m2/day, days - 15 to - 10) were administered followed by mBu/Cy conditioning. All patients achieved engraftment. The cumulative incidences (CIs) of acute graft-versus-host disease (GVHD) grades II-IV and III-IV were 35.0% and 10.5%, respectively. The 1-year cumulative incidence of chronic GVHD was 8.1%. The 1-year CI of relapse was 29.7% among all patients, 0% in patients who achieved the first complete remission (CR1) prior to conditioning, and 0% in those with MRD-negative prior to conditioning. The 1-year non-relapse mortality was 5.4%. The 1-year probabilities of overall survival, disease-free survival, and GVHD-free relapse-free survival were 70.3%, 62.2%, and 54.1%, respectively. In conclusion, the novel conditioning showed primary efficacy in terms of a reduction in relapse in high-risk patients with AML after allo-HSCT, especially in those who achieved CR1 and MRD-negative prior to conditioning. Also, the new conditioning regimen may help reduce the incidence of chronic GVHD. ClinicalTrials.gov identifier: NCT04582604.
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Affiliation(s)
- Yujun Wei
- School of Medicine, Nankai University, Tianjin, 300071, China
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Kun Qian
- School of Medicine, Nankai University, Tianjin, 300071, China
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Ning Le
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Lili Wang
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Fei Li
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Songhua Luan
- Department of Hematology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Lu Wang
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Xiangshu Jin
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Bo Peng
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Nan Wang
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Liping Dou
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China.
| | - Daihong Liu
- School of Medicine, Nankai University, Tianjin, 300071, China.
- Chief Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China.
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Dou L, Peng B, Li X, Wang L, Jia M, Xu L, Li F, Liu D. Ruxolitinib-corticosteroid as first-line therapy for newly diagnosed high-risk acute graft versus host disease: study protocol for a multicenter, randomized, phase II controlled trial. Trials 2022; 23:470. [PMID: 35668528 PMCID: PMC9169300 DOI: 10.1186/s13063-022-06426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The response rate of the first-line therapy with corticosteroid for acute graft versus host disease (aGVHD) is about 50%, and steroid-refractory disease is associated with high mortality. The improved response rate to the first-line therapy of newly diagnosed aGVHD patients would result in therapeutic benefits. Ruxolitinib, a selective Janus kinase (JAK) 1/2 inhibitor, has been approved for the treatment of steroid-refractory acute GVHD. The addition of ruxolitinib to the first-line therapy may improve the efficacy of corticosteroids. METHODS This investigator-initiated, open-label, multicenter, prospective randomized, and controlled two-arm phase II study compares the efficacy and safety of ruxolitinib combined with 1 mg/kg methylprednisolone versus 2 mg/kg methylprednisolone alone in newly diagnosed aGVHD patients. Patients with intermediate or high-risk aGVHD, as defined by the Minnesota aGVHD high-risk score and biomarker algorithm, are eligible for this study. A total of 198 patients will be randomized at a 1:1 ratio and assigned a GVHD risk (intermediate versus high risk) and disease status before transplantation (complete remission versus no complete remission). The primary endpoint is the overall response rate on day 28, which is defined as an improvement of at least one stage in the severity of aGVHD in one organ without deterioration in any other organ or disappearance of any GVHD signs from all organs without requiring new systemic immunosuppressive treatment. The secondary objectives consist of response time, response duration, overall survival, disease-free survival, non-relapse mortality, failure-free survival, and changes in serum levels of proinflammatory cytokines and GVHD-related biomarkers. DISCUSSION This open-label, multicenter, two-arm randomized trial will evaluate whether the addition of ruxolitinib combined with corticosteroid is superior to corticosteroid alone in newly diagnosed high-risk aGVHD. TRIAL REGISTRATION ClinicalTrials.gov NCT04061876 (version number: 2019.5.18). Registered on July 16, 2019.
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Affiliation(s)
- Liping Dou
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Medical School of Chinese PLA, Beijing, 100853, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Bo Peng
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Medical School of Chinese PLA, Beijing, 100853, China
| | - Xin Li
- Department of Quality Control, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Lu Wang
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mingyu Jia
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lingmin Xu
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Fei Li
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Daihong Liu
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China. .,Medical School of Chinese PLA, Beijing, 100853, China.
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Elevated REG3α predicts refractory aGVHD in patients who received steroids-ruxolitinib as first-line therapy. Ann Hematol 2021; 101:621-630. [PMID: 34816294 PMCID: PMC8610441 DOI: 10.1007/s00277-021-04727-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/16/2021] [Indexed: 02/02/2023]
Abstract
We started a single-arm, phase II, open-label, prospective clinical trial using steroids-ruxolitinib as the first-line therapy for intermediate- to high-risk aGVHD (NCT04397367). Here, we report the association of a biomarker panel (sST2, REG3α, sTNFR1, IL-6 and IL-8) with responses to GVHD therapy. The novel first-line therapy for 39 patients with newly diagnosed aGVHD consisted of 1 mg/kg methylprednisolone and 5 mg/day ruxolitinib. The serum concentrations of the biomarkers were prospectively detected at planned time points. Of the 39 patients, the complete response rate at day 28 was 82.05%. In patients who achieved CR, the concentrations of REG3α (P14 = 0.01; P28 = 0.10) and sTNFR1 (P14 = 0.42; P28 = 0.04) declined at day 14 and day 28 compared with the pre-enrolment levels. In refractory patients, the levels of REG3α at day 14 were higher than those pre-enrolment (P = 0.04). REG3α (P = 0.02) was elevated in the refractory patients compared with the patients achieving CR at day 14 after enrolment, while there was no significant difference in the levels of sST2, sTNFR1 or IL-6. Elevated REG3α levels may predict refractory aGVHD after novel first-line therapy with steroids-ruxolitinib.
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Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history. Chin Med J (Engl) 2021; 134:1431-1440. [PMID: 34091525 PMCID: PMC8213243 DOI: 10.1097/cm9.0000000000001569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes. Methods: A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs). Results: The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88–40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001). Conclusions: These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.
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Liu C, Han D, Liang P, Li Y, Cao F. The Current Dilemma and Breakthrough of Stem Cell Therapy in Ischemic Heart Disease. Front Cell Dev Biol 2021; 9:636136. [PMID: 33968924 PMCID: PMC8100527 DOI: 10.3389/fcell.2021.636136] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/29/2021] [Indexed: 01/15/2023] Open
Abstract
Ischemic heart disease (IHD) is the leading cause of mortality worldwide. Stem cell transplantation has become a promising approach for the treatment of IHD in recent decades. It is generally recognized that preclinical cell-based therapy is effective and have yielded encouraging results, which involves preventing or reducing myocardial cell death, inhibiting scar formation, promoting angiogenesis, and improving cardiac function. However, clinical studies have not yet achieved a desired outcome, even multiple clinical studies showing paradoxical results. Besides, many fundamental puzzles remain to be resolved, for example, what is the optimal delivery timing and approach? Additionally, limited cell engraftment and survival, challenging cell fate monitoring, and not fully understood functional mechanisms are defined hurdles to clinical translation. Here we review some of the current dilemmas in stem cell-based therapy for IHD, along with our efforts and opinions on these key issues.
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Affiliation(s)
- Chuanbin Liu
- Medical School of Chinese PLA, Beijing, China
- The Second Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Dong Han
- The Second Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasond, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yang Li
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Feng Cao
- The Second Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Disease, Beijing, China
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Hou C, Dou L, Jia M, Li F, Wang S, Gao X, Wang L, Jin X, Wang L, Gao C, Liu D. Ruxolitinib Combined with Corticosteroids as First-Line Therapy for Acute Graft-versus-Host Disease in Haploidentical Peripheral Blood Stem Cell Transplantation Recipients. Transplant Cell Ther 2020; 27:75.e1-75.e10. [PMID: 32961370 DOI: 10.1016/j.bbmt.2020.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 12/14/2022]
Abstract
Corticosteroids are commonly used as first-line treatment for acute graft-versus-host disease (aGVHD); however, they are effective in only approximately one-half of patients. This study prospectively evaluated the use of ruxolitinib combined with 1 mg/kg methylprednisolone in the initial treatment of aGVHD. A total of 32 patients were enrolled. aGVHD involved the skin (53.1%), gastrointestinal tract (68.8%), and liver (6.0%). The complete response rate at day +28 was 96.9%. The 1-year and 2-year cumulative incidence rates of chronic GVHD were 9.4% and 13.8%, respectively. The 1- year cumulative incidence of nonrelapse mortality was 8.7%, and the Kaplan-Meier curve estimated 1-year overall survival after transplantation at 73.4%. This prospective study suggests that patients with aGVHD show a high response rate to ruxolitinib (5 mg/day) combined with 1 mg/kg/day methylprednisolone. This novel regimen was seen to spare steroid exposure, alleviate toxicity, and improve long-term survival.
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Affiliation(s)
- Cheng Hou
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Liping Dou
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Mingyu Jia
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Fei Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Shuhong Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoning Gao
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Lu Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Xiangshu Jin
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Lijun Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Chunji Gao
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Daihong Liu
- Department of Hematology, Chinese PLA General Hospital, Beijing, China.
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Xu ZL, Huang XJ. COVID-19 & Allogeneic Transplant: Activity and Preventive Measures for Best Outcomes in China. ACTA ACUST UNITED AC 2020; 3:e94. [PMID: 32838212 PMCID: PMC7300541 DOI: 10.1002/acg2.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Zheng-Li Xu
- Peking University People's Hospital Peking University Institute of Hematology National Clinical Research Center for Hematologic Disease Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
| | - Xiao-Jun Huang
- Peking University People's Hospital Peking University Institute of Hematology National Clinical Research Center for Hematologic Disease Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
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Bao X, Zhang T, Wu X, Yuan X, Li Y, Chen L, He J. Population‐specific criterion to distinguish killer cell immunoglobulin‐like receptor genotypes and haplotypes in a large Eastern Han population. HLA 2019; 95:15-22. [PMID: 31496074 DOI: 10.1111/tan.13686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/14/2019] [Accepted: 09/04/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Xiaojing Bao
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Tengteng Zhang
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Xiaojin Wu
- Department of Hematology, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Xiaoni Yuan
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Yang Li
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Luyao Chen
- Department of HLA Laboratory, Jiangsu Institute of Hematology First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
| | - Jun He
- Department of HLA Laboratory, Jiangsu Institute of Hematology Center for Clinical Laboratory, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University Suzhou Jiangsu PR China
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