1
|
Loke J, Labopin M, Craddock C, Socié G, Gedde-Dahl T, Blaise D, Forcade E, Salmenniemi U, Huynh A, Versluis J, Yakoub-Agha I, Labussière-Wallet H, Maertens J, Passweg J, Bulabois CE, Gabellier L, Mielke S, Castilla-Llorente C, Deconinck E, Brissot E, Nagler A, Ciceri F, Mohty M. Prognostic impact of number of induction courses to attain complete remission in patients with acute myeloid leukemia transplanted with either a matched sibling or human leucocyte antigen 10/10 or 9/10 unrelated donor: An Acute Leukemia Working Party European Society for Blood and Marrow Transplantation study. Cancer 2024. [PMID: 38581695 DOI: 10.1002/cncr.35308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION For the majority of patients with acute myeloid leukemia (AML) an allogeneic stem cell transplant (SCT) in first complete remission (CR) is preferred. However, whether the number of courses required to achieve CR has a prognostic impact is unclear. It is unknown which factors remain important in patients requiring more than one course of induction to attain remission. METHODS This Acute Leukaemia Working Party study from the European Society for Blood and Marrow Transplantation identified adults who received an allograft in first CR from either a fully matched sibling or 10/10 or 9/10 human leucocyte antigen (HLA)-matched unrelated donor (HLA-A, HLA-B, HLA-C, HLA-DR, or HLA-DQ). Univariate and multivariate analyses were undertaken to identify the prognostic impact of one or two courses of induction to attain CR. RESULTS A total of 4995 patients were included with 3839 (77%) patients attaining a CR following one course of induction chemotherapy (IND1), and 1116 patients requiring two courses (IND2) to attain CR. IND2 as compared to IND1 was a poor prognostic factor in a univariate analysis and remained so in a multivariate Cox model, resulting in an increased hazard ratio of relapse (1.38; 95% confidence interval [CI], 1.16-1.64; p = .0003) and of death (1.27; 95% CI, 1.09-1.47; p = .002). Adverse prognostic factors in a multivariate analysis of the outcomes of patients requiring IND2 included age, FLT3-ITD, adverse cytogenetics, and performance status. Pretransplant measurable residual disease retained a prognostic impact regardless of IND1 or IND2. CONCLUSION Initial response to chemotherapy as determined by number of courses to attain CR, retained prognostic relevance even following SCT in CR.
Collapse
Affiliation(s)
- Justin Loke
- University of Birmingham, Birmingham, UK
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Myriam Labopin
- Acute Leukaemia Working Party, Paris Study Office, European Society for Blood and Marrow Transplantation, Paris, France
- Hematology Department, AP-HP, Sorbonne Universités, INSERM, Centre de Recherche Saint-Antoine (CRSA), Saint Antoine Hospital, Paris, France
| | - Charles Craddock
- Birmingham Centre for Cellular Therapy and Transplantation, Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
- University of Warwick, Warwick, UK
| | - Gérard Socié
- Department of Hematology-BMT, Hopital St. Louis, Paris, France
| | - Tobias Gedde-Dahl
- Hematology Department, Oslo University Hospital, Rikshospitalet Clinic for Cancer Medicine, Oslo, Norway
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | | | - Urpu Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Anne Huynh
- CHU-Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France
| | - Jurjen Versluis
- Erasmus MC Cancer Institute University Medical Center, Rotterdam, Netherlands
| | | | | | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | - Ludovic Gabellier
- Département d`Hématologie Clinique, CHU Lapeyronie, Montpellier, France
| | - Stephan Mielke
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Eric Deconinck
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, Besançon, France
- Hématologie, CHU Besançon, Besançon, France
| | - Eolia Brissot
- Hematology Department, AP-HP, Sorbonne Universités, INSERM, Centre de Recherche Saint-Antoine (CRSA), Saint Antoine Hospital, Paris, France
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Università Vita Salute San Raffaele, Milan, Italy
| | - Mohamad Mohty
- Hematology Department, AP-HP, Sorbonne Universités, INSERM, Centre de Recherche Saint-Antoine (CRSA), Saint Antoine Hospital, Paris, France
| |
Collapse
|
2
|
Paviglianiti A, Ngoya M, Peña M, Boumendil A, Gülbas Z, Ciceri F, Bonifazi F, Russo D, Fegueux N, Stolzel F, Bulabois CE, Socié G, Forcade E, Solano C, Finel H, Robinson S, Glass B, Montoto S. Graft-versus-host-disease prophylaxis with ATG or PTCY in patients with lymphoproliferative disorders undergoing reduced intensity conditioning regimen HCT from one antigen mismatched unrelated donor. Bone Marrow Transplant 2024:10.1038/s41409-024-02225-2. [PMID: 38331980 DOI: 10.1038/s41409-024-02225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
Post-transplant cyclophosphamide (PTCY) has been introduced as graft-versus-host disease (GvHD) prophylaxis in mismatched and matched unrelated hematopoietic cell transplant (HCT). However, data comparing outcomes of PTCY or ATG in patients undergoing a 1 antigen mismatched HCT for lymphoproliferative disease are limited. We compared PTCY versus ATG in adult patients with lymphoproliferative disease undergoing a first 9/10 MMUD HCT with a reduced intensity conditioning regimen from 2010 to 2021. Patients receiving PTCY were matched to patients receiving ATG according to: age, disease status at transplant, female to male matching, stem cell source and CMV serology. Grade II-IV acute GvHD at 100 day was 26% and 41% for the ATG and PTCY group, respectively (p = 0.08). Grade III-IV acute GvHD was not significantly different between the two groups. No differences were observed in relapse incidence, non-relapse mortality, progression-free survival, overall survival and GvHD-relapse-free survival at 1 year. The cumulative incidence of 1-year extensive chronic GvHD was 18% in the ATG and 5% in the PTCY group, respectively (p = 0.06). In patients with lymphoproliferative diseases undergoing 9/10 MMUD HCT, PTCY might be a safe option providing similar results to ATG prophylaxis. Due to the limited number of patients, prospective randomized trials are needed.
Collapse
Affiliation(s)
- Annalisa Paviglianiti
- Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Maud Ngoya
- Lymphoma Working Party, EBMT, Paris, France
| | - Marta Peña
- Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | | | - Zafer Gülbas
- Bone Marrow Transplantation Department, Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Domenico Russo
- Unit of Blood Diseases and Bone Marrow Transplantation, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Nathalie Fegueux
- Department of Hematology and Oncology, CHU Lapeyronie, Montpellier, France
| | - Friedrich Stolzel
- University Hospital, Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Claude Eric Bulabois
- CHU Grenoble Alpes - Université Grenoble Alpes, Service d'Hématologie, Grenoble, France
| | - Gerard Socié
- Hopital Saint Louis, Department of Hematology - BMT, Paris, France
| | | | - Carlo Solano
- Hospital Clínico de Valencia, Servicio de Hematología, University of Valencia, Valencia, Spain
| | | | | | | | - Silvia Montoto
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Haemato-oncology St.Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
3
|
Nagler A, Labopin M, Dholaria B, Blaise D, Bondarenko S, Vydra J, Choi G, Rovira M, Reményi P, Meijer E, Bulabois CE, Diez-Martin JL, Yakoub-Agha I, Brissot E, Spyridonidis A, Sanz J, Patel A, Arat M, Bazarbachi A, Bug G, Savani BN, Giebel S, Ciceri F, Mohty M. Impact of measurable residual disease on outcomes of unrelated donor haematopoietic cell transplantation with post-transplant cyclophosphamide in AML in first complete remission. Br J Haematol 2023. [PMID: 36949658 DOI: 10.1111/bjh.18765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
Pre-transplant measurable residual disease (MRD) predicts relapse and outcome of allogeneic haematopoietic cell transplantation (allo-HCT). The impact of MRD on the outcomes of post-transplant cyclophosphamide (PTCy)-based allo-HCT from a matched unrelated donor (UD) is unknown. This study assessed the impact of MRD in acute myeloid leukaemia (AML) in the first complete remission (CR1). A total of 272 patients (MRD negative [MRD-], n = 165; MRD positive [MRD+], n = 107) with a median follow-up of 19 (range: 16-24) months were studied. The incidence of grades II-IV and grades III-IV acute GVHD at day 180 was 25.2% and 25% (p = 0.99), and 10.6% and 6.8% (p = 0.29), respectively, and 2-year chronic GVHD was 35% and 30.4% (p = 0.96) in MRD+ and MRD- cohorts, respectively. In multivariate analysis, MRD+ status was associated with a higher incidence of relapse (RI) (hazard ratio [HR] = 2.56, 95% CI: 1.39-4.72), lower leukaemia-free survival (LFS) (HR = 2.04, 95% CI: 1.23-3.39), overall survival (OS) (HR = 1.83, 95% CI: 1.04-3.25) and GVHD-free, relapse-free survival (GRFS) (HR = 1.69, 95% CI: 1.10-2.58). MRD status did not have a significant impact on non-relapse mortality (NRM), or acute or chronic GVHD risk. Among patients with AML undergoing UD allo-HCT with PTCy, pre-transplant MRD+ status predicted a higher relapse rate, lower LFS, OS and GRFS.
Collapse
Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | - Myriam Labopin
- INSERM UMRs 938, Sevice d'hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne University, Paris, France
| | | | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Sergey Bondarenko
- Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, First State Pavlov Medical University of St Petersburg, St Petersburg, Russian Federation
| | - Jan Vydra
- Servicio de Hematología, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Goda Choi
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Montserrat Rovira
- Hematology, Hospital Clinic, Institute of Hematology & Oncology, Barcelona, Spain
| | - Péter Reményi
- Haematology and Stem Cell Transplant, Dél-pesti Centrumkórház-Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Ellen Meijer
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - J L Diez-Martin
- Department of Hematology, Hospital GU Gregorio Marañon, Instituto de Investigacion sanitaria Gregorio Marañon, Medicina, UCM, Madrid, Spain
| | | | - Eolia Brissot
- Hematology, Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, Paris, France
| | - Alexandros Spyridonidis
- Bone Marrow Transplantation Unit and Institute of Cell Therapy, University of Patras, Patras, Greece
| | - Jaime Sanz
- Hematology Department at University Hospital La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Amit Patel
- Royal University Hospital, Liverpool, UK
| | - Mutlu Arat
- Sisli Florence Nightingale Hospital, Istanbul, Turkey
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gesine Bug
- Department of Medicine 2, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sebastian Giebel
- Bone Marrow Transplantation and Hematology-Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch Wybrzeze Armii Krajowej, Gliwice, Poland
| | - Fabio Ciceri
- Haematology and BMT, Ospedale San Raffaele s.r.l, Milan, Italy
| | - Mohamad Mohty
- INSERM UMRs 938, Sevice d'hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne University, Paris, France
| |
Collapse
|
4
|
Guisnel C, Schirmer L, Morisset S, Robin M, Labussière-Wallet H, Duléry R, Ceballos P, Forcade E, Nguyen S, Poiré X, Maertens J, Chantepie S, Chevallier P, Daguindau E, Villate A, Charbonnier A, Castilla-Llorente C, Contentin N, Huynh A, Yakoub-Agha I, Bulabois CE, Rubio MT, D'Aveni M. On behalf of the SFGM-TC: prophylactic donor lymphocyte infusion in patients treated with allogeneic stem-cell transplantation for high-risk myelodysplastic syndrome and acute myeloid leukemia. Acta Haematol 2023:000528184. [PMID: 36603565 DOI: 10.1159/000528184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 11/13/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the best curative option for high-risk myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Unfortunately, it is still associated with a significant risk of relapse due to mechanisms of escape from the control of alloreactive T cells. Repetitive adjuvant donor lymphocyte infusions (DLI), termed prophylactic DLI (proDLI), as an effective strategy in preventing relapse is still debated. METHODS We performed a retrospective multicenter study to evaluate the efficacy of proDLI in allografted AML and MDS. We identified 56 patients treated with proDLI (DLI planned in full chimeras without any sign of disease relapse) and matched them to 167 patients in control group, (DLI performed for mixed chimerism or positive minimal residual disease) based on similar age, initial disease, cytogenetic prognosis, and conditioning intensity. RESULTS In univariate analysis, the incidence of severe aGVHD at 100 days and incidence of all grades of chronic GVHD 1 year after allo-HSCT were similar in the two groups. We also observed a trend of higher 3-year RI (52.61% [95% confidence interval 25.99-79.23]) in the proDLI group versus the control group (29.31% [20.28-38.34], p=0.067). However, 3-year overall survival (p=0.892), progression-free survival (p=0.239), and non-relapse mortality (p=0.343) were similar between the two groups. In multivariate analysis, the only factor influencing overall and progression-free survival was anti-thymocyte globulin administration during the conditioning regimen. DISCUSSION/CONCLUSION The proDLI strategy had an acceptable toxicity profile but did not improve patient outcomes compared to the pre-emptive strategy.
Collapse
|
5
|
Chauvet P, Paviglianiti A, Labopin M, Labussière H, Boissel N, Robin M, Maillard N, Ouachée-Chardin M, Forcade E, Poiré X, Chantepie S, Huynh A, Bulabois CE, Leclerc M, Maury S, Chevallier P, Cluzeau T, Mear JB, Cornillon J, Bilger K, Simand C, Beguin Y, Rubio MT, Yakoub-Agha I, Brissot E. Combining blinatumomab and donor lymphocyte infusion in B-ALL patients relapsing after allogeneic hematopoietic cell transplantation: a study of the SFGM-TC. Bone Marrow Transplant 2023; 58:72-79. [PMID: 36261707 DOI: 10.1038/s41409-022-01846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 01/07/2023]
Abstract
Relapsed B-cell acute lymphoblastic leukemia (B-ALL) after allogeneic stem cell transplantation (allo-HCT) still represents a major concern with poor outcomes. The aim of this study is to compare the efficacy and safety of blinatumomab and donor lymphocyte infusion (DLI) versus blinatumomab alone in this setting. This is a multicenter retrospective study from centers of SFGM-TC. All transplanted patients who received blinatumomab salvage therapy were included. Patients who received DLI from 1 month before to 100 days after the starting of blinatumomab were included in the blina-DLI group. Seventy-two patients were included. Medium follow-up was 38 months. Fifty received blinatumomab alone and 22 the association blinatumomab-DLI. Two-year overall survival (OS) was 31% in the blinatumomab group and 43% in the blinatumomab-DLI group (p = 0.31). Studying DLI as a time dependent variable, PFS did not significantly differ between the 2 groups (HR:0.7, 95% CI: 0.4-1.5). In multivariate analysis, DLI was not a prognostic factor for OS, progression-free survival and progression/relapse incidence. Adverse events and graft-versus-disease rates were comparable in the 2 groups. In conclusion, adding DLI between 1 month before and 100 days after start of blinatumomab is safe and does not seem to improve outcomes in B-ALL patients who relapsed after allo-HCT.
Collapse
Affiliation(s)
- Paul Chauvet
- CHU de Lille, Maladies du Sang, Université de Lille, 59000, Lille, France.
| | - Annalisa Paviglianiti
- Sorbonne University, INSERM UMR-S 938, Saint-Antoine Research Centre, AP-PH, Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, Paris, France.,Institut Català d'Oncologia, Cell Transplant/Cell Therapy Unit, Barcelona, Spain
| | - Myriam Labopin
- Sorbonne University, INSERM UMR-S 938, Saint-Antoine Research Centre, AP-PH, Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, Paris, France
| | - Hélène Labussière
- Hospices Civils de Lyon, Lyon-Sud Hospital, Clinical Hematology, Pierre-Bénite, France
| | - Nicolas Boissel
- Université de Paris Cité, Institut de Recherche Saint-Louis, URP-3518, Assistance Publique-Hôpitaux de Paris, University Hospital Saint-Louis, 75010, Paris, France.,Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marie Robin
- Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | | | | | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | - Xavier Poiré
- Section of Hematology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Anne Huynh
- CHU - IUCT O, 31059, Toulouse, Toulouse, France
| | | | - Mathieu Leclerc
- Service d'Hématologie et de Thérapie Cellulaire, Hôpital Henri Mondor, Créteil, France
| | - Sébastien Maury
- Service d'Hématologie et de Thérapie Cellulaire, Hôpital Henri Mondor, Créteil, France
| | | | | | | | - Jérôme Cornillon
- Département d'Hématologie Clinique et de Thérapie Cellulaire, CHU de Saint Etienne, Saint-Priest-en-Jarez, France
| | - Karin Bilger
- Service d'Hématologie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Célestine Simand
- Service d'Hématologie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Yves Beguin
- Division of Haematology, Department of Medicine, University and CHU of Liège, Liège, Belgium
| | - Marie-Thérèse Rubio
- Service d'Hématologie, Hôpital Brabois, CHRU Nancy, Equipe 6 IMoPa, Biopole de L'université de Lorraine, CNRS UMR 7563, Nancy, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Maladies du Sang, Université de Lille, 59000, Lille, France.,CHU de Lille, université de Lille, Inserm U1286, Infinite, 59000, Lille, France
| | - Eolia Brissot
- Sorbonne University, INSERM UMR-S 938, Saint-Antoine Research Centre, AP-PH, Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, Paris, France.
| |
Collapse
|
6
|
Baron F, Labopin M, Tischer J, Ciceri F, Raiola AM, Blaise D, Sica S, Vydra J, Fanin R, Diez-Martin JL, Bulabois CE, Stölzel F, Busca A, Jindra P, Koc Y, Chevallier P, Forcade E, Rösler W, Passweg J, Kulagin A, Carella AM, Simand C, Bazarbachi A, Pioltelli P, Nagler A, Mohty M. Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia. Bone Marrow Transplant 2022; 57:1657-1663. [PMID: 35978005 DOI: 10.1038/s41409-022-01781-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/09/2022]
Abstract
HLA-haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) is frequently used as treatment for patients with active acute myeloid leukemia (AML). Here, we investigated whether 9/10 HLA-mismatched unrelated donor transplantation (MMUD-HCT) with post-transplant cyclophosphamide (PTCy) is an adequate alternative. Inclusion criteria in this retrospective registry study consisted of adult patients, first HCT with a Haplo donor or MMUD between 2010 and 2020 using PTCy as graft-versus-host disease (GVHD) prophylaxis, and primary refractory or relapsed disease. MMUD patients were pair-matched 1 to 2 with Haplo-recipients. A total of 73 MMUD patients met the inclusion criteria. Their data were compared to those of 146 Haplo patients in a matched-pair analysis. Median follow-up was 27 months in MMUD patients and 36 months in Haplo recipients. Two-year incidences of relapse and non-relapse mortality (NRM) were 40% and 18% in MMUD patients, respectively, versus 50% (P = 0.23) and 24% (P = 0.18) in Haplo recipients. Two-year leukemia-free survival (LFS) and overall survival (OS) was 42% and 46% in MMUD recipients, respectively, versus 26% (P = 0.1) and 28% (P = 0.061) in Haplo-patients. In conclusions, in AML patients with active disease at transplantation, MMUD-HCT results in at least comparable outcomes to Haplo-HCT when PTCy is applied.
Collapse
Affiliation(s)
- Frédéric Baron
- Laboratory of Hematology, GIGA-I3, University of Liege and CHU of Liège, Liege, Belgium.
| | - Myriam Labopin
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Service d'Hématologie Clinique, Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs 938, Paris, France.,Sorbonne University, Paris, France
| | - Johanna Tischer
- University Hospital of Munich - Campus Grosshadern, LMU, Department of Internal Medicine III, München, Germany
| | - Fabio Ciceri
- IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Didier Blaise
- Programme de Transplantation &Therapie Cellulaire, Département d'hématologie Centre de Recherche en Cancérologie de Marseille, Aix-Marseille University, Institut Paoli Calmettes, Marseille, France
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Renato Fanin
- Division of Hematology, University Hospital and DAME, Udine, Italy
| | - Jose Luis Diez-Martin
- Head of Hematology Department, Hospital G U Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañon, Medicine Dpt. UCM, Madrid, Spain
| | - Claude Eric Bulabois
- CHU Grenoble Alpes - Université Grenoble Alpes, Service d'Hématologie, CS, 10217, Grenoble, France
| | - Friedrich Stölzel
- Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, TU Dresden, Dresden, Germany
| | - Alessandro Busca
- S.S.C.V.D Trapianto di Cellule Staminali A.O.U Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Pavel Jindra
- Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | - Yener Koc
- Medicana International Hospital Istanbul, Bone Marrow Transplant Unit, Istanbul, Turkey
| | | | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | - Wolf Rösler
- Department of Internal Medicine 5, University Hospital Erlangen, Erlangen, Germany
| | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Angelo Michele Carella
- Ematologia e Centro Trapianti CSE Dipartimento di Scienze Mediche Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pietro Pioltelli
- Ospedale San Gerardo, Clinica Ematologica dell'Universita Milano-Biocca, Monza, Italy
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mohamad Mohty
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Service d'Hématologie Clinique, Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs 938, Paris, France.,Sorbonne University, Paris, France
| |
Collapse
|
7
|
Nagler A, Labopin M, Dholaria B, Ciceri F, Fraccaroli A, Blaise D, Fanin R, Bruno B, Forcade E, Vydra J, Chevallier P, Bulabois CE, Jindra P, Bornhäuser M, Canaani J, Sanz J, Savani BN, Spyridonidis A, Giebel S, Brissot E, Bazarbachi A, Esteve J, Mohty M. Impact of Cytogenetic Risk on Outcomes of Non-T-Cell–Depleted Haploidentical Hematopoietic Cell Transplantation in Patients with Relapsed or Refractory Acute Myeloid Leukemia. Transplant Cell Ther 2022; 28:773.e1-773.e8. [DOI: 10.1016/j.jtct.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
|
8
|
Drozd-Sokołowska J, Gras L, Zinger N, Snowden JA, Arat M, Basak G, Pouli A, Crawley C, Wilson KMO, Tilly H, Byrne J, Bulabois CE, Passweg J, Ozkurt ZN, Schroyens W, Lioure B, Colorado Araujo M, Poiré X, Van Gorkom G, Gurman G, de Wreede LC, Hayden PJ, Beksac M, Schönland SO, Yakoub-Agha I. Autologous hematopoietic cell transplantation for relapsed multiple myeloma performed with cells procured after previous transplantation-study on behalf of CMWP of the EBMT. Bone Marrow Transplant 2022; 57:633-640. [PMID: 35169284 PMCID: PMC8993690 DOI: 10.1038/s41409-022-01592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/23/2021] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
Abstract
Autologous hematopoietic cell transplantation (auto-HCT) may be performed in multiple myeloma (MM) patients relapsing after a previous auto-HCT. For those without an adequate dose of stored stem cells, remobilization is necessary. This retrospective study included patients who, following disease relapse after the first auto-HCT(s), underwent stem cell remobilization and auto-HCT performed using these cells. There were 305 patients, 68% male, median age at salvage auto-HCT was 59 years. The median time to relapse after the first-line penultimate auto-HCT(s) was 30.6 months, the median follow-up after salvage auto-HCT 31 months. The 2- and 4-year non-relapse mortality (NRM) after the salvage auto-HCT was 5 and 9%, the relapse incidence 56 and 76%, respectively. Overall survival (OS) after 2 and 4 years was 76 and 52%, progression-free survival (PFS) 39 and 15%. In multivariable analysis an increasing interval between the penultimate auto-HCT and relapse was associated with better OS and PFS, later calendar year of salvage auto-HCT with better OS. In conclusion, salvage auto-HCT performed with cells remobilized after a previous auto-HCT was associated with acceptable NRM. The leading cause of failure was disease progression of MM, which correlated with a shorter interval from the penultimate auto-HCT to the first relapse.
Collapse
Affiliation(s)
| | - Luuk Gras
- EBMT Statistical Unit Data Office, Leiden, the Netherlands
| | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Mutlu Arat
- Florence Nightingale Sisli Hospital, Istanbul, Turkey
| | - Grzegorz Basak
- Central Clinical Hospital, The Medical University of Warsaw, Warsaw, Poland
| | - Anastasia Pouli
- Haematology Department, "St Savvas" Oncology Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | - Bruno Lioure
- Techniciens d'Etude Clinique suivi de patients greffes, Strasbourg, France
| | | | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | | | - Gunhan Gurman
- Ankara University Faculty of Medicine, Ankara, Turkey
| | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Patrick J Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - Meral Beksac
- Ankara University Faculty of Medicine, Ankara, Turkey
| | - Stefan O Schönland
- Medizinische Klinik u. Poliklinik V, University of Heidelberg, Heidelberg, Germany.
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000 Lille, Lille, France
| |
Collapse
|
9
|
Pochon C, Detrait M, Dalle JH, Michel G, Dhédin N, Chalandon Y, Brissot E, Forcade E, Sirvent A, Izzadifar-Legrand F, Michallet M, Renard C, Yakoub-Agha I, Gonzales F, Bay JO, Kanold J, Cornillon J, Bulabois CE, Angoso M, Nguyen S, Balza M, Chevallier P, Rialland F, Bazarbachi A, Beguin Y, Huynh A, Ménard AL, Schneider P, Neven B, Paillard C, Raus N, Albuisson E, Remen T, Rubio MT. Improved outcome in children compared to adolescents and young adults after allogeneic hematopoietic stem cell transplant for acute myeloid leukemia: a retrospective study from the Francophone Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC). J Cancer Res Clin Oncol 2021; 148:2083-2097. [PMID: 34480598 PMCID: PMC9293841 DOI: 10.1007/s00432-021-03761-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022]
Abstract
Background There are currently few data on the outcome of acute myeloid leukemia (AML) in adolescents after allogeneic HSCT. The aim of this study is to describe the outcome and its specific risk factors for children, adolescents and young adults after a first allogeneic HSCT for AML. Methods In this retrospective study, we compared the outcome of AML patients receiving a first allogeneic HSCT between 2005 and 2017 according to their age at transplantation’s time: children (< 15 years, n = 564), adolescent and post-adolescent (APA) patients (15–25 years, n = 647) and young adults (26–40 years; n = 1434). Results With a median follow-up of 4.37 years (min–max 0.18–14.73 years), the probability of 2-year overall survival (OS) was 71.4% in children, 61.1% in APA patients and 62.9% in young adults (p = 0.0009 for intergroup difference). Both relapse and non-relapse mortality (NRM) Cumulative Incidence (CI) estimated at 2 years were different between the age groups (30.8% for children, 35.2% for APA patients and 29.4% for young adults—p = 0.0254, and 7.0% for children, 10.6% for APA patients and 14.2% for young adults, p < 0.0001; respectively). Whilst there was no difference between the three groups for grade I to IV acute GVHD CI at 3 months, the chronic GVHD CI at 2 years was higher in APA patients and young adults (31.4% and 36.4%, respectively) in comparison to the children (17.5%) (p < 0.0001). In multivariable analysis, factors associated with death were AML cytogenetics (HR1.73 [1.29–2.32] for intermediate risk 1, HR 1.50 [1.13–2.01] for intermediate risk 2, HR 2.22 [1.70–2.89] for high cytogenetics risk compared to low risk), use of TBI ≥ 8 Grays (HR 1.33 [1.09–1.61]), disease status at transplant (HR 1.40 [1.10–1.78] for second Complete Remission (CR), HR 2.26 [1.02–4.98] for third CR and HR 3.07 [2.44–3.85] for active disease, compared to first CR), graft source (HR 1.26 [1.05–1.50] for Peripheral Blood Stem Cells compared to Bone Marrow) and donor age (HR 1.01 (1–1.02] by increase of 1 year). Conclusion Age is an independent risk factor for NRM and extensive chronic GVHD. This study suggests that APA patients with AML could be beneficially treated with a chemotherapy-based MAC regimen and bone marrow as a stem cells source. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03761-w.
Collapse
Affiliation(s)
- Cécile Pochon
- CHRU de Nancy, hôpitaux de Brabois, service d'oncohématologie pédiatrique, 54500, Vandœuvre-lès-Nancy, France.
| | - Marie Detrait
- CHRU de Nancy, hôpitaux de Brabois, service d'hématologie, 54500, Vandœuvre-lès-Nancy, France.,Biopôle de l'université de Lorraine, UMR 7365 CNRS-UL, IMoPa, 54500, Vandœuvre-lès-Nancy, France
| | - Jean-Hugues Dalle
- Hôpital Robert-Debré, Université Paris, département d'hémato-immunologie pédiatrique7-Paris Diderot, 5, rue Thomas-Mann, 75013, Paris, France
| | - Gérard Michel
- Pediatric Hematology Department, Hopital de La Timone, Marseille, France
| | - Nathalie Dhédin
- Unité d'Hématologie-Adolescents et jeunes adultes, Hôpital Saint-Louis, EA-3518, Université Paris, 7-Denis Diderot, Paris, France
| | - Yves Chalandon
- Service d'Hématologie, Hôpitaux Universitaires de Genève, Université de Genève, 4, rue Gabrielle-Perret-Gentil, 1211 Genève and faculté de médecine, Geneva, Switzerland
| | - Eolia Brissot
- Service d'Hematologie Clinique, Saint-Antoine Hospital, AP-HP, Sorbonne University, and INSERM UMRs 938, Paris, France
| | - Edouard Forcade
- CHU Bordeaux, service d'hematologie et therapie Cellulaire, 33000, Bordeaux, France
| | - Anne Sirvent
- Hôpital Arnaud-de-Villeneuve, service d'onco-hématologie pédiatrique, 371, avenue du Doyen-Gaston-Giraud, 34090, Montpellier, France
| | - Faezeh Izzadifar-Legrand
- Institut Paoli-Calmette, unité de greffe, 232, boulevard de Sainte-Marguerite, 13009, Marseille, France
| | | | - Cécile Renard
- Institute of Hematology and Oncology Paediatrics, Hospices Civils de Lyon, Lyon, France
| | - Ibrahim Yakoub-Agha
- CHRU de Lille, unité d'allogreffe de CSH, maladies du sang, 59037, Lille, France.,Université de Lille 2, Inserm U995, LIRIC, 59000, Lille, France
| | - Fanny Gonzales
- CHU de Lille, hématologie pédiatrique, 59000, Lille, France
| | | | - Justyna Kanold
- Department of Pediatric Oncology and Hematology, Hôpital Estaing, Clermont-Ferrand, France
| | - Jérome Cornillon
- Institut de Cancérologie Lucien-Neuwirth, département d'hématologie clinique, 108 Bis, avenue Albert-Raimond, 42271, St-Priest-en-Jarez, France
| | | | - Marie Angoso
- Hôpital d'enfants, unité d'hématologie oncologie pédiatrique, place Amélie-Raba-Léon, 33000, Bordeaux, France
| | - Stéphanie Nguyen
- Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, centre d'immunologie et des maladies infectieuses (CIMI-Paris), service d'hématologie clinique, UPMC CR7, CNRS ERL8255, Inserm U1135, 75013, Paris, France
| | - Marie Balza
- Hematology Department, HCL, Hôpitaux Lyon-Sud, Pierre-Bénite, France
| | | | - Fanny Rialland
- Pediatric Hematology Department, CHU de Nantes, Nantes, France
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beyrouth, Lebanon
| | - Yves Beguin
- Department of Haematology, CHU and University of Liège, Liège, Belgium
| | - Anne Huynh
- Institut Universitaire du Cancer, Toulouse, France
| | - Anne-Lise Ménard
- Centre Henri-Becquerel, département d'hématologie clinique, rue d'Amiens, 76038, Rouen, France
| | - Pascale Schneider
- Service d'hémato-oncologie pédiatrie, Hôpital Charles-Nicolle, CHU, 1, rue Germont, 76031, Rouen cedex, France
| | - Bénédicte Neven
- Service d'immuno-Hématologie Pédiatrique, Hôpital Necker-Enfants-Malades, 149-161, rue de Sèvres, 75743, Paris Cedex 15, France
| | - Catherine Paillard
- Department of Haematology, Hôpital de Haute-Pierre, 67200, Strasbourg, France
| | - Nicole Raus
- Data Management of SFGMT-TC, HCL, Hôpitaux Lyon Sud, Pierre Bénite, France
| | - Eliane Albuisson
- CHRU-Nancy, DRCI, Département MPI, Unité de Méthodologie, Data Management et Statistique UMDS, 54000, Nancy, France
| | - Thomas Remen
- CHRU-Nancy, DRCI, Département MPI, Unité de Méthodologie, Data Management et Statistique UMDS, 54000, Nancy, France
| | - Marie-Thérèse Rubio
- CHRU de Nancy, hôpitaux de Brabois, service d'hématologie, 54500, Vandœuvre-lès-Nancy, France.,Biopôle de l'université de Lorraine, UMR 7365 CNRS-UL, IMoPa, 54500, Vandœuvre-lès-Nancy, France
| |
Collapse
|
10
|
Bazarbachi AH, Labopin M, Kröger N, Brecht A, Blaise D, Clausen J, Fanin R, Einsele H, Cavanna L, Itäla-Remes M, Bulabois CE, Kündgen L, Martin H, Schmid C, Wagner-Drouet EM, Alakel N, Bazarbachi A, Savani B, Nagler A, Mohty M. Predictive Factors for Outcome of First Allogeneic Transplant for Elderly Patients With Acute Lymphoblastic Leukemia. Clin Lymphoma Myeloma Leuk 2021; 21:831-840. [PMID: 34373225 DOI: 10.1016/j.clml.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION/BACKGROUND The treatment of acute lymphoblastic leukemia (ALL) in patients older than 70 is extremely challenging with dismal outcome. Allogeneic stem cell transplantation (alloHCT) has seen many advancements in the last decades showing benefits in younger ALL patients, but this treatment modality is decreasingly used with increasing age due to high treatment-related mortality. PATIENTS AND METHODS We identified 84 ALL patients 70 to 84 years old allografted In 2002 to 2019 from a matched related (23%), unrelated (58%), haploidentical (17%), or cord blood (2%) donor at EBMT participating centers with a median follow-up of 23 months. RESULTS The 2-year relapse incidence (RI) and non-relapse mortality were 37% and 28%, respectively, and 2-year leukemia-free survival (LFS), overall survival (OS) and GVHD-free, relapse-free survival (GRFS) were 35%, 39% and 23%, respectively. The strongest predictor of outcome was disease status at transplant whereby patients in first complete remission (CR1) had >50% 2-year OS, reflected in multivariate analysis (MVA) with significant improvement in RI, LFS, and GRFS (HR 0.23, 0.49, and 0.54, respectively). Furthermore, karnofsky score ≥90 reflective of good functional status positively influenced non-relapse mortality in both univariate and MVA (HR 0.37), and interestingly, donor CMV positivity appeared to negatively affect RI, LFS and OS in univariate analysis and RI in MVA (HR 2.87). CONCLUSION Our data suggest that alloHCT is an option for elderly ALL patients, particularly those carefully selected and transplanted in CR1 especially if failed or without access to novel non-chemotherapy-based approaches.
Collapse
Affiliation(s)
- Abdul Hamid Bazarbachi
- Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France; Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Myriam Labopin
- Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne Brecht
- German Clinic for Diagnistics, KMT Zentrum, Wiesbaden, Germany
| | - Didier Blaise
- Departement D'Hematologie, Programme de Transplantation et de Therapie Cellulaire, Centre de Recherche en Cancerologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Johannes Clausen
- Department of Internal Medicine I, Ordensklinikum Linz -Elisabethinen, Linz, Austria
| | - Renato Fanin
- Clinica Ematologica, Azienda sanitaria Universitaria Integrata, DAMe, Università di Udine, Udine, Italy
| | - Herman Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Germany
| | - Luigi Cavanna
- Departments of Oncology-Hematology, Ospedale "G. da Saliceto", Piacenza, Italy.
| | - Maija Itäla-Remes
- Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | | | - Lukas Kündgen
- Department of Hematology and Oncology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Hans Martin
- Department of Medicine II, Goethe University, Frankfurt, Germany
| | - Christof Schmid
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Eva Maria Wagner-Drouet
- 3rd Medical Department, Hematology, Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Nael Alakel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France.
| |
Collapse
|
11
|
Bouvier A, Hamel JF, Delaunay J, Delabesse E, Dumas PY, Ledoux MP, Peterlin P, Luquet I, Roth Guepin G, Bulabois CE, Gallego Hernanz MP, Guillerm G, Guieze R, Hicheri Y, Simand C, Himberlin C, Hunault-Berger M, Bernard M, Jourdan E, Caillot D, Dorvaux V, Tavernier E, Daguindau E, Banos A, Ojeda-Uribe M, Gyan E, Alexis M, Marolleau JP, Turlure P, Bouscary D, Humbrecht C, Zerazhi H, Béné MC, Pigneux A, Carre M, Ifrah N, Blanchet O, Vey N, Récher C, Cornillet-Lefèbvre P. Molecular classification and prognosis in younger adults with acute myeloid leukemia and intermediate-risk cytogenetics treated or not by gemtuzumab ozogamycin: Final results of the GOELAMS/FILO acute myeloid leukemia 2006-intermediate-risk trial. Eur J Haematol 2021; 107:111-121. [PMID: 33765335 DOI: 10.1111/ejh.13626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022]
Abstract
In this randomized phase 3 study, the FILO group tested whether the addition of 6 mg/m2 of gemtuzumab ozogamycin (GO) to standard chemotherapy could improve outcome of younger patients with de novo acute myeloid leukemia (AML) and intermediate-risk cytogenetics. GO arm was prematurely closed after 254 inclusions because of toxicity. A similar complete remission rate was observed in both arms. Neither event-free survival nor overall survival were improved by GO in younger AML patients (<60 years) ineligible for allogeneic stem-cell transplantation. (P = .086; P = .149, respectively). Using unsupervised hierarchical clustering based on mutational analysis of seven genes (NPM1, FLT3-ITD, CEBPA, DNMT3A, IDH1, IDH2, and ASXL1), six clusters of patients with significant different outcome were identified. Five clusters were based on FLT3-ITD, NPM1, and CEBPA mutations as well as epigenetic modifiers (DNMT3A, IDH1/2, ASXL1), whereas the last cluster, representing 25% of patients, had no mutation and intermediate risk. One cluster isolated FLT3-ITD mutations with higher allelic ratio and a very poor outcome. The addition of GO had no impact in these molecular clusters. Although not conclusive for GO impact in AML patients <60 years, this study provides a molecular classification that distinguishes six AML clusters influencing prognosis in younger AML patients with intermediate-risk cytogenetic.
Collapse
Affiliation(s)
- Anne Bouvier
- Hématologie Biologique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Jean-François Hamel
- Departement de Biostatistiques, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Jacques Delaunay
- Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Eric Delabesse
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Pierre-Yves Dumas
- Hématologie Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marie-Pierre Ledoux
- Hématologie Clinique, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Pierre Peterlin
- Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Isabelle Luquet
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Claude Eric Bulabois
- Hématologie Clinique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | | | - Gaëlle Guillerm
- Hématologie Clinique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Romain Guieze
- Hématologie Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Yosr Hicheri
- Hématologie Clinique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Célestine Simand
- Hématologie Clinique, Institut cancérologique de Strasbourg Europe, Strasbourg, France
| | - Chantal Himberlin
- Hématologie Clinique, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Mathilde Hunault-Berger
- Hématologie clinique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Inserm, CRCINA, Angers, France
| | - Marc Bernard
- Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Eric Jourdan
- Hématologie Clinique, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Denis Caillot
- Hématologie Clinique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Véronique Dorvaux
- Hématologie Clinique, Centre Hospitalier Régional de Metz, Metz, France
| | | | - Etienne Daguindau
- Hématologie Clinique, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Anne Banos
- Hématologie Clinique, Centre Hospitalier Côte Basque, Bayonne, France
| | - Mario Ojeda-Uribe
- Hématologie Clinique, Centre Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Emmanuel Gyan
- Service d'Hématologie et thérapie cellulaire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Magda Alexis
- Hématologie Clinique, Centre Hospitalier Régional Orléans, Orléans, France
| | | | - Pascal Turlure
- Hématologie Clinique, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | | | - Hacène Zerazhi
- Hématologie Clinique, Centre Hospitalier d'Avignon, Avignon, France
| | - Marie-Christine Béné
- Hématologie Biologique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Arnaud Pigneux
- Hématologie Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Martin Carre
- Hématologie Clinique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Norbert Ifrah
- Hématologie clinique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Inserm, CRCINA, Angers, France
| | - Odile Blanchet
- Hématologie Biologique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Norbert Vey
- Hématologie Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Christian Récher
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | | |
Collapse
|
12
|
Cleuziou JP, Desgranges C, Henry I, Jaumot M, Chartier P, Sihanath R, Carré M, Bulabois CE, Cahn JY, Pasteris C, Balosso J, Gabelle-Flandin I, Verry C, Giraud JY. Total body irradiation using helical tomotherapy: Set-up experience and in-vivo dosimetric evaluation. Cancer Radiother 2021; 25:213-221. [PMID: 33402290 DOI: 10.1016/j.canrad.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Helical Tomotherapy (HT) appears as a valuable technique for total body irradiation (TBI) to create highly homogeneous and conformal dose distributions with more precise repositioning than conventional TBI techniques. The aim of this work is to describe the technique implementation, including treatment preparation, planning and dosimetric monitoring of TBI delivered in our institution from October 2016 to March 2019. MATERIAL AND METHOD Prior to patient care, irradiation protocol was set up using physical phantoms. Gafchromic films were used to assess dose distribution homogeneity and evaluate imprecise patient positioning impact. Sixteen patients' irradiations with a prescribed dose of 12Gy were delivered in 6 fractions of 2Gy over 3 days. Pre-treatment quality assurance (QA) was performed for the verification of dose distributions at selected positions. In addition, in-vivo dosimetry was carried out using optically stimulated luminescence dosimeters (OSLD). RESULTS Planning evaluation, as well as results of pre-treatment verifications, are presented. In-vivo dosimetry showed the strong consistency of OSLD measured doses. OSLD mean relative dose differences between measurement and calculation were respectively +0,96% and -2% for armpit and hands locations, suggesting better reliability for armpit OSLD positioning. Repercussion of both longitudinal and transversal positioning inaccuracies on phantoms is depicted up to 2cm shifts. CONCLUSION The full methodology to set up TBI protocol, as well as dosimetric evaluation and pre-treatment QA, were presented. Our investigations reveal strong correspondence between planned and delivered doses shedding light on the dose reliability of OSLD for HT based TBI in-vivo dosimetry.
Collapse
Affiliation(s)
- J-P Cleuziou
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - C Desgranges
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - I Henry
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - M Jaumot
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - P Chartier
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - R Sihanath
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - M Carré
- Service d'hématologie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - C E Bulabois
- Service d'hématologie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - J-Y Cahn
- Service d'hématologie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - C Pasteris
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - J Balosso
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - I Gabelle-Flandin
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - C Verry
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France
| | - J-Y Giraud
- Service de radiothérapie, centre hospitalier universitaire Grenoble-Alpes (CHUGA), CS 10217, Grenoble cedex 9, France.
| |
Collapse
|
13
|
Paviglianiti A, Labopin M, Blaise D, Socié G, Bulabois CE, Lioure B, Ceballos P, Blau IW, Guillerm G, Maertens J, Chevallier P, Huynh A, Turlure P, Deconinck E, Forcade E, Nagler A, Mohty M. Comparison of mycophenolate mofetil and calcineurin inhibitor versus calcineurin inhibitor-based graft-versus-host-disease prophylaxis for matched unrelated donor transplant in acute myeloid leukemia. A study from the ALWP of the EBMT. Bone Marrow Transplant 2020; 56:1077-1085. [PMID: 33249424 DOI: 10.1038/s41409-020-01155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/13/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022]
Abstract
The association of Cyclosporine A (CsA) and mycophenolate mofetil (MMF) has increased in the setting of reduced intensity conditioning (RIC). Nevertheless, the use of CsA or CsA+MMF has not been reported in a large and uniform cohort. We analyzed 497 patients with acute myeloid leukemia in complete remission (CR) who underwent matched unrelated donor (MUD) hematopoietic stem cell transplantation (HSCT). All patients received a fludarabine busulfan RIC regimen and anti-thymocyte globulin (ATG) with either CsA alone or in combination with MMF. The cumulative incidence (CI) of grade II-IV acute GvHD was 27% (95% CI 21-33%) for CsA and 33% (95% CI 27-38%) for CsA+MMF (p = 0.25). The 2-year CI of chronic GvHD was 38% (95% CI 31-45%) and 33% (95% CI 28-39%) for the CsA and the CsA+MMF group, respectively (p = 0.26). On multivariate analysis, no statistically significant differences with respect to relapse incidence (RI), non-relapse mortality (NRM), leukemia-free survival (LFS), overall survival (OS), acute and chronic GvHD were found between the two groups, also when conducting a subgroup analysis in peripheral blood stem cells (PBSC) recipients. Our results support the importance of randomized trial to identify patients who could benefit from the addition of MMF in MUD HSCT.
Collapse
Affiliation(s)
- Annalisa Paviglianiti
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France.
| | - Myriam Labopin
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France
| | - Didier Blaise
- Programme de Transplantation & Thérapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Gerard Socié
- Hopital St. Louis, Department of Hematology - BMT, Paris, France
| | - Claude Eric Bulabois
- CHU Grenoble Alpes - Université Grenoble Alpes, Service d'Hématologie, Grenoble, France
| | - Bruno Lioure
- Hopital de Hautepierre, CHU de Strasbourg, Service Hématologie adulte, F-67200, Strasbourg, France
| | - Patrice Ceballos
- CHU Lapeyronie, Département d'Hématologie Clinique, Montpellier, France
| | - Igor Wolfgang Blau
- Charité Universitaetsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Hämatologie/Onkologie, Berlin, Germany
| | | | - Johan Maertens
- University Hospital Gasthuisberg, Department of Hematology, Leuven, Belgium
| | | | - Anne Huynh
- CHU - Institut Universitaire du Cancer Toulouse, Oncopole, I.U.C.T-O, Toulouse, France
| | - Pascal Turlure
- CHRU Limoges Service d'Hématologie Clinique, Limoges, France
| | - Eric Deconinck
- Hopital Jean Minjoz, Service d'Hématologie, Besancon, France
| | - Edouard Forcade
- CHU Bordeaux, Service d'hematologie et thérapie Cellulaire, F-, 33000, Bordeaux, France
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel.,Acute Leukemia Working Party Office, Paris, France
| | - Mohamad Mohty
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France
| |
Collapse
|
14
|
Bazarbachi A, Labopin M, Blaise D, Forcade E, Socié G, Berceanu A, Angelucci E, Bulabois CE, Kröger N, Rambaldi A, Ceballos P, Mielke S, El Cheikh J, Yakoub-Agha I, Savani B, Spyridonidis A, Nagler A, Mohty M. Comparable outcomes of haploidentical transplant with TBF conditioning versus matched unrelated donor with fludarabine/busulfan conditioning for acute myeloid leukemia. Bone Marrow Transplant 2020; 56:622-634. [PMID: 33020591 DOI: 10.1038/s41409-020-01074-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/09/2022]
Abstract
We compared transplant outcomes of 708 acute myeloid leukemia (AML) patients receiving haploidentical allogeneic hematopoietic-cell transplantation using thiotepa/busulfan/fludarabine (TBF) conditioning with posttransplant cyclophosphamide (ptCy), to 2083 patients receiving matched unrelated donor (MUD) transplantation using fludarabine/busulfan (FB) conditioning and in vivo T-cell depletion. For intermediate cytogenetic risk AML transplanted in first complete remission (CR1), multivariate analysis revealed that haplo-TBF significantly increased nonrelapse mortality (NRM) (HR 2.1; p = 0.0006) but did not affect relapse incidence (RI), leukemia-free survival (LFS), overall survival (OS), or graft-versus-host disease-free, relapse-free survival (GRFS). For high cytogenetic risk AML transplanted in CR1, haplo-TBF significantly increased NRM (HR = 2.7; p = 0.02), decreased RI (HR = 0.45; p = 0.03) but had no influence on LFS, OS, or GRFS. For AML transplanted in CR2, haplo-TBF significantly increased NRM (HR = 2.36; p = 0.008), decreased RI (HR = 0.38; p = 0.005), but had no influence on LFS, OS, or GRFS. Finally, for AML patients transplanted with active disease, haplo-TBF had no influence on transplant outcomes. In conclusion, compared to MUD-FB, haplo-TBF increased NRM, reduced RI in high-risk AML in CR, resulting in similar LFS, OS, and GRFS. These results comparing two different approaches support the use of a haploidentical family donor for high-risk AML patients lacking a matched sibling donor.
Collapse
Affiliation(s)
- Ali Bazarbachi
- Bone Marrow Transplant Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Myriam Labopin
- Department of Haematology and EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, INSERM UMR 938, Université Pierre et Marie Curie, Paris, France
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Edouard Forcade
- CHU Bordeaux, service d'hematologie et therapie Cellulaire, F-33000, Bordeaux, France
| | - Gerard Socié
- Department of Hematology-BMT, Hopital St. Louis, Paris, France
| | - Ana Berceanu
- Service d'Hématologie, Hopital Jean Minjoz, Besancon, France
| | - Emanuele Angelucci
- Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Claude Eric Bulabois
- Service d'Hématologie, CHU Grenoble Alpes-Université Grenoble Alpes, Grenoble, France
| | - Nicolaus Kröger
- Bone Marrow Transplantation Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Alessandro Rambaldi
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Patrice Ceballos
- Département d'Hématologie Clinique, 11 CHU Saint Eloi, Unité de Greffes Hématologiques, Montpellier, France
| | - Stephan Mielke
- Department of Laboratory Medicine, CAST, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Jean El Cheikh
- Bone Marrow Transplant Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Bipin Savani
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Arnon Nagler
- Chaim Sheba Medical Center, Tel Aviv University, Tel HaShomer, Israel
| | - Mohamad Mohty
- Department of Haematology and EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, INSERM UMR 938, Université Pierre et Marie Curie, Paris, France.
| |
Collapse
|
15
|
Brissot E, Labopin M, Moiseev I, Cornelissen JJ, Meijer E, Van Gorkom G, Rovira M, Ciceri F, Griskevicius L, Blaise D, Forcade E, Mistrik M, Mielke S, Bulabois CE, Niittyvuopio R, Deconinck E, Ruggeri A, Sanz J, Spyridonidis A, Savani B, Giebel S, Nagler A, Mohty M. Post-transplant cyclophosphamide versus antithymocyte globulin in patients with acute myeloid leukemia in first complete remission undergoing allogeneic stem cell transplantation from 10/10 HLA-matched unrelated donors. J Hematol Oncol 2020; 13:87. [PMID: 32620146 PMCID: PMC7333262 DOI: 10.1186/s13045-020-00923-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Graft-versus-host disease (GVHD) remains a major contributor to mortality and morbidity after allogeneic stem-cell transplantation (allo-HSCT). The updated recommendations suggest that rabbit antithymocyte globulin or anti-T-lymphocyte globulin (ATG) should be used for GVHD prophylaxis in patients undergoing matched-unrelated donor (MUD) allo-HSCT. More recently, using post-transplant cyclophosphamide (PTCY) in the haploidentical setting has resulted in low incidences of both acute (aGVHD) and chronic GVHD (cGVHD). Therefore, the aim of our study was to compare GVHD prophylaxis using either PTCY or ATG in patients with acute myeloid leukemia (AML) who underwent allo-HSCT in first remission (CR1) from a 10/10 HLA-MUD. METHODS Overall, 174 and 1452 patients from the EBMT registry receiving PTCY and ATG were included. Cumulative incidence of aGVHD and cGVHD, leukemia-free survival, overall survival, non-relapse mortality, cumulative incidence of relapse, and refined GVHD-free, relapse-free survival were compared between the 2 groups. Propensity score matching was also performed in order to confirm the results of the main analysis RESULTS: No statistical difference between the PTCY and ATG groups was observed for the incidence of grade II-IV aGVHD. The same held true for the incidence of cGVHD and for extensive cGVHD. In univariate and multivariate analyses, no statistical differences were observed for all other transplant outcomes. These results were also confirmed using matched-pair analysis. CONCLUSION These results highlight that, in the10/10 HLA-MUD setting, the use of PTCY for GVHD prophylaxis may provide similar outcomes to those obtained with ATG in patients with AML in CR1.
Collapse
Affiliation(s)
- Eolia Brissot
- Sorbonne Université, AP-HP, INSERM UMRs938, Paris, France.
- Service d'Hématologie clinique et de Thérapie cellulaire, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint Antoine, 75012, Paris, France.
| | - Myriam Labopin
- European Society for Blood and Marrow Transplantation Paris Study Office/CEREST-TC, Paris, France
| | - Ian Moiseev
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russian Federation
| | - J J Cornelissen
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ellen Meijer
- Amsterdam University Medical Center, VU Medical Center, Department of Hematology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Gwendolyn Van Gorkom
- Dept. Internal Medicine, Hematology/Oncology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Montserrat Rovira
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Laimonas Griskevicius
- Hematology, Oncology & Transfusion Center, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Didier Blaise
- Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | | | - Martin Mistrik
- Department of Haematology and Transfusion Medicine, University Hospital and Comenius University, Bratislava, Slovak Republic
| | - Stephan Mielke
- Department of Internal Medicine II, University Hospital of Würzburg, Oberdürrbacher Str. 6, D-97080, Würzburg, Germany
| | | | - Riitta Niittyvuopio
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Eric Deconinck
- Service d'Hématologie, Hopital Jean Minjoz, Besançon, France
| | - Annalisa Ruggeri
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Jaime Sanz
- Department of Haematology, University Hospital La Fe, University of Valencia, Valencia, Spain
- Department of Haematology, Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Alexandros Spyridonidis
- Department of Internal Medicine, Bone Marrow Transplantation Unit, University Hospital of Patras, Patras, Greece
| | - Bipin Savani
- Long Term Transplant Clinic, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cencer Center and Institute of Oncology, Gliwice, Poland
| | - Arnon Nagler
- Hematology Division, BMT and Cord Blood Bank, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- Sorbonne Université, AP-HP, INSERM UMRs938, Paris, France
- Service d'Hématologie clinique et de Thérapie cellulaire, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint Antoine, 75012, Paris, France
| |
Collapse
|
16
|
Michallet M, Sobh M, Garban F, Bulabois CE, Yakoub-Agha I, Coiteux V, Dulery R, Rohrlich PS, Legrand F, Clement L, Praire A, Detrait M, Barraco F, Nicolini FE, Hequet O. Extracorporeal photopheresis for GVHD prophylaxis after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation: a prospective multicenter phase 2 study. Leuk Lymphoma 2017; 59:372-380. [PMID: 28587506 DOI: 10.1080/10428194.2017.1334120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We performed a prospective multicenter phase 2 study to evaluate the safety and efficacy of prophylactic Extracorporeal Photopheresis (ECP) in adult patients with hematological malignancies early after RIC allo-HSCT on day 21 twice per week during the first two weeks and then once per week for the next four weeks for a total of eight ECP courses. A total of 20 patients were included; 10 were males, median age was 60 years. All patients engrafted, 17 (85%) received the total eight ECP courses. There were no adverse effects related to ECP. Seven patients developed acute graft-versus-host disease (GVHD), with 15% grade ≥ II cumulative incidence at day 100. The cumulative incidence of chronic GVHD at 2 years was 22%. The 2 years probability of overall survival (OS) and progression-free survival (PFS) were 84 and 74%, respectively. This study shows encouraging results with low acute and chronic GVHD incidence and no interference with graft-versus-leukemia (GVL) effect.
Collapse
Affiliation(s)
- Mauricette Michallet
- a Hematology Department 1G , Centre Hospitalier Lyon Sud , Pierre Benite , France
| | - Mohamad Sobh
- a Hematology Department 1G , Centre Hospitalier Lyon Sud , Pierre Benite , France
| | - Frederic Garban
- b Hematology Department , CHU de Grenoble , Grenoble , France
| | | | - Ibrahim Yakoub-Agha
- c Service des Maladies du Sang , Hopital Claude Huriez, CHRU Lille , Lille , France
| | - Valerie Coiteux
- c Service des Maladies du Sang , Hopital Claude Huriez, CHRU Lille , Lille , France
| | - Remy Dulery
- c Service des Maladies du Sang , Hopital Claude Huriez, CHRU Lille , Lille , France
| | | | | | | | - Aline Praire
- a Hematology Department 1G , Centre Hospitalier Lyon Sud , Pierre Benite , France
| | - Marie Detrait
- a Hematology Department 1G , Centre Hospitalier Lyon Sud , Pierre Benite , France
| | - Fiorenza Barraco
- a Hematology Department 1G , Centre Hospitalier Lyon Sud , Pierre Benite , France
| | | | - Olivier Hequet
- f Blood Bank Center , Centre Hospitalier Lyon Sud , Pierre Benite , France
| |
Collapse
|
17
|
Rio B, Chevret S, Vigouroux S, Chevallier P, Fürst S, Sirvent A, Bay JO, Socié G, Ceballos P, Huynh A, Cornillon J, Françoise S, Legrand F, Yakoub-Agha I, Michel G, Maillard N, Margueritte G, Maury S, Uzunov M, Bulabois CE, Michallet M, Clement L, Dauriac C, Bilger K, Gluckman E, Ruggeri A, Buzyn A, Nguyen S, Simon T, Milpied N, Rocha V. Decreased nonrelapse mortality after unrelated cord blood transplantation for acute myeloid leukemia using reduced-intensity conditioning: a prospective phase II multicenter trial. Biol Blood Marrow Transplant 2014; 21:445-53. [PMID: 25460357 DOI: 10.1016/j.bbmt.2014.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/07/2014] [Indexed: 01/27/2023]
Abstract
A prospective phase II multicenter trial was performed with the aim to obtain less than 25% nonrelapse mortality (NRM) after unrelated cord blood transplantation (UCBT) for adults with acute myeloid leukemia (AML) using a reduced-intensity conditioning regimen (RIC) consisting of total body irradiation (2 Gy), cyclophosphamide (50 mg/kg), and fludarabine (200 mg/m(2)). From 2007 to 2009, 79 UCBT recipients were enrolled. Patients who underwent transplantation in first complete remission (CR1) (n = 48) had a higher frequency of unfavorable cytogenetics and secondary AML and required more induction courses of chemotherapy to achieve CR1 compared with the others. The median infused total nucleated cells (TNC) was 3.4 × 10(7)/kg, 60% received double UCBT, 77% were HLA mismatched (4/6), and 40% had major ABO incompatibility. Cumulative incidence of neutrophil recovery at day 60 was 87% and the cumulative incidence of 100-day acute graft-versus-host disease (II to IV) was 50%. At 2 years, the cumulative incidence of NRM and relapse was 20% and 46%, respectively. In multivariate analysis, major ABO incompatibility (P = .001) and TNC (<3.4 × 10(7)/kg; P = .001) were associated with increased NRM, and use of 2 or more induction courses to obtain CR1 was associated with increased relapse incidence (P = .04). Leukemia-free survival (LFS) at 2 years was 35%, and the only factor associated with decreased LFS was secondary AML (P = .04). In conclusion, despite the decreased NRM observed, other RIC regimens with higher myelosuppression should be evaluated to decrease relapse in high-risk AML. (EUDRACT 2006-005901-67).
Collapse
Affiliation(s)
- Bernard Rio
- Service d'Hématologie, Hôtel-Dieu Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvie Chevret
- Department de Bioinformatique et Statistique Médicale, Hopital Saint-Louis, Paris, France
| | - Stéphane Vigouroux
- Service d'Hématologie, Service d'Hématologie clinique et de thérapie cellulaire, CHU de Bordeaux Hopital du Haut-Lévèque, Pessac, France
| | - Patrice Chevallier
- Service d'Hématologie, Hematology Department, CHU de Nantes, Nantes, France
| | - Sabine Fürst
- Service d'Hématologie, Service de Greffe de Moelle, Institut Paoli Calmettes, Marseille, France
| | - Anne Sirvent
- Service d'Hématologie, Hematologie Clinique, Hopital de l'Archet I, Nice, France
| | - Jacques-Olivier Bay
- Service d'Hématologie, Service d'Hématologie Clinique, CHU Estaing, Clermont-Ferrand, France
| | - Gérard Socié
- Service d'Hématologie, Hematology-Bone Marrow Transplantation, Hopital Saint-Louis, Paris, France
| | | | - Anne Huynh
- Service d'Hématologie, Hématologie Clinique, CHU, Toulouse, France
| | - Jérôme Cornillon
- Service d'Hématologie, Hematology, Institut de Cancérologie de la Loire, Loire, France
| | | | - Faezeh Legrand
- Service d'Hématologie, Hematology, CHU Besançon, Besancon, France
| | | | - Gérard Michel
- Department of Hematology, Hôpital La Timone, Marseille, France
| | | | | | - Sébastien Maury
- Service d'Hématologie, Service d'Hematologie, Hôpital Henri Mondor, Creteil, France
| | - Madalina Uzunov
- Service d'Hématologie, Pitié-Salpêtrière (AP-HP), Paris, France
| | | | | | | | | | - Karin Bilger
- Service d'Hématologie, CHRU Strasbourg, Strasbourg, France
| | - Eliane Gluckman
- Service d'Hématologie, Eurocord Office, Hôpital Saint-Louis, Paris, France
| | - Annalisa Ruggeri
- Service d'Hématologie, Eurocord Office, Hôpital Saint-Louis, Paris, France; Service d'Hématologie, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Agnès Buzyn
- Service d'Hématologie, Comité Scientifique, SFGM-TC, Hôpital Necker (AP-HP), Paris, France
| | - Stéphanie Nguyen
- Service d'Hématologie, Hôpital Pitié Salpêtrière (AP-HP), Paris, France
| | - Tabassome Simon
- Service d'Hématologie, URC Est Saint Antoine (AP-HP), Paris, France
| | - Nöel Milpied
- Service d'Hématologie, Service d'Hématologie clinique et de thérapie cellulaire, CHU de Bordeaux Hopital du Haut-Lévèque, Pessac, France
| | - Vanderson Rocha
- Service d'Hématologie, Eurocord Office, Hôpital Saint-Louis, Paris, France; Department of Haematology, Churchill Hospital, Oxford, United Kingdom.
| | | |
Collapse
|
18
|
Meunier M, Bulabois CE, Thiebaut-Bertrand A, Itzykson R, Carre M, Carras S, Garban F, Cahn JY. Alemtuzumab for severe steroid-refractory gastrointestinal acute graft-versus-host disease. Biol Blood Marrow Transplant 2014; 20:1451-4. [PMID: 24910381 DOI: 10.1016/j.bbmt.2014.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
Acute graft-versus-host disease (aGVHD) still remains the main cause of morbidity and mortality after allogeneic stem cell transplantation. Moreover, patients who did not respond to first-line treatment with glucocorticosteroids have a very poor outcome. Some studies suggested that alemtuzumab (a humanized monoclonal antibody against the CD52 antigen) might be effective for treatment of refractory aGVHD. Here we report a single-center experience with alemtuzumab in refractory gastrointestinal aGVHD. From September 2009 to April 2012 at the Grenoble medical university center, 24 patients who had presented a refractory gastrointestinal aGVHD to corticosteroid, or after another immunosuppressive drug, were retrospectively analyzed. Most patients (n = 19) presented stage 4 gastrointestinal aGVHD. Response to treatment (either complete or partial) was observed in 15 patients (62.4%). The overall survival rate at 1 year for all patients was 33.3% (95% confidence interval [CI], 15.9% to 51.9%) and for responders, 53.3% (95% CI, 26.3% to 74.4%). Two patients died from infection, 5 patients from recurrent GVHD, and 1 from an uncontrolled post-transplant lymphoproliferative disorder.
Collapse
Affiliation(s)
- Mathieu Meunier
- Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France.
| | | | | | - Raphaël Itzykson
- Service d'hématologie-greffe, Hôpital Saint-Louis, Assistance Publique, hôpitaux de Paris, Université Paris, France
| | - Martin Carre
- Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France
| | - Sylvain Carras
- Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France
| | - Fréderic Garban
- Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France; Etablissement français du sang, CHU de Grenoble, UMR 5525 CNRS-UJF, France
| | - Jean Yves Cahn
- Clinique d'hématologie, CHU de Grenoble, UMR 5525 CNRS-UJF, France
| |
Collapse
|
19
|
Le Gouill S, Kröger N, Dhedin N, Nagler A, Bouabdallah K, Yakoub-Agha I, Kanouni T, Bulabois CE, Tournilhac O, Buzyn A, Rio B, Moles MP, Shimoni A, Bacher U, Ocheni S, Milpied N, Harousseau JL, Moreau P, Leux C, Mohty M. Reduced-intensity conditioning allogeneic stem cell transplantation for relapsed/refractory mantle cell lymphoma: a multicenter experience. Ann Oncol 2012; 23:2695-2703. [PMID: 22440229 DOI: 10.1093/annonc/mds054] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite therapeutic approach that combines rituximab-containing chemotherapy, followed or not by autologous stem cell transplantation (auto-SCT), mantle cell lymphoma (MCL) patients experience relapses. Reduced-intensity conditioning allogeneic stem cell transplantation (RIC-allo-SCT) at time of relapse may represent an attractive strategy. PATIENTS AND METHODS We report a multicenter retrospective analysis. Seventy MCL patients underwent RIC-allo-SCT in 12 centers. RESULTS Median age at transplantation was 56 years and median time from diagnosis to transplantation was 44 months. The median number of previous therapies was 2 (range, 1-5) including autologous transplantation in 47 cases. At time of transplantation, 35 patients were in complete remission, 20 were in partial response and 15 in stable disease or progressive disease. The median follow-up for living patients was 24 months. The 2-year event-free survival (EFS) and overall survival (OS) rates were 50% and 53%, respectively. The 1- and 2-year transplant-related mortality rates were 22% and 32%, respectively. The statistical analysis demonstrated that disease status at transplantation was the only parameter influencing EFS and OS. CONCLUSIONS These results suggest that RIC-allo-SCT may be an effective therapy in MCL patients with a chemo-sensitive disease at time of transplantation, irrespective of the number of lines of prior therapy. Studies are warranted to investigate the best type of RIC regimen.
Collapse
Affiliation(s)
- S Le Gouill
- Division of Hematology, University of Nantes, Hôtel-Dieu, Nantes; Centre de recherches en Cancérologie Nantes/Angers, INSERM, UMR 892, équipe 10, UFR Médecine et Techniques Médicales, Université de Nantes, Nantes; Centre d'Investigation Clinique en Cancérologie (CI2C); Unité de Recherche clinique en onco-hématologie, University of Nantes, Nantes, France.
| | - N Kröger
- Bone Marrow Transplantation Unit, University of Hamburg, Hamburg, Germany
| | - N Dhedin
- Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - A Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - K Bouabdallah
- Division of Hematology, University of Bordeaux, Pessac
| | | | - T Kanouni
- Division of Hematology, University of Montpellier, Montpellier
| | | | - O Tournilhac
- Division of Hematology, University of Clermont-Ferrand, Clermont-Ferrand
| | - A Buzyn
- Hôpital Necker-Enfants malades
| | | | - M P Moles
- Division of Hematology, University of Angers, Angers
| | - A Shimoni
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - U Bacher
- Bone Marrow Transplantation Unit, University of Hamburg, Hamburg, Germany
| | - S Ocheni
- Bone Marrow Transplantation Unit, University of Hamburg, Hamburg, Germany
| | - N Milpied
- Division of Hematology, University of Bordeaux, Pessac
| | | | - P Moreau
- Division of Hematology, University of Nantes, Hôtel-Dieu, Nantes; Unité de Recherche clinique en onco-hématologie, University of Nantes, Nantes, France
| | - C Leux
- Cancer Registry of Loire-Atlantique and Vendée, Nantes, France
| | - M Mohty
- Division of Hematology, University of Nantes, Hôtel-Dieu, Nantes; Centre d'Investigation Clinique en Cancérologie (CI2C); Unité de Recherche clinique en onco-hématologie, University of Nantes, Nantes, France
| |
Collapse
|
20
|
Affiliation(s)
- Benoit Busser
- Département de Biochimie, Toxicologie, Pharmacologie, Pôle de Biologie, CHU Grenoble, Grenoble, France.
| | | | | | | | | |
Collapse
|
21
|
Deconinck E, Kribs M, Rebibou JM, Bulabois CE, Ducloux D, Cahn JY. Cytomegalovirus infection and chronic graft-versus-host disease are significant predictors of renal failure after allogeneic hematopoietic stem cell transplantation. Haematologica 2005; 90:569-70. [PMID: 15820963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
We investigated the frequencies and predictive factors of prolonged renal failure (PRF) in a retrospective study of 181 consecutive patients undergoing allogeneic hematopoietic stem cell transplantation. Twenty-six patients (23% of long-term survivors) developed PRF. We identified 4 independent prognostic factors; cytomegalovirus infection and chronic graft-versus-host disease appeared as major risk factors for PRF.
Collapse
|
22
|
Mohty M, Attal M, Marit G, Bulabois CE, Garban F, Gratecos N, Rio B, Vernant JP, Sotto JJ, Cahn JY, Blaise D, Jouet JP, Facon T, Yakoub-Agha I. Thalidomide salvage therapy following allogeneic stem cell transplantation for multiple myeloma: a retrospective study from the Intergroupe Francophone du Myélome (IFM) and the Société Française de Greffe de Moelle et Thérapie Cellulaire (SFGM-TC). Bone Marrow Transplant 2004; 35:165-9. [PMID: 15531895 DOI: 10.1038/sj.bmt.1704756] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thalidomide is effective in multiple myeloma (MM), even in patients who have relapsed after high-dose therapy. A potent graft-versus-myeloma (GVM) effect can be induced against MM after allogeneic stem cell transplantation (allo-SCT). In all, 31 MM patients received thalidomide as a salvage therapy after progression following allo-SCT. The median maximum daily dose of thalidomide was 200 mg (range, 50-600). Thalidomide had to be discontinued in six patients (19%) because of toxicity. In all, nine patients (29%; 95% CI, 13-45) achieved an objective response with thalidomide therapy (six partial and three very good partial responses, VGPR). Five patients developed graft-versus-host disease (GVHD) after thalidomide therapy, including the three patients achieving a VGPR. These data demonstrate that thalidomide is potentially effective in MM patients failing allo-SCT.
Collapse
Affiliation(s)
- M Mohty
- Unité de Transplantation et de Thérapie Cellulaire (UTTC), Institut Paoli-Calmettes, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Milpied N, Gaillard F, Moreau P, Mahé B, Souchet J, Rapp MJ, Bulabois CE, Morineau N, Harousseau JL. High-dose therapy with stem cell transplantation for mantle cell lymphoma: results and prognostic factors, a single center experience. Bone Marrow Transplant 1998; 22:645-50. [PMID: 9818691 DOI: 10.1038/sj.bmt.1701400] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
From 1991 to 1997 18 consecutive patients with well-defined mantle cell lymphoma (MCL) underwent high-dose therapy with unpurged autologous (17 patients) or allogeneic (one patient) stem cell transplantation. Tissue sections were reviewed for morphology, immunophenotype, cyclin D1 and P53 expression as well as proliferation index (PI). Median age of patients was 47 years (range 40-60). Sixteen had stage IV disease with bone marrow involvement in 12 and performance status was > or =1 in 12 patients. At the time of high-dose therapy 10 patients were in first partial response (PR), one was in second complete remission (CR), four were in second PR and three were refractory to conventional anthracycline-containing chemotherapy. The conditioning regimen consisted of TBI plus chemotherapy in 13 patients and chemotherapy only (BEAM) in five patients. No treatment-related deaths were observed. With a median follow-up of 36 months (range 13-80) after transplant, disease-free survival (DFS) and overall survival (OS) are estimated to be 48 and 80% at 4 years, respectively. Significantly better results are achieved for patients transplanted after a TBI containing regimen with a 4 year OS and DFS estimated at 89 and 71%, respectively compared to 60 and 0% respectively for patients who were conditioned without TBI (P = 0.07 for OS and P < 0.0001 for DFS). There is a trend towards better DFS when the transplant is performed in PR1 (4 year DFS: 80% with eight patients out of 10 in continuous CR 13 to 80 months, median 36 months after transplant) compared to more advanced stages (4 year DFS: 18% with only three patients out of eight in continuous CR 16, 17 and 58 months after transplant). Blastic histology and P53 overexpression are also associated with a trend towards a worst prognosis.
Collapse
Affiliation(s)
- N Milpied
- Department of Hematology, University Hospital, Nantes, France
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Moreau P, Milpied N, Rapp MJ, Moreau A, Bourdin S, Mahe MA, Dupas B, Le Tortorec S, Hamidou M, Maisoneuve H, Mahe B, Bulabois CE, Morineau N, Jardel H, Harousseau JL. Early intensive therapy with autologous stem cell transplantation in high-risk Hodgkin's disease: long-term follow-up in 35 cases. Leuk Lymphoma 1998; 30:313-24. [PMID: 9713963 DOI: 10.3109/10428199809057544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Thirty-five adult patients with high-risk HD (HD) defined by (1) Ann Arbor stage IV or bulky nodal disease (tumor/thorax ratio > 0.45) and (2) no or partial response (PR) (< 75%) to the initial 3 courses of ABVD, received an early intensive therapy with autologous stem cell transplantation (ASCT). Thirty patients were considered as partial responders and 5 as refractory to initial chemotherapy. Conditioning regimen consisted of chemotherapy alone (CBV in 11 patients before 1993, BEAM in 13 patients since 1993) followed by adjuvant radiotherapy: 40 Gy) on the initial sites of bulky disease, or 12 Gy total body irradiation plus 120 mg/kg cyclophosphamide in 11 patients with disseminated extra-nodal disease. All 30 patients in PR at the time of ASCT experienced prolonged complete remission (CR). One patient died in CR from an acute myocardial infarction 48 months after ASCT. Four out of the 5 patients with refractory disease at the time of ASCT experienced rapid progression of HD leading to death in 3 cases. After 6 years of CR post-ASCT, the last refractory patient died of myelodysplastic syndrome diagnosed 2 years after intensive therapy. With a median follow-up for surviving patients of 51 months (range: 11-111), the cumulative probability of 8-year overall survival is 75.6% for the entire group of patients, 94.1% for the chemosensitive ones, and 0% for the primary refractory (P < .0001). The cumulative probability of 8-year event-free survival is 79.9% for the entire group of patients, 94.1% for the chemosensitive ones, and 0% for the primary refractory (P < .0001). We conclude that early intensive therapy with ASCT is feasible in patients with high-risk HD and induces a high cure rate in chemosensitive patients. In primary refractory patients, new therapeutic approaches are warranted.
Collapse
Affiliation(s)
- P Moreau
- Department of Hematology, CHU Hôtel-Dieu, Nantes, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Moreau P, Milpied N, Voillat L, Colombat P, Mahé B, Rapp MJ, Moreau A, Dupas B, Bulabois CE, Juge-Morineau N, Harousseau JL. Peripheral blood stem cell transplantation as front-line therapy in patients aged 61 to 65 years: a pilot study. Bone Marrow Transplant 1998; 21:1193-6. [PMID: 9674850 DOI: 10.1038/sj.bmt.1701272] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of the present trial was to investigate the feasibility of high-dose therapy followed by autologous peripheral blood stem cell transplantation (PBSCT) as a component of front-line treatment in patients with disseminated intermediate- and high-grade non-Hodgkin's lymphoma (NHL) aged 61-65 years. From October 1993 to June 1996, 14 consecutive patients entered this single-center prospective pilot trial. Patients were five males and nine females, median age 63 (range 61-65). The first-line treatment consisted of three courses of CHOP therapy. Patients achieving either a partial response (PR) or a complete response (CR) after initial therapy were eligible for PBSCT, while those with refractory or progressive disease were not autografted but included in the feasibility study in an intent-to-treat analysis. Of the 14 patients, 11 achieved either a CR (one) or a PR (10) after three courses of CHOP while the three patients with no response were not autografted and subsequently died of progressive disease. PBSC collection was feasible in responding patients after G-CSF priming (10 microg/kg/day for 6 days). Conditioning therapy was the BEAM protocol. All patients engrafted after PBSCT. The median time to granulocyte (>0.5 x 10(9)/l) and platelet recovery (>25 x 10(9)/l) was 12 (range 9-18) and 13 days (range 7-22), respectively. No toxic deaths VOD or IP were observed. Four of the 11 responding patients relapsed 2, 7, 9 and 12 months after PBSCT, respectively, and all died from progressive disease. Overall, 7/14 patients are alive and free from disease, 16-43 months after initial diagnosis (median 28). The actuarial overall survival is 45.7 %, and the actuarial event-free survival is 50% at 3.5 years. This study shows the feasibility of high-dose therapy and PBSCT in patients with intermediate- or high-grade disseminated NHL aged 61-65 years. Such patients should not be excluded from trials evaluating the role of ASCT as part of initial treatment for disseminated and histologically aggressive NHL.
Collapse
Affiliation(s)
- P Moreau
- Department of Haematology, CHU Hôtel-Dieu, Nantes, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Bulabois CE, Yerly-Motta V, Mortensen BT, Fixe P, Remy-Martin JP, Hervé P, Tiberghien P, Charbord P. Retroviral-mediated marker gene transfer in hematopoiesis-supportive marrow stromal cells. J Hematother 1998; 7:225-39. [PMID: 9621256 DOI: 10.1089/scd.1.1998.7.225] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A Moloney-derived retrovirus containing both LacZ and NeoR genes (G1BgSVNa from Genetic Therapy, Inc.), was used to transduce human and murine bone marrow stromal cells. Different kinds of stromal cells that were able to support hematopoiesis were transduced by incubation for 24 h in the presence of virus-containing supernatant. Semiconfluent layers of MRC-5 (human, myofibroblastic, fetal, pulmonary) and MS-5 (murine, myofibroblastic, medullary) cells were successfully transduced after one 24-h incubation, as demonstrated by G418 resistance and Escherichia coli beta-galactosidase staining. In contrast, human stromal cells, purified from primary confluent layers grown for 3-4 weeks, could not be transduced. However, stromal cells generated after 10-12 days in culture from Stro-1+ and 1B10+ stromal precursors were successfully transduced in the presence of basic fibroblast growth factor. Transduced stromal cells maintained a myofibroblastic phenotype, although with a decreased number of alpha-SM actin-positive microfilaments in MS-5 cells. The ability to support the generation of stroma-adherent colony-forming cells from cocultured cord blood CD34+ cells after 4 weeks in culture was similar before and after transduction and G418 selection. In conclusion, human primary stromal precursors can be efficiently transduced, and the stromal cell phenotype and function are not significantly altered after retroviral-mediated transfer of marker genes.
Collapse
Affiliation(s)
- C E Bulabois
- Etablissement de Transfusion Sanguine de Franche-Comté, Besançon, France
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Moreau P, Kergueris MF, Milpied N, Le Tortorec S, Mahé B, Bulabois CE, Rapp MJ, Larousse C, Bataille R, Harousseau JL. A pilot study of 220 mg/m2 melphalan followed by autologous stem cell transplantation in patients with advanced haematological malignancies: pharmacokinetics and toxicity. Br J Haematol 1996; 95:527-30. [PMID: 8943896 DOI: 10.1046/j.1365-2141.1996.d01-1932.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We studied the pharmacokinetics and toxicity of 220 mg/m2 melphalan (HDM 220) followed by autologous stem cell transplantation in 16 patients with advanced haematological malignancies. Pharmacokinetic parameters (mean values of steady-state volume of distribution 14.6 l/m2, total body clearance 313 ml/min/m2, elimination half-life 46 min) were the same as those of 140 or 200 mg/m2 melphalan in previous reports. HDM 220 was feasible. Extramedullary toxicity was mainly W.H.O. grade 4 mucositis (13/16 patients). The median duration of 41 d (10, not reached) of thrombocytopenia < 25 x 10(9)/l was long. In multiple myeloma the response rate was 89% in heavily pretreated patients, suggesting that HDM 220 could be considered earlier in the course of the disease as an alternative consolidation therapy.
Collapse
MESH Headings
- Adolescent
- Adult
- Combined Modality Therapy
- Female
- Hematopoietic Stem Cell Transplantation/methods
- Hodgkin Disease/drug therapy
- Hodgkin Disease/metabolism
- Hodgkin Disease/therapy
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/therapy
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/metabolism
- Lymphoma, Non-Hodgkin/therapy
- Male
- Melphalan/adverse effects
- Melphalan/pharmacokinetics
- Melphalan/therapeutic use
- Multiple Myeloma/drug therapy
- Multiple Myeloma/metabolism
- Multiple Myeloma/therapy
- Pilot Projects
- Transplantation, Autologous
Collapse
Affiliation(s)
- P Moreau
- Department of Haematology, Nantes, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Moreau P, LeTortorec S, Mahé MA, Mahé B, Moreau A, Bourdin S, Bulabois CE, Bureau B, Harousseau JL, Milpied N. Autologous bone marrow transplantation using TBI and CBV for disseminated high/intermediate grade cutaneous non-epidermotropic non-Hodgkin's lymphoma. Bone Marrow Transplant 1994; 14:775-8. [PMID: 7889011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patients with stage IV high/intermediate grade cutaneous non-epidermotropic lymphoma of skin as first localization of the disease have a poor prognosis. In this setting, autologous bone marrow transplantation (BMT) has rarely been evaluated. We report here on the treatment of four patients with such lymphomas with autologous BMT using 12 Gy total body irradiation (TBI) and CBV (cyclophosphamide, carmustine and etoposide). Using a plexiglass screen, TBI delivered an homogenized dose to the skin. With this conditioning regimen, all patients are still in complete remission 22, 44, 46 and 51, respectively, months after high-dose chemotherapy, TBI and autologous BMT.
Collapse
Affiliation(s)
- P Moreau
- Haematology Department, CHU Hôtel-Dieu, Nantes, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|