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Fraebel J, Park S, Shah R, Prieto-Granada C, Mason EF, Sengsayadeth S, Chinratanalab W, Savani B, Jayani RV, Kassim A, Dholaria BR, Kim TK. GVHD like skin eruption post-autologous stem cell transplantation. Bone Marrow Transplant 2024; 59:900-903. [PMID: 38467749 DOI: 10.1038/s41409-024-02259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Johnathan Fraebel
- Division of Hematology/Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Silvia Park
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Rahul Shah
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Carlos Prieto-Granada
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Emily F Mason
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Salyka Sengsayadeth
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Wichai Chinratanalab
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Bipin Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Reena V Jayani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
| | - Adetola Kassim
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Bhagirathbhai R Dholaria
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA
| | - Tae Kon Kim
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Vanderbilt-Ingram Cancer Center (VICC), Nashville, TN, 37232, USA.
- Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37232, USA.
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Justus JLP, Beltrame MP, de Azambuja AP, Schluga YC, Martins EA, Rocha MTL, Rodrigues AM, Loth G, Lima ACM, Bonfim C. Immune recovery and the role of recent thymic emigrated T lymphocytes after pediatric hematopoietic stem cell transplantation. Cytotherapy 2024:S1465-3249(24)00685-6. [PMID: 38762804 DOI: 10.1016/j.jcyt.2024.04.073] [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: 09/17/2023] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND AIMS Adequate re-establishment of thymopoiesis is critical for long-term immune reconstitution after hematopoietic cell transplantation (HCT), potentially impacting patient survival rates. This study aimed to evaluate immune reconstitution in pediatric HCT recipients by quantifying recent thymic emigrants (RTEs), specifically CD3+CD31+CD45RA+ cells. METHODS We conducted a retrospective analysis of 186 pediatric patients transplanted between 2013 and 2020, undergoing their first allogeneic HCT, who were alive in the first 100 days after transplantation with immune recovery evaluation at three time points: day 100, day 180 and day 360 after HCT. We analyzed the distribution of peripheral blood subsets of T, B and natural killer lymphocytes and assessed the impact of underlying disease, HCT type, stem cell source, recipient age, conditioning regimen, graft-versus-host disease (GVHD) occurrence and cytomegalovirus (CMV) reactivation on immune recovery. RESULTS At day 100, patients under 10 years exhibited higher RTE CD4+ and CD8+CD31+CD45RA+ counts compared with older patients (5.3 versus 2.2 cells/µL, P = 0.022 and 48 versus 72.8 cells/µL, P = 0.049, respectively). Patients with haploidentical HCT had lower RTE CD4+ counts compared with those with unrelated or related donors (2.4 versus 4.4 versus 7.9 cells/µL, P = 0.024). Administration of rabbit anti-thymocyte globulin negatively impacted RTE CD4+ production (median, 6.5 versus 2.4 cells/µL, P = 0.007). At day 180, the presence of GVHD had a negative influence on RTE production (11.7 versus 56.8 cells/µL, P < 0.001), particularly higher-grade acute GVHD (without, 56.8 cells/µL, grade 1-2, 28.1 cells/µL, grade 3-4, 6.0 cells/µL, P < 0.001). Patients with CMV reactivation had higher CD8+CD31+CD45RA+ compared with those without reactivation (median, 204.6 versus 100.2 cells/µL, P = 0.022). At day 360, no variables significantly affected RTE recovery. Overall survival at 5-year follow-up was 87.7%, with a median of 1170 days (range, 122-3316). Multivariate analysis showed that age >10 years (P = 0.038), negative CMV donor serology (P = 0.0029) and acute GVHD (P = 0.0026) had a negative impact on survival. CONCLUSIONS This study highlights variations in RTE production based on patient age, donor type and immunosuppression regimen employed.
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Affiliation(s)
- Julie Lillian Pimentel Justus
- Flow Cytometry Laboratory, Clinics Hospital, Federal University of Paraná, Curitiba, Brazil; Post-Graduation Program in Children and Adolescent Health, Clinics Hospital, Federal University of Parana, Curitiba, Brazil.
| | - Miriam P Beltrame
- Flow Cytometry Laboratory, Clinics Hospital, Federal University of Paraná, Curitiba, Brazil; Post-Graduation Program in Children and Adolescent Health, Clinics Hospital, Federal University of Parana, Curitiba, Brazil
| | - Ana Paula de Azambuja
- Flow Cytometry Laboratory, Clinics Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Yara C Schluga
- Flow Cytometry Laboratory, Clinics Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Edna A Martins
- Flow Cytometry Laboratory, Clinics Hospital, Federal University of Paraná, Curitiba, Brazil
| | | | - Adriana Mello Rodrigues
- Pediatric Blood and Marrow Transplantation Division, Clinics Hospital, Federal University of Paraná, Curitiba, Brazil
| | - Gisele Loth
- Pediatric Blood and Marrow Transplantation Division, Clinics Hospital, Federal University of Paraná, Curitiba, Brazil
| | | | - Carmem Bonfim
- Post-Graduation Program in Children and Adolescent Health, Clinics Hospital, Federal University of Parana, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Division, Hospital Pequeno Príncipe, Curitiba, Brazil
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3
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Och K, Turki AT, Götz KM, Selzer D, Brossette C, Theobald S, Braun Y, Graf N, Rauch J, Rohm K, Weiler G, Kiefer S, Schwarz U, Eisenberg L, Pfeifer N, Ihle M, Grandjean A, Fix S, Riede C, Rissland J, Smola S, Beelen DW, Kaddu‐Mulindwa D, Bittenbring J, Lehr T. A dynamic time-to-event model for prediction of acute graft-versus-host disease in patients after allogeneic hematopoietic stem cell transplantation. Cancer Med 2024; 13:e6833. [PMID: 38132807 PMCID: PMC10807572 DOI: 10.1002/cam4.6833] [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: 07/21/2023] [Revised: 10/26/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Acute graft-versus-host disease (aGvHD) is a major cause of death for patients following allogeneic hematopoietic stem cell transplantation (HSCT). Effective management of moderate to severe aGvHD remains challenging despite recent advances in HSCT, emphasizing the importance of prophylaxis and risk factor identification. METHODS In this study, we analyzed data from 1479 adults who underwent HSCT between 2005 and 2017 to investigate the effects of aGvHD prophylaxis and time-dependent risk factors on the development of grades II-IV aGvHD within 100 days post-HSCT. RESULTS Using a dynamic longitudinal time-to-event model, we observed a non-monotonic baseline hazard overtime with a low hazard during the first few days and a maximum hazard at day 17, described by Bateman function with a mean transit time of approximately 11 days. Multivariable analysis revealed significant time-dependent effects of white blood cell counts and cyclosporine A exposure as well as static effects of female donors for male recipients, patients with matched related donors, conditioning regimen consisting of fludarabine plus total body irradiation, and patient age in recipients of grafts from related donors on the risk to develop grades II-IV aGvHD. Additionally, we found that higher cumulative hazard on day 7 after allo-HSCT are associated with an increased incidence of grades II-IV aGvHD within 100 days indicating that an individual assessment of the cumulative hazard on day 7 could potentially serve as valuable predictor for later grades II-IV aGvHD development. Using the final model, stochastic simulations were performed to explore covariate effects on the cumulative incidence over time and to estimate risk ratios. CONCLUSION Overall, the presented model showed good descriptive and predictive performance and provides valuable insights into the interplay of multiple static and time-dependent risk factors for the prediction of aGvHD.
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Affiliation(s)
- Katharina Och
- Department of Clinical PharmacySaarland UniversitySaarbrückenGermany
| | - Amin T. Turki
- Department of Hematology and Stem Cell Transplantation, West‐German Cancer CenterUniversity Hospital EssenEssenGermany
| | - Katharina M. Götz
- Department of Clinical PharmacySaarland UniversitySaarbrückenGermany
| | - Dominik Selzer
- Department of Clinical PharmacySaarland UniversitySaarbrückenGermany
| | - Christian Brossette
- Department of Pediatric Oncology and HematologySaarland UniversityHomburgGermany
| | - Stefan Theobald
- Department of Pediatric Oncology and HematologySaarland UniversityHomburgGermany
| | - Yvonne Braun
- Department of Pediatric Oncology and HematologySaarland UniversityHomburgGermany
| | - Norbert Graf
- Department of Pediatric Oncology and HematologySaarland UniversityHomburgGermany
| | - Jochen Rauch
- Department of Biomedical Data & BioethicsFraunhofer Institute for Biomedical Engineering (IBMT)SulzbachGermany
| | - Kerstin Rohm
- Department of Biomedical Data & BioethicsFraunhofer Institute for Biomedical Engineering (IBMT)SulzbachGermany
| | - Gabriele Weiler
- Department of Biomedical Data & BioethicsFraunhofer Institute for Biomedical Engineering (IBMT)SulzbachGermany
| | - Stephan Kiefer
- Department of Biomedical Data & BioethicsFraunhofer Institute for Biomedical Engineering (IBMT)SulzbachGermany
| | - Ulf Schwarz
- Institute for Formal Ontology and Medical Information ScienceSaarland UniversitySaarbrückenGermany
| | - Lisa Eisenberg
- Department of Computer ScienceUniversity of TübingenTübingenGermany
| | - Nico Pfeifer
- Department of Computer ScienceUniversity of TübingenTübingenGermany
| | | | | | | | | | - Jürgen Rissland
- Institute of VirologySaarland University Medical CentreHomburgGermany
| | - Sigrun Smola
- Institute of VirologySaarland University Medical CentreHomburgGermany
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI)Saarland University CampusSaarbrückenGermany
| | - Dietrich W. Beelen
- Department of Hematology and Stem Cell Transplantation, West‐German Cancer CenterUniversity Hospital EssenEssenGermany
| | | | - Jörg Bittenbring
- Department of Internal Medicine 1University Hospital of the SaarlandHomburgGermany
| | - Thorsten Lehr
- Department of Clinical PharmacySaarland UniversitySaarbrückenGermany
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Ao YQ, Jiang JH, Gao J, Wang HK, Ding JY. Recent thymic emigrants as the bridge between thymoma and autoimmune diseases. Biochim Biophys Acta Rev Cancer 2022; 1877:188730. [DOI: 10.1016/j.bbcan.2022.188730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022]
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Bertaina A, Abraham A, Bonfim C, Cohen S, Purtill D, Ruggeri A, Weiss D, Wynn R, Boelens JJ, Prockop S. An ISCT Stem Cell Engineering Committee Position Statement on Immune Reconstitution: the importance of predictable and modifiable milestones of immune reconstitution to transplant outcomes. Cytotherapy 2022; 24:385-392. [PMID: 35331394 DOI: 10.1016/j.jcyt.2021.09.011] [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: 06/21/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022]
Abstract
Allogeneic stem cell transplantation is a potentially curative therapy for some malignant and non-malignant disease. There have been substantial advances since the approaches first introduced in the 1970s, and the development of approaches to transplant with HLA incompatible or alternative donors has improved access to transplant for those without a fully matched donor. However, success is still limited by morbidity and mortality from toxicity and imperfect disease control. Here we review our emerging understanding of how reconstitution of effective immunity after allogeneic transplant can protect from these events and improve outcomes. We provide perspective on milestones of immune reconstitution that are easily measured and modifiable.
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Affiliation(s)
- Alice Bertaina
- Center for Cancer and Immunology Research, CETI, Children's National Hospital, Washington, District of Columbia, USA
| | - Allistair Abraham
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Carmem Bonfim
- Pediatric Bone Marrow Transplantation Division, Hospital Pequeno Principe, Curitiba, Brazil
| | - Sandra Cohen
- Université de Montréal and Maisonneuve Rosemont Hospital, Montréal, Québec, Canada
| | - Duncan Purtill
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | | | - Robert Wynn
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Jaap Jan Boelens
- Stem Cell Transplantation and Cellular Therapies, Memorial Sloan Kettering Cancer Center, and Department of Pediatrics, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Susan Prockop
- Stem Cell Transplant Program, Division of Hematology/Oncology Boston Children's Hospital and Department of Pediatric Oncology, Dana Farber Cancer Institute.
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Matkowska-Kocjan A, Owoc-Lempach J, Chruszcz J, Kuźnik E, Szenborn F, Jurczenko L, Wójcik M, Banyś D, Szenborn L, Ussowicz M. The COVID-19 mRNA BNT163b2 Vaccine Was Well Tolerated and Highly Immunogenic in Young Adults in Long Follow-Up after Haematopoietic Stem Cell Transplantation. Vaccines (Basel) 2021; 9:vaccines9101209. [PMID: 34696317 PMCID: PMC8539173 DOI: 10.3390/vaccines9101209] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 01/14/2023] Open
Abstract
Sixty five patients (18–31 years) who had received allogeneic haematopoietic stem cell transplantation (3–27 years from HSCT) were evaluated for the tolerance and immunogenicity of the COVID-19 mRNA BNT163b2 vaccine. Methods: Patients were vaccinated with two doses at 5 weeks interval. After each dose, patients completed a survey concerning adverse events (AE) and anti-SARS-CoV-2 IgG antibodies were measured before the first vaccine dose (1stVD) and 14–21 days after the second dose (2ndVD). AE reported after 1stVD and 2ndVD, respectively were: fever 0%, 1.7%; fatigue 15.4%, 25.8%; headache 15.4%, 24.1%; chills 6.1%, 12.0%; muscle pain 15.4%, 24.1%; joint pain 3.0%, 6.9%; nausea 6.1%, 6.9%; pain at injection site 30.7%, 34.4%; swelling 3.0%, 10.3%; redness 0, 3.4%; pruritus 0, 5.2%; and axillary lymphadenopathy 3.0%, 1.7%. After 2ndVD, 96.5% patients were positive for anti-SARS-CoV-2 (GMC 3290.94 BAU/mL). No correlation presented between the antibody titer and symptoms of chronic Graft-versus-Host disease, total IgG, lymphocyte CD4+, or AE. Significantly higher titers were observed in COVID-19 convalescents, and inverse correlation (R2 = −0.0925, p = 0.02) between the time from HSCT and titers after 2ndVD was present. Conclusions: The young adults after HSCT tolerate the COVID-19 mRNA vaccine well and show immunologic response.
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Affiliation(s)
- Agnieszka Matkowska-Kocjan
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland; (J.C.); (M.W.); (D.B.); (L.S.)
- Correspondence:
| | - Joanna Owoc-Lempach
- Department and Clinic of Paediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, 50-556 Wrocław, Poland; (J.O.-L.); (L.J.); (M.U.)
| | - Joanna Chruszcz
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland; (J.C.); (M.W.); (D.B.); (L.S.)
| | - Edwin Kuźnik
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, 50-529 Wrocław, Poland;
| | - Filip Szenborn
- Faculty of Electronics, Wroclaw University of Science and Technology, 50-370 Wrocław, Poland;
| | - Lidia Jurczenko
- Department and Clinic of Paediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, 50-556 Wrocław, Poland; (J.O.-L.); (L.J.); (M.U.)
| | - Marta Wójcik
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland; (J.C.); (M.W.); (D.B.); (L.S.)
| | - Dorota Banyś
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland; (J.C.); (M.W.); (D.B.); (L.S.)
| | - Leszek Szenborn
- Department and Clinic of Pediatric Infectious Diseases, Wroclaw Medical University, 50-368 Wrocław, Poland; (J.C.); (M.W.); (D.B.); (L.S.)
| | - Marek Ussowicz
- Department and Clinic of Paediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, 50-556 Wrocław, Poland; (J.O.-L.); (L.J.); (M.U.)
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Non-classical manifestations of acute GVHD. Blood 2021; 138:2165-2172. [PMID: 34482399 DOI: 10.1182/blood.2021012431] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022] Open
Abstract
Acute graft-versus-host disease (GVHD) is a major life-threatening complication after allogeneic hematopoietic cell transplantation (allo-HCT). The classical target organs of acute GVHD include the intestines, liver, and skin. The damage of these organs is relatively easy to detect for the clinician as diarrhea, increased bilirubin, and rash. However, there is increasing evidence that also other organs, where the acute damage is less apparent or more difficult to distinguish from drug toxicity, such as the central nervous system, the lungs, the ovaries and testis, the thymus, the bone marrow and the kidney, can be target organs of acute GVHD. Here, we review current evidence for non-classical manifestations of acute GVHD in rodent models and in patients and discuss them in the context of novel emerging therapies for GVHD. A better understanding of the involvement of the non-classical GVHD target organs may help to improve patient outcomes after allo-HCT.
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