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Nampoothiri RV, Law AD, Lam W, Chen C, Al-Shaibani Z, Loach D, Michelis FV, Kim DDH, Mattsson J, Kumar R, Lipton JH, Viswabandya A. Predictors of outcomes of therapy-related acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. Hematol Oncol Stem Cell Ther 2021; 15:27-35. [PMID: 33775624 DOI: 10.1016/j.hemonc.2021.03.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE Existing literature on allogeneic hematopoietic stem cell transplantation (allo-HSCT) in therapy-related acute myeloid leukemia (t-AML) is confounded by the inclusion of patients with secondary AML and t-MDS. We aim to report our 20-year experience of HSCT in t-AML. METHODS We retrospectively reviewed patients with t-AML who underwent HSCT. Patients were analyzed for prior malignancy, therapy, time to diagnosis of t-AML, transplant details, relapse-free survival (RFS), overall survival (OS), and predictors of outcomes. RESULTS In total, 68 patients (59.9% female; median age, 56.5 years) underwent HSCT. Acute and chronic graft-versus-host disease (GVHD) occurred in 39 (57.4%) and 23 (33.8%) patients, respectively. Cumulative incidence of relapse, nonrelapse mortality, RFS, and OS at 2 years were 17.9%, 34.5%, 47.6%, and 49.3%, respectively. Significant predictors of reduced OS were presence of 11q23 rearrangement (hazard ratio [HR], 3.24), using induction regimens other than FLAG-Ida or 7 + 3 (HR, 3.65), haploidentical donors (HR, 3.48), Eastern Cooperative Oncology Group performance status 2 or higher (HR, 5.83), and using cyclosporine A-methotrexate as GVHD prophylaxis (HR, 2.41). A significant decrement in survival was seen with an increasing number of any of these prognostic factors. CONCLUSION Outcomes of t-AML are satisfactory after allo-HSCT. Patients with t-AML with good-risk karyotypes, good performance status, having HLA-matched donors, and receiving intensive induction regimens have better outcomes after HSCT.
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Affiliation(s)
- Ram Vasudevan Nampoothiri
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Arjun Datt Law
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Wilson Lam
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Carol Chen
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Zeyad Al-Shaibani
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - David Loach
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Fotios V Michelis
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Jonas Mattsson
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Rajat Kumar
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Howard Lipton
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Auro Viswabandya
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
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Bacopoulos AJ, Ho L, Yang A, Ng P, Dara C, Loach D, Deotare U, Michelis FV, Viswabandya A, Kim DD, Lipton JH, Messner HA, Thyagu S. Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit. J Oncol Pharm Pract 2020; 27:33-39. [PMID: 32183586 DOI: 10.1177/1078155220908948] [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] [Indexed: 11/16/2022]
Abstract
At our institution, tacrolimus is used as a second-line agent for the prevention and treatment of graft-versus-host-disease in the allogeneic hematopoietic stem cell transplantation (HSCT) unit after patients have experienced a serious or intolerable adverse event to cyclosporine. As per our standard practice, tacrolimus is administered via 2-h intermittent IV infusions (IIVs) every 12 h rather than continuous IV infusion. Shorter infusion times are cautioned due to concerns of higher rates of nephrotoxicity, neurotoxicity and infusion-related reactions, although there is a paucity of data to support this claim. Our primary objective was to evaluate the safety of a 2-h IIV of tacrolimus in an adult HSCT population. We retrospectively reviewed the charts of 104 patients who received tacrolimus by IIV (3574 doses; median = 22, range 1-158, IQR = 28) from 2002 to 2016. Primary outcomes collected include rates of nephrotoxicity, neurotoxicity and infusion-related reactions. One (0.9%) grade 2 infusion-related reaction occurred and resolved without discontinuation of tacrolimus. Of 16 incidences (13.6%) of nephrotoxicity, all but 10 (8.5%) cases resolved. Precipitating factors for nephrotoxicity unrelated to tacrolimus were identified in all 10 cases. There were 41 incidences (35%) of neurotoxicity, of which, 8 (6.8%) were considered serious. All neurotoxicity reverted to baseline or resolved completely. We propose that a 2-h IIV of tacrolimus is a safe method of administration in the adult HSCT setting.
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Affiliation(s)
- Alexander Js Bacopoulos
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Department of Pharmacy, University Health Network, Toronto, Canada
| | - Lina Ho
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Department of Pharmacy, University Health Network, Toronto, Canada.,Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada
| | - Anjie Yang
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Department of Pharmacy, University Health Network, Toronto, Canada
| | - Pamela Ng
- Department of Pharmacy, University Health Network, Toronto, Canada
| | - Celina Dara
- Department of Pharmacy, University Health Network, Toronto, Canada
| | - David Loach
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Uday Deotare
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Fotios V Michelis
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Auro Viswabandya
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Dennis D Kim
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jeffrey H Lipton
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hans A Messner
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Santhosh Thyagu
- Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
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Vasudevan Nampoothiri R, Law AD, Lam W, Chen C, Al-Shaibani Z, Loach D, Michelis FV, Kim DDH, Mattsson J, Kumar R, Lipton JH, Viswabandya A. Outcomes of therapy-related acute lymphoblastic leukemia in adults after allogeneic stem cell transplantation. Eur J Haematol 2020; 105:24-29. [PMID: 32115767 DOI: 10.1111/ejh.13403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/03/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Therapy-related acute lymphoblastic leukemia (t-ALL) is an increasingly recognized subset of therapy-related acute leukemia. There are limited data on the role of allogeneic hematopoietic stem cell transplantation (HSCT) in t-ALL. Recent reports suggest comparable outcomes of t-ALL with de novo ALL after HSCT. PATIENTS AND METHODS We retrospectively reviewed all patients of t-ALL who underwent HSCT at our center. Patients were analyzed for prior malignancy, therapy, time to diagnosis of t-ALL, clinical, laboratory characteristics, transplant details, relapse-free survival (RFS), and overall survival (OS). RESULTS Eighteen patients (M:F ratio 1:1; Median age 44 years) underwent HSCT for t-ALL. Median latent period from primary malignancy to t-ALL was 44.8 months. 11q23 rearrangement and t(9;22) were present in 33.3% and 22.2% patients, respectively. Stem cell donors were matched related, matched unrelated, and haploidentical in 27.8% (n = 5), 55.6% (n = 10), and 16.7% (n = 3) patients, respectively. Five patients died before D+ 100 (27.8%). Estimated 2-year RFS and OS were 47.1% and 51.8%, respectively. We did not find any pretransplant and post-transplant risk factors that were predictive of improved OS or RFS after multivariate analysis. CONCLUSIONS Allogeneic HSCT outcomes in t-ALL were comparable to HSCT outcomes in de novo ALL. Multicenter studies with more patients and longer follow-up may provide factors affecting outcome and survival.
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Affiliation(s)
- Ram Vasudevan Nampoothiri
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Arjun Datt Law
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Wilson Lam
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Carol Chen
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Zeyad Al-Shaibani
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - David Loach
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Fotios V Michelis
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Jonas Mattsson
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Rajat Kumar
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Howard Lipton
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Auro Viswabandya
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
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Nampoothiri RV, Law AD, Chen C, Lam W, Al-Shaibani Z, Loach D, Michelis FV, Kim DD, Mattsson J, Kumar R, Lipton JH, Viswabandya A. Predictors of Outcomes in Adult Patients with Therapy Related Acute Myeloid Leukemia Undergoing Allogeneic Hematopoietic Stem Cell Transplant - Twenty Year Experience from a Tertiary Care Centre. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.614] [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] [Indexed: 10/25/2022]
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Prem S, Loach D, Lipton J, Kumar R, Gupta V. EBV reactivation mimicking a lymphoproliferative disorder associated with ruxolitinib therapy for myelofibrosis. Blood Res 2019; 54:282-284. [PMID: 31915655 PMCID: PMC6942146 DOI: 10.5045/br.2019.54.4.282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/22/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Shruti Prem
- Division of Allo-BMT, Princess Margaret Centre, Toronto, ON, Canada
| | - David Loach
- Division of Allo-BMT, Princess Margaret Centre, Toronto, ON, Canada
| | - Jeffrey Lipton
- Division of Allo-BMT, Princess Margaret Centre, Toronto, ON, Canada
| | - Rajat Kumar
- Division of Allo-BMT, Princess Margaret Centre, Toronto, ON, Canada
| | - Vikas Gupta
- Division of Leukemia, Princess Margaret Centre, Toronto, ON, Canada
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Salas MQ, Lam W, Law AD, Kim DDH, Michelis FV, Loach D, Al-Shaibani Z, Lipton JH, Kumar R, Mattsson J, Viswabandya A. Reduced-intensity conditioning allogeneic transplant with dual T-cell depletion in myelofibrosis. Eur J Haematol 2019; 103:597-606. [PMID: 31514253 DOI: 10.1111/ejh.13327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/14/2019] [Revised: 08/29/2019] [Accepted: 09/05/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND There remains a significant mortality in recipients with MF who undergo allogeneic stem cell transplant (allo-HSCT). The combination of antithymocyte globulin (ATG) and post-transplant cyclophosphamide (PTCy) provides good control of graft-versus-host disease (GVHD) when peripheral blood stem cell grafts are used. METHODS We report the outcome of 37 recipients with myelofibrosis who underwent reduced-intensity conditioning (RIC) allo-HSCT with ATG and PTCy. Median follow-up was 16.4 months. RESULTS Nine (24.3%) recipients received 10/10 MRD grafts, 17 (45.9%) 10/10 MUD grafts, 4 (10.8%) 9/10 MUD grafts, and 7 (18.9%) haploidentical donor grafts. Six (16.3%) patients had graft failure. The cumulative incidence of grade II-IV and grade III-IV aGVHD at day +100 and moderate/severe chronic GVHD at 1 year was as follows: 13.5%, 5.4%, and 17%. There were no deaths secondary to GVHD. One-year overall survival (OS), relapse-free survival (RFS), non-relapse mortality (NRM), and GVHD-free/RFS (GRFS) were respectively 74.4%, 71.3%, 23%, and 43.3%. Those recipients who had worse KPS ≤ 80% had worse OS and RFS. CONCLUSION RIC allo-HSCT with ATG and PTCy results in high OS and RFS in patients with myelofibrosis and absence of mortality secondary to GVHD. Further investigations are required to reduce NRM and graft failure rates.
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Affiliation(s)
- Maria Queralt Salas
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wilson Lam
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Arjun Datt Law
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Fotios V Michelis
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David Loach
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zeyad Al-Shaibani
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey Howard Lipton
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rajat Kumar
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonas Mattsson
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Auro Viswabandya
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Salas MQ, Prem S, Atenafu EG, Law AD, Lam W, Al-Shaibani Z, Loach D, Kim DDH, Michelis FV, Lipton JH, Kumar R, Mattsson J, Viswabandya A. Reduced intensity allogeneic stem cell transplant with anti-thymocyte globulin and post-transplant cyclophosphamide in acute myeloid leukemia. Eur J Haematol 2019; 103:510-518. [PMID: 31449699 DOI: 10.1111/ejh.13321] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 07/03/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We aimed to study the efficacy of reduced intensity conditioning (RIC) allo-HSCT combined with anti-thymocyte globulin (ATG) and post-transplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis in AML. METHODS One hundred forty-seven patients were included. All patients underwent unmanipulated peripheral blood stem cell RIC allo-HSCT. Median follow-up was 12.8 months (range 0.5-39). RESULTS Median age was 58 years. Twenty-nine (20%) recipients received 10/10 MRD grafts, 69 (47%) 10/10 MUD grafts, 20 (13.6%) 9/10 MMUD, and 29 (20%) haploidentical grafts. The cumulative incidence of grade II-IV and III-IV acute GVHD at day +100, and moderate/severe chronic GVHD at 1-year were as follow: 14.3%, 1.4%, and 8.3%. There were no significant differences according to donor type (P = .46) and cumulative incidence of GVHD. One-year overall survival (OS), relapse-free survival (RFS), non-relapse mortality, and GVHD-free/Relapse-free survival were as follows: 66.9% (95% CI 58.4-74), 59.9%, and 18.7% and 53.7%. KPS ≤ 80 was predictive of worst OS (P = .04). Those recipients who received MUD transplants had better RFS (P = .01). CONCLUSIONS RIC allo-HSCT combined with ATG and PTCy is safe and a potentially curative strategy and it is associated with impressive GRFS in AML.
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Affiliation(s)
- Maria Queralt Salas
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shruti Prem
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princes Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Arjun Datt Law
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wilson Lam
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zeyad Al-Shaibani
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David Loach
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Fotios V Michelis
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey Howard Lipton
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rajat Kumar
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonas Mattsson
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Auro Viswabandya
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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8
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Salas MQ, Law AD, Lam W, Al-Shaibani Z, Loach D, Kim DDH, Michelis FV, Thyagu S, Kumar R, Lipton JH, Mattsson J, Viswabandya A. Safety and Efficacy of Haploidentical Peripheral Blood Stem Cell Transplantation for Myeloid Malignancies Using Post-transplantation Cyclophosphamide and Anti-thymocyte Globulin as Graft- versus-Host Disease Prophylaxis. Clin Hematol Int 2019; 1:105-113. [PMID: 34595418 PMCID: PMC8432390 DOI: 10.2991/chi.d.190316.003] [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: 02/18/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022] Open
Abstract
Haploidentical stem cell transplantation (haploSCT) has greatly improved access to curative treatment for myeloid malignancies in patients without suitable matched sibling/unrelated donors. We investigated the safety and efficacy of haploSCT after reduced intensity conditioning (RIC) with anti-thymocyte globulin (ATG), post-transplant cyclophosphamide (PTCy), and cyclosporine to prevent rejection and graft-versus-host disease (GVHD). In this study, 47 patients received RIC using fludarabine, busulfan, and total body irradiation (200 cGy). Unmanipulated peripheral blood grafts were used. GVHD prophylaxis included ATG (4.5 mg/kg day−3 to −1), PTCy (50 mg/kg/day day +3, +4), and cyclosporine from day +5. The median follow-up was 15 months (range 3–27). Thirty one (66%) patients had acute myeloid leukemia (AML), 10 (21%) had high-risk myelodysplastic syndrome, and 6 (13%) had a myeloproliferative neoplasia. Median age was 60 years (range 22–73). The d+100 cumulative incidences of grade II–IV and III–IV acute GVHD were 17% (95% confidence interval (CI) 7.9–29.1) and 6.4% (1.6–15.9), respectively. The cumulative incidence of moderate-severe chronic GVHD at 1 year was 15.2% (95% CI 6.5–27.1). Overall survival (OS) and relapse-free survival (RFS) were 55.2% (95% CI 39.5–68.4) and 49.5% (95% CI 34.2–63), respectively. Nonrelapse mortality (NRM) for all patients at 1 year was 37.1% (95% CI 23.2–51.1). Infection was the main cause of death (26%). For AML, 1-year OS, RFS, and NRM were 64.1% (95% CI 43.3–78.9), 54.5 (95% CI 34.6–70.7), and 26.8% (95% CI 12.3–43.6), respectively. In conclusion, unmanipulated haploidentical peripheral blood stem cells (PBSC) transplantation following RIC and dual in vivo T-cell depletion results in a low incidence of acute and chronic GVHD for patients diagnosed with myeloid malignancies.
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Affiliation(s)
- Maria Queralt Salas
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Arjun Datt Law
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Wilson Lam
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Zeyad Al-Shaibani
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - David Loach
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Dennis Dong Hwan Kim
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Fotios V Michelis
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Santhosh Thyagu
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Rajat Kumar
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jeffrey Howard Lipton
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jonas Mattsson
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Auro Viswabandya
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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Prem S, Atenafu EG, Al‐Shaibani Z, Loach D, Law A, Lam W, Michelis FV, Thyagu S, Kim D(DH, Howard Lipton J, Kumar R, Viswabandya A. Low rates of acute and chronic GVHD with ATG and PTCy in matched and mismatched unrelated donor peripheral blood stem cell transplants. Eur J Haematol 2019; 102:486-493. [DOI: 10.1111/ejh.13230] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Shruti Prem
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Eshetu G Atenafu
- Department of Biostatistics Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Zeyad Al‐Shaibani
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - David Loach
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Arjun Law
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Wilson Lam
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Fotios V. Michelis
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Santhosh Thyagu
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Dennis (Dong Hwan) Kim
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Jeffrey Howard Lipton
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Rajat Kumar
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Auro Viswabandya
- Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology Princess Margaret Cancer Centre Toronto Ontario Canada
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Bacopoulos AJ, Ho L, Yang A, Ng P, Dara C, Loach D, Deotare U, Michelis FV, Viswabandya A, Kim DD, Lipton JH, Messner HA, Thyagu S. Safety of Two-Hour Intermittent Intravenous Infusions of Tacrolimus in the Allogeneic Hematopoietic Stem Cell Transplantation Unit. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Deotare U, Atenafu EG, Loach D, Michelis FV, Kim D, Thyagu S, Lipton JH, Messner HA, Viswabandya A. Reduction of severe acute graft-versus-host disease using a combination of pre transplant anti-thymocyte globulin and post-transplant cyclophosphamide in matched unrelated donor transplantation. Bone Marrow Transplant 2017; 53:361-365. [DOI: 10.1038/s41409-017-0053-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/06/2017] [Accepted: 10/23/2017] [Indexed: 11/09/2022]
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Michelis FV, Messner HA, Loach D, Uhm J, Gupta V, Lipton JH, Seftel MD, Kuruvilla J, Kim DD. Early lymphocyte recovery at 28 d post-transplant is predictive of reduced risk of relapse in patients with acute myeloid leukemia transplanted with peripheral blood stem cell grafts. Eur J Haematol 2014; 93:273-80. [DOI: 10.1111/ejh.12338] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Fotios V. Michelis
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - Hans A. Messner
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - David Loach
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - Jieun Uhm
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - Vikas Gupta
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - Jeffrey H. Lipton
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - Matthew D. Seftel
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - John Kuruvilla
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - Dennis D. Kim
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Faculty of Medicine; University of Toronto; Toronto ON Canada
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Michelis FV, Messner HA, Atenafu EG, Kim DD, Kuruvilla J, Lipton JH, Uhm J, Loach D, Gupta V. Benefit of allogeneic transplantation in patients age ≥ 60 years with acute myeloid leukemia is limited to those in first complete remission at time of transplant. Biol Blood Marrow Transplant 2013; 20:474-9. [PMID: 24345422 DOI: 10.1016/j.bbmt.2013.12.560] [Citation(s) in RCA: 19] [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] [Received: 08/27/2013] [Accepted: 12/11/2013] [Indexed: 01/30/2023]
Abstract
We evaluated the impact of age and remission status on 242 consecutive patients who underwent allogeneic hematopoietic cell transplantation for acute myeloid leukemia (AML) in our program between 1999 and 2011. Median age of all patients was 48 years (range, 18 to 71). Based on age and remission status, patients were divided into 4 groups: first complete remission (CR1) age <60 years (n = 116), second complete remission (CR2) age <60 years (n = 78), CR1 age ≥60 years (n = 32), and CR2 age ≥60 years (n = 16). Donors were matched related (n = 155, 64%) or matched unrelated (n = 87, 36%). Median follow-up of survivors was 65 months (range, 12 to 145). In a univariate analysis, 3-year overall survival rates of the 4 groups were 57%, 43%, 39%, and 16% (P = .003), respectively. In a multivariable analysis, hazard ratios of nonrelapse mortality and survival were 2.08 (P = .06) and 1.52 (P = .23), respectively, in patients ≥60 years in CR2 compared with ≥ 60 years in CR1. Although a plateau in survival was observed for patients ≥60 years in CR1 similar to those <60 years in CR1 and CR2, no long-term survivors were seen in patients ≥60 years in CR2. Our data suggest disappointing outcomes in AML patients ≥60 years of age transplanted in CR2. Therefore, if a transplant is indicated, early referral is recommended in patients ≥60 years with AML.
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Affiliation(s)
- Fotios V Michelis
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hans A Messner
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dennis D Kim
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John Kuruvilla
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey H Lipton
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jieun Uhm
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Loach
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vikas Gupta
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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14
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Loach D, Frischen A. Investigating an inhibitory account of the attentional blink. J Vis 2010. [DOI: 10.1167/7.9.675] [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] [Indexed: 11/24/2022] Open
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Frischen A, Loach D. Processing of the ignored object during eye gaze cueing. J Vis 2010. [DOI: 10.1167/7.9.651] [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] [Indexed: 11/24/2022] Open
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Shapiro K, Schmitz F, Martens S, Mueller K, Loach D, Akyurek E, Hommel B, Schnitzler A. MEG reveals correlation between task difficulty and magnitude of the attentional blink. J Vis 2010. [DOI: 10.1167/2.7.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gupta V, Xu W, Sutherland R, Kamel-Reid S, Kuruvilla J, Loach D, Lipton J, Messner H. Optimization Of Alemtuzumab Dose For Graft-Versus-Host Disease Prophylaxis For Reduced Intensity Transplantation From Unrelated Donors For Patients With Hematologic Malignancies. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kim DH, Jamal N, Saragosa R, Loach D, Wright J, Gupta V, Kuruvilla J, Lipton JH, Minden M, Messner HA. Similar Outcomes of Cryopreserved Allogeneic Peripheral Stem Cell Transplants (PBSCT) Compared to Fresh Allografts. Biol Blood Marrow Transplant 2007; 13:1233-43. [PMID: 17889361 DOI: 10.1016/j.bbmt.2007.07.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 07/05/2007] [Indexed: 11/22/2022]
Abstract
The BMT program at Princess Margaret Hospital performed 105 transplants using cryopreserved peripheral blood stem cells (PBSC) from related allogeneic donors. The outcomes were compared with those of a historic control of 106 patients transplanted with freshly procured PBSC. The infusions were tolerated with limited toxicity related to nausea/vomiting or bradycardia, correlated with the total amount of DMSO infused. The average viability of the total nucleated cell (TNC) population after thawing was 71%. The survival of clonogenic progenitors amounted to 75% for colony-forming unit-granulocyte-macrophage (CFU-GM), 69% for burst-forming units erythroid (BFU-E), and 78% for colony-forming units granulocyte-erythrocyte-monocyte-megakaryocyte (CFU-GEMM). In contrast, colony-forming units megakaryocyte (CFU-MEG) was significantly more cryosensitive with recovery rates of 39%. The number of viable CD34(+) cells transplanted was correlated with the number of transplanted viable CFU-GM (P < .001), BFU-E (P < .001), CFU-MEG (P < .001), and CFU-GEMM (P = .049), but not with the TNC dose. The number of transplanted CD34(+) cells was correlated with engraftment of neutrophils (P = .012) and platelets (P = .013). The outcomes of cryopreseved or fresh PBSC transplants (PBSCT) with respect to engraftment of neutrophils (P = .178) and platelets (P = .785), lymphocyte recovery (P = .926), acute (P = .113), and chronic graft-versus-host disease (P = .673), recurrence (P = .295), nonrelapse mortality (P = .340), and overall survival (P = .668) were not significantly different. It is therefore reasonable to consider the option of cryopreserved allografts.
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Affiliation(s)
- Dong Hwan Kim
- Department of Hematology/Medical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada
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Zaretsky Y, Rifkind J, Lockwood G, Tsang R, Kiss T, Hasegawa W, Fyles G, Tejpar I, Loach D, Minden M, Messner H, Lipton JH. Long-term follow-up of allogeneic bone marrow transplantation for patients with chronic phase chronic myeloid leukemia prepared with a regimen consisting of cyclophosphamide, cytarabine and single-dose total body irradiation conditioning. Bone Marrow Transplant 2007; 40:423-30. [PMID: 17603516 DOI: 10.1038/sj.bmt.1705755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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
We evaluated long-term toxicities and outcomes in 96 patients with chronic phase chronic myeloid leukemia treated with a single bone marrow allograft regimen. Conditioning was cytosine arabinoside, cyclophosphamide (120 mg/kg) and single fraction total body irradiation (500 cGy). Median follow-up was 12.8 years (0.4-19.9 years). Graft failure occurred in one patient, nonfatal veno-occlusive disease in 13 patients (14%). Overall incidences of acute (a) and chronic (c) graft-vs-host disease (GVHD) were 77 and 63%. The 100-day and 1-year transplant-related mortality (TRM) were 1 and 9.2%, respectively, with no change through 5 years. Five- and 10-year event-free survival rates were 56 and 49%, overall survival (OS) rates 72 and 70%, respectively. Forty patients have relapsed: 8 cytogenetic (20%), 10 hematologic (25%) and 22 molecular (55%). Most have been salvaged with donor-leukocyte infusion, second transplants and/or imatinib therapy. Survival was worse for patients transplanted >2 years from diagnosis (10-year OS 56 vs 78%, P=0.01), for patients over 50 years old (10-year OS 44 vs 75%, P=0.05) and for patients without cGVHD (10-year OS 53 vs 86%, P<0.001). This regimen resulted in successful engraftment, low risk of TRM and long-term survival. In an era when imatinib is first line therapy, this regimen offers a potentially low-toxicity, highly successful alternative in the event of poor imatinib response.
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Affiliation(s)
- Y Zaretsky
- Department of Medical Oncology and Hematology, University of Toronto Allogeneic Blood and Marrow Transplant Program, Toronto, Ontario, Canada
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Siegal D, Keller A, Xu W, Bhuta S, Loach D, Kim D, Walia J, Kuruvilla J, Lipton J, Minden M, Messner H, Gupta V. 241: Neurological complications in the recipients of allogeneic hematopoietic cell transplant. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.246] [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] [Indexed: 10/23/2022]
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Mates M, Michalska H, Hasegawa W, Kiss T, Daly A, Loach D, Messner H, Lipton J. Once daily intravenous busulfan as part of a busulfan/cyclophosphamide conditioning regimen for allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.165] [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] [Indexed: 11/16/2022]
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Couban S, Stewart AK, Loach D, Panzarella T, Meharchand J. Autologous and allogeneic transplantation for multiple myeloma at a single centre. Bone Marrow Transplant 1997; 19:783-9. [PMID: 9134169 DOI: 10.1038/sj.bmt.1700738] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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: 02/04/2023]
Abstract
We report the results of a consecutive series of patients who underwent autologous (auto) (40), allogeneic (allo) (22) or syngeneic transplantation (2) for multiple myeloma (MM) at our centre. Median age at diagnosis was 45.5 (auto) and 43 (allo) years. Most patients had stage 2 (27% auto; 27% allo) or stage 3 (62% auto; 50% allo) disease and 73% demonstrated chemosensitivity prior to transplant. Median time from diagnosis to transplant was 18.6 months (auto) and 16.4 months (allo). Standard conditioning regimens were used. Median time to neutrophil engraftment was 11 days (7-18) (auto) and 18 days (13-24) (allo) and median time to platelet engraftment was 11 days (6-60) and 18 days (13-105), respectively. Ninety-day mortality was 5% (auto) and 27% (allo). Median follow-up was 15 months (6-48) (auto) and 42 months (24-52) (allo). Three-year progression-free survival (PFS) was 17 +/- 10% (auto) and 22 +/- 9% (allo) and 3-year overall survival (OS) was 74 +/- 11% (auto) and 32 +/- 10% (allo). Autologous transplantation for MM is a safe procedure with good OS although disease progression following transplant is frequent. Allogeneic transplantation has a high procedure-related mortality and PFS comparable to autologous transplantation but OS is poor. The early mortality and high OS of autologous transplantation in MM compares favourably with both the results of allogeneic transplantation and published results of standard therapy in this retrospective analysis.
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Affiliation(s)
- S Couban
- Department of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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