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Kordelas L, Terzer T, Gooley T, Davis C, Sandmaier BM, Sorror M, Penack O, Schaeper NDE, Blau IW, Beelen D, Radujkovic A, Dreger P, Luft T. EASIX-1year and late mortality after allogeneic stem cell transplantation. Blood Adv 2023; 7:5374-5381. [PMID: 37477588 PMCID: PMC10509665 DOI: 10.1182/bloodadvances.2022008617] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/18/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
Patients with hematological malignancies who survive the first year after allogeneic stem cell transplantation (allo-SCT) without relapse have a substantial risk of nonrelapse mortality (NRM) and missing predictive markers. The Endothelial Activation and Stress Index (EASIX) predicts endothelial complications and NRM early after allo-SCT. We hypothesized that EASIX assessed 1 year after allo-SCT in survivors who were disease free may predict late NRM. Survivors who were relapse-free at 1 year after allo-SCT were retrospectively studied in 2 independent cohorts (training cohort, n = 610; merged validation cohort, n = 852). EASIX determined 1 year after allo-SCT correlated with the overall survival (OS), NRM, and relapse. Serum endothelial and inflammatory markers were measured in the training cohort and correlated with EASIX-1year, which predicted OS and NRM but not relapse risk in both the training and validation cohorts in univariable and multivariable Cox regression analyses. Brier score and c-index analyses validated the univariable EASIX effects. There was no significant interaction between EASIX-1year and incidence of chronic graft-versus-host disease (GVHD) on OS. EASIX-1year predicted the outcome irrespective of preexisting comorbidities. Principal causes of NRM in both training and validation cohorts were infections with and without GVHD as well as cardiovascular complications. EASIX-1year correlated with sCD141 and interleukin-18 but not with C-reactive protein, suppressor of tumorigenicity-2, angiopoietin-2, CXCL9, or CXCL8. To our knowledge, EASIX-1year is the first validated predictor of late overall and NRM. Patients who are high risk as defined by EASIX-1year might be considered for intensified surveillance and prophylactic measures.
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Affiliation(s)
- Lambros Kordelas
- Department of Bone Marrow Transplantation, West German Cancer Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tobias Terzer
- Division of Biostatistics, German Cancer Research Centre, Heidelberg, Germany
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
| | - Chris Davis
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Brenda M. Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
| | - Mohamed Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
| | - Olaf Penack
- Hematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nigel D. E. Schaeper
- Hematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Igor W. Blau
- Hematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, West German Cancer Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Peter Dreger
- Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Luft
- Medicine V, University Hospital Heidelberg, Heidelberg, Germany
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2
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Bornhäuser M, Schliemann C, Schetelig J, Röllig C, Kramer M, Glass B, Platzbecker U, Burchert A, Hänel M, Müller LP, Klein S, Bug G, Beelen D, Rösler W, Schäfer-Eckart K, Schmid C, Jost E, Lenz G, Tischer J, Spiekermann K, Pfirrmann M, Serve H, Stölzel F, Alakel N, Middeke JM, Thiede C, Ehninger G, Berdel WE, Stelljes M. Allogeneic Hematopoietic Cell Transplantation vs Standard Consolidation Chemotherapy in Patients With Intermediate-Risk Acute Myeloid Leukemia: A Randomized Clinical Trial. JAMA Oncol 2023; 9:519-526. [PMID: 36757706 PMCID: PMC9912165 DOI: 10.1001/jamaoncol.2022.7605] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/18/2022] [Indexed: 02/10/2023]
Abstract
Importance The ideal postremission strategy in intermediate-risk acute myeloid leukemia (AML) in first complete remission (CR) has been a matter of debate. Objective To explore the optimal therapy for patients with intermediate-risk AML after first complete remission. Design, Settings, and Participants This investigator-initiated, open-label, 2-armed, phase 3 randomized clinical trial assessed patients at 16 hospitals in Germany from February 2, 2011, until July 1, 2018. Key eligibility criteria included cytogenetically defined intermediate-risk AML according to Medical Research Council classification, first CR or CR with incomplete blood cell count recovery after conventional induction therapy, age of 18 to 60 years, and availability of a human leukocyte antigen (HLA)-matched sibling or unrelated donor. A detailed statistical analysis plan was written and finalized on July 7, 2020. Data were exported for analysis on April 13, 2021. Interventions Patients were randomized 1:1 to receive allogeneic hematopoietic cell transplantation (HCT) or high-dose cytarabine for consolidation and salvage HCT only in case of relapse. Strata for randomization included age (18-40 vs 41-60 years), NPM1 and CEBPA variation status, and donor type (unrelated vs related). Main Outcomes and Measures End points included overall-survival as the primary outcome and disease-free survival, cumulative incidence of relapse, treatment-related mortality, and quality of life measured according to the Medical Outcomes Study 36-Item Short-Form Health Survey as secondary outcomes. Results A total of 143 patients (mean [SD] age, 48.2 [9.8] years; 81 [57%] male) with AML who fulfilled the eligibility criteria were randomized. In the intention-to-treat analysis, the probability of survival at 2 years was 74% (95% CI, 62%-83%) after primary allogeneic HCT and 84% (95% CI, 73%-92%) after consolidation chemotherapy (P = .22). Disease-free survival after HCT at 2 years was 69% (95% CI, 57%-80%) compared with 40% (95% CI, 28%-53%) after consolidation chemotherapy (P = .001). Allogeneic HCT during the first CR was associated with a cumulative incidence of relapse at 2 years of 20% (95% CI, 13%-31%) compared with 58% (95% CI, 47%-71%; P < .001). Nonrelapse mortality at 2 years after primary allogeneic HCT was 9% (95% CI, 5%-19%) and 2% (95% CI, 0%-11%) after consolidation chemotherapy (P = .005). Similar outcomes were observed when analyses were confined to the 96 patients at intermediate risk according to the European Leukemia Network classification. Most importantly, all 41 patients relapsing after consolidation chemotherapy (36 hematologic, 4 molecular, and 1 extramedullary) proceeded to allogeneic HCT. No significant differences in health-related quality of life measures were observed between groups. Conclusions and Relevance Primary allogeneic HCT during first CR was not associated with superior overall survival compared with consolidation chemotherapy in patients 60 years or younger with intermediate-risk AML during the first CR and an available donor. Trial Registration ClinicalTrials.gov Identifier: NCT01246752.
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Affiliation(s)
- Martin Bornhäuser
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- National Center for Tumor Diseases, Dresden, Germany
| | | | - Johannes Schetelig
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Christoph Röllig
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Michael Kramer
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Uwe Platzbecker
- Department for Hematology and Cellular Therapy, University Hospital, Leipzig, Germany
| | - Andreas Burchert
- Department for Hematology and Oncology, University Hospital, Marburg, Germany
| | - Mathias Hänel
- Medical Clinic III, Klinikum Chemnitz, Chemnitz, Germany
| | - Lutz P. Müller
- Department of Internal Medicine IV, University Hospital Halle Martin Luther, University Halle-Wittenberg, Halle, Germany
| | | | - Gesine Bug
- Department of Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Wolf Rösler
- Department of Hematology, Oncology, and Immunotherapy, University Hospital Erlangen, Erlangen, Germany
| | | | - Christoph Schmid
- Department of Hematology, University Hospital Augsburg, Augsburg, Germany
| | - Edgar Jost
- University Hospital Aachen, Aachen, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - Johanna Tischer
- University Hospital Munich-Grosshadern, Department of Internal Medicine III, Ludwig-Maximilian University Munich, Munich, Germany
| | - Karsten Spiekermann
- University Hospital Munich-Grosshadern, Department of Internal Medicine III, Ludwig-Maximilian University Munich, Munich, Germany
| | - Markus Pfirrmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Hubert Serve
- Department of Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Friedrich Stölzel
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Nael Alakel
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jan Moritz Middeke
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Christian Thiede
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Gerhard Ehninger
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Matthias Stelljes
- Department of Medicine A, University Hospital Münster, Münster, Germany
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3
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Al Hamed R, Labopin M, Daguindau E, Niittyvuopio R, Huynh A, Socié G, Srour M, Henri Bourhis J, Kröger N, Tholouli E, Choi G, Poiré X, Martin H, Rubio MT, Jindra P, Blaise D, Beelen D, Labussière-Wallet H, Nagler A, Bazarbachi A, Mohty M. Measurable residual disease, FLT3-ITD mutation, and disease status have independent prognostic influence on outcome of allogeneic stem cell transplantation in NPM1-mutated acute myeloid leukemia. Cancer Med 2022; 11:1068-1080. [PMID: 35048553 PMCID: PMC8855908 DOI: 10.1002/cam4.4218] [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: 07/09/2021] [Revised: 07/24/2021] [Accepted: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
Nucleophosmin‐1 (NPM1) mutations in acute myeloid leukemia (AML) confer a survival advantage in the absence of FLT3‐internal tandem duplication (FLT3‐ITD). Here, we investigated the main predictors of outcome after allogeneic hematopoietic stem cell transplantation (allo‐HCT). We identified 1572 adult (age ≥ 18 year) patients with NPM1‐mutated AML in first complete remission (CR1:78%) or second complete remission (CR2:22%) who were transplanted from matched sibling donors (30.8%) or unrelated donors (57.4%) between 2007 and 2019 at EBMT participating centers. Median follow‐up for survivors was 23.7 months. FLT3‐ITD was present in 69.3% of patients and 39.2% had detectable minimal/measurable residual disease (MRD) at transplant. In multivariate analysis, relapse incidence (RI) and leukemia‐free survival (LFS) were negatively affected by concomitant FLT3‐ITD mutation (HR 1.66 p = 0.0001, and HR 1.53, p < 0.0001, respectively), MRD positivity at transplant (HR 2.18, p < 10−5 and HR 1.71, p < 10−5, respectively), and transplant in CR2 (HR 1.36, p = 0.026, and HR 1.26, p = 0.033, respectively), but positively affected by Karnofsky score ≥90 (HR 0.74, p = 0.012, and HR 0.7, p = 0.0002, respectively). Overall survival (OS) was also negatively influenced by concomitant FLT3‐ITD (HR 1.6, p = 0.0001), MRD positivity at transplant (HR 1.61, p < 10−5), and older age (HR 1.22 per 10 years, p < 0.0001), but positively affected by matched sibling donor (unrelated donor: HR 1.35, p = 0.012; haploidentical donor: HR 1.45, p = 0.037) and Karnofsky score ≥90 (HR 0.73, p = 0.004). These results highlight the independent and significant role of FLT3‐ITD, MRD status, and disease status on posttransplant outcomes in patients with NPM1‐mutated AML allowing physicians to identify patients at risk of relapse who may benefit from posttransplant prophylactic interventions.
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Affiliation(s)
- Rama Al Hamed
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Myriam Labopin
- Department of Hematology, EBMT Paris Office, CEREST-TC, Saint Antoine Hospital, Paris, France
| | | | - Riitta Niittyvuopio
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Anne Huynh
- CHU - Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France
| | - Gerard Socié
- Department of Hematology - BMT, Hôpital St. Louis, Paris, France
| | - Micha Srour
- CHU de Lille, Université de Lille, Lille, France
| | - Jean Henri Bourhis
- Department of Hematology, Gustave Roussy Cancer Campus, BMT Service, Villejuif, France
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
| | - Eleni Tholouli
- Clinica Haematology Department, Manchester Royal Infirmary, Manchester, UK
| | - Goda Choi
- Department of Hematology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Xavier Poiré
- Department of Haematology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Hans Martin
- Goethe-Universitaet, Medizinische Klinik II, Hämatologie, Medizinische Onkologie, Frankfurt, Germany
| | | | - Pavel Jindra
- Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | | | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamad Mohty
- Department of Hematology, EBMT Paris Office, CEREST-TC, Saint Antoine Hospital, Paris, France
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4
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Kröger N, Sbianchi G, Sirait T, Wolschke C, Beelen D, Passweg J, Robin M, Vrhovac R, Helbig G, Sockel K, Conneally E, Rubio MT, Beguin Y, Finke J, Bernasconi P, Morozova E, Clausen J, von dem Borne P, Schaap N, Schroyens W, Patriarca F, Di Renzo N, Yeğin ZA, Hayden P, McLornan D, Yakoub-Agha I. Impact of prior JAK-inhibitor therapy with ruxolitinib on outcome after allogeneic hematopoietic stem cell transplantation for myelofibrosis: a study of the CMWP of EBMT. Leukemia 2021; 35:3551-3560. [PMID: 34023851 PMCID: PMC8632691 DOI: 10.1038/s41375-021-01276-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/07/2021] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Abstract
JAK1/2 inhibitor ruxolitinib (RUX) is approved in patients with myelofibrosis but the impact of pretreatment with RUX on outcome after allogeneic hematopoietic stem cell transplantation (HSCT) remains to be determined. We evaluated the impact of RUX on outcome in 551 myelofibrosis patients who received HSCT without (n = 274) or with (n = 277) RUX pretreatment. The overall leukocyte engraftment on day 45 was 92% and significantly higher in RUX responsive patients than those who had no or lost response to RUX (94% vs. 85%, p = 0.05). The 1-year non-relapse mortality was 22% without significant difference between the arms. In a multivariate analysis (MVA) RUX pretreated patients with ongoing spleen response at transplant had a significantly lower risk of relapse (8.1% vs. 19.1%; p = 0.04)] and better 2-year event-free survival (68.9% vs. 53.7%; p = 0.02) in comparison to patients without RUX pretreatment. For overall survival the only significant factors were age > 58 years (p = 0.03) and HLA mismatch donor (p = 0.001). RUX prior to HSCT did not negatively impact outcome after transplantation and patients with ongoing spleen response at time of transplantation had best outcome.
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Affiliation(s)
- Nicolaus Kröger
- Department of Stem Cell Transplantation University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Giulia Sbianchi
- Department of Biology, University of Rome "Tor Vergata", Rome, Italy
| | | | - Christine Wolschke
- Department of Stem Cell Transplantation University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | | | - Yves Beguin
- University of Liege and CHU of Liege, Liege, Belgium
| | | | | | - Elena Morozova
- First State Pavlov Medical University of St. Petersburg, St. Petersburg, Russia
| | | | | | | | | | - Francesca Patriarca
- Division of Hematology and Stem Cell Transplantation Center, University Hospital and DAME, Udine, Italy
| | - Nicola Di Renzo
- Unita Operativa di Ematologia e Trapianto di Cellule Staminali, Lecce, Italy
| | | | - Patrick Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Donal McLornan
- Department of Haematology, Guy's Hospital and Department of Stem Cell Transplantation, University College London Hospital, London, England
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5
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Sellner L, Schetelig J, Koster L, Choi G, Blaise D, Beelen D, Schianca FC, Passweg J, Schanz U, Gyan E, Sora F, Kröger N, Wulf GG, Van Gorkom G, Mayer J, Orvain C, Bourhis JH, Jindra P, Potter V, Zallio F, Vandenberghe E, Robinson S, Hayden PJ, Yakoub-Agha I, Montoto S, Dreger P. Correction: Idelalisib exposure before allogeneic stem cell transplantation in patients with follicular lymphoma: an EBMT survey. Bone Marrow Transplant 2021; 56:3108. [PMID: 34621022 PMCID: PMC8636245 DOI: 10.1038/s41409-021-01490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Leopold Sellner
- University Hospital Heidelberg, Heidelberg, Germany. .,Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany.
| | | | | | - Goda Choi
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Didier Blaise
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | | | | | | | - Urs Schanz
- University Hospital of Zurich, Zurich, Switzerland
| | - Emmanuel Gyan
- Hematology and cell therapy department, Centre hospitalier Universitaire, Université de Tours, CIC Inserm 1415, Tours, France
| | - Federica Sora
- Sez. Ematologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | | | | | | | - Jiri Mayer
- University Hospital Brno, Brno, Czech Republic
| | | | | | - Pavel Jindra
- Charles University Hospital, Pilsen, Czech Republic
| | | | - Francesco Zallio
- Divisione di Ematologia, AO SS Antonio e Biagio e Cesare Arrigo Alessandria, Alessandria, Italy
| | - Elisabeth Vandenberghe
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | | | - Patrick J Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Ibrahim Yakoub-Agha
- Univ. Lille, Inserm, CHU Lille, INSERM, Infinite, U1286F-59000, Lille, France
| | - Silvia Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Peter Dreger
- University Hospital Heidelberg, Heidelberg, Germany
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6
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Hernández‐Boluda J, Pereira A, Kröger N, Cornelissen JJ, Finke J, Beelen D, Witte M, Wilson K, Platzbecker U, Sengeloev H, Blaise D, Einsele H, Sockel K, Krüger W, Lenhoff S, Salaroli A, Martin H, García‐Gutiérrez V, Pavone V, Alvarez‐Larrán A, Raya J, Zinger N, Gras L, Hayden P, Czerw T, P. McLornan D, Yakoub‐Agha I. Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry. Am J Hematol 2021; 96:1186-1194. [PMID: 34152630 DOI: 10.1002/ajh.26279] [Citation(s) in RCA: 13] [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] [Received: 04/18/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 01/13/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly used in older myelofibrosis (MF) patients, but its risk/benefit ratio compared to non-transplant approaches has not been evaluated in this population. We analyzed the outcomes of allo-HCT in 556 MF patients aged ≥65 years from the EBMT registry, and determined the excess mortality over the matched general population of MF patients ≥65 years managed with allo-HCT (n = 556) or conventional drug treatment (n = 176). The non-transplant cohort included patients with intermediate-2 or high risk DIPSS from the Spanish Myelofibrosis Registry. After a median follow-up of 3.4 years, the estimated 5-year survival rate, non-relapse mortality (NRM), and relapse incidence after transplantation was 40%, 37%, and 25%, respectively. Busulfan-based conditioning was associated with decreased mortality (HR: 0.7, 95% CI: 0.5-0.9) whereas the recipient CMV+/donor CMV- combination (HR: 1.7, 95% CI: 1.2-2.4) and the JAK2 mutated genotype (HR: 1.9, 95% CI: 1.1-3.5) predicted higher mortality. Busulfan-based conditioning correlated with improved survival due to less NRM, despite its higher relapse rate when compared with melphalan-based regimens. Excess mortality was higher in transplanted patients than in the non-HCT cohort in the first year of follow-up (ratio: 1.93, 95% CI: 1.13-2.80), whereas the opposite occurred between the fourth and eighth follow-up years (ratio: 0.31, 95% CI: 0.18-0.53). Comparing the excess mortality of the two treatments, male patients seemed to benefit more than females from allo-HCT, mainly due to their worse prognosis with non-transplant approaches. These findings could potentially enhance counseling and treatment decision-making in elderly transplant-eligible MF patients.
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Affiliation(s)
| | - Arturo Pereira
- Department of Hemotherapy and Hemostasis Hospital Clínic Barcelona Spain
| | - Nicolaus Kröger
- Hematology Department University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Jan J. Cornelissen
- Erasmus MC Cancer Center University Medical Center Rotterdam the Netherlands
| | - Jürgen Finke
- Medical Center University of Freiburg, Faculty of Medicine Freiburg Germany
| | | | - Moniek Witte
- Hematology Department University Medical Center Utrecht the Netherlands
| | - Keith Wilson
- Hematology Department University Hospital of Wales Cardiff UK
| | - Uwe Platzbecker
- Hematology Department University Hospital Leipzig Leipzig Germany
| | | | - Didier Blaise
- Hematology Department Institut Paoli Calmettes Marseille France
| | - Hermann Einsele
- Hematology Department Universitaetsklinikum Würzburg Wuerzburg Germany
| | - Katja Sockel
- Hematology Department University Hospital Dresden, TU Dresden Dresden Germany
| | - William Krüger
- Hematology Department Universitaetsklinikum Greifswald Greifswald Germany
| | - Stig Lenhoff
- Hematology Department Skanes University Hospital Lund Sweden
| | | | - Hans Martin
- Hematology Department Universitaetsklinikum Frankfurt Frankfurt Germany
| | | | | | | | - José‐María Raya
- Hematology Department Hospital Universitario de Canarias Tenerife Spain
| | | | - Luuk Gras
- EBMT Statistical Unit Leiden The Netherlands
| | - Patrick Hayden
- Hematology Department Trinity College Dublin, St. James's Hospital Dublin Ireland
| | - Tomasz Czerw
- Hematology Department Maria Skłodowska‐Curie National Research Institute of Oncology, Gliwice Branch Gliwice Poland
| | - Donal P. McLornan
- Hematology Department Guys' and St. Thomas' NHS Foundation Trust and University College London Hospitals London UK
| | - Ibrahim Yakoub‐Agha
- Hematology Department CHU de Lille, Université de Lille, INSERM U1286 Lille France
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7
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Peric Z, Peczynski C, Polge E, Kröger N, Sengeloev H, Radujkovic A, Helbig G, Russell N, Bunjes D, Socié G, Potter V, Beelen D, Crawley C, Bloor A, Finke J, Schoemans H, Penack O, Snowden JA, Koenecke C, Basak GW. Influence of pretransplant inflammatory bowel disease on the outcome of allogeneic hematopoietic stem cell transplantation: a matched-pair analysis study from the Transplant Complications Working Party (TCWP) of the EBMT. Bone Marrow Transplant 2021; 56:3084-3087. [PMID: 34561559 DOI: 10.1038/s41409-021-01458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 08/04/2021] [Accepted: 09/01/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Zinaida Peric
- University Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Christophe Peczynski
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Emmanuelle Polge
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
| | - Henrik Sengeloev
- Bone Marrow Transplant Unit, National University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Grzegorz Helbig
- Silesian Medical Academy, Univ. Dept. of Haematology and BMT, Katowice, Poland
| | | | - Donald Bunjes
- Klinik fuer Innere Medzin III, Universitätsklinikum Ulm, Ulm, Germany
| | - Gerard Socié
- Dept.of Hematology-BMT, Hopital St. Louis, Paris, France
| | - Victoria Potter
- GKT School of Medicine, Dept. of Haematological Medicine, King's Denmark Hill Campus, London, UK
| | - Dietrich Beelen
- Dept. of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - Charles Crawley
- Department of Haematology, Addenbrookes Hospital, Cambridge, UK
| | - Adrian Bloor
- Adult Leukaemia and Bone Marrow Transplant Unit, Christie NHS Trust Hospital, Manchester, UK
| | - Jürgen Finke
- Department of Medicine-Hematology, Oncology and Medical Faculty University Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Helene Schoemans
- Department of Hematology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Olaf Penack
- Department of Hematology, Oncology and Tumorimmunology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christian Koenecke
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation and Institute of Immunology, Hannover, Germany
| | - Grzegorz W Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
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8
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Shimoni A, Robin M, Iacobelli S, Beelen D, Mufti GJ, Ciceri F, Bethge W, Volin L, Blaise D, Ganser A, Luft T, Chevallier P, Schwerdtfeger R, Koster L, de Witte T, Kröger N, Nagler A, Yakoub-Agha I. Allogeneic hematopoietic cell transplantation in patients with myelodysplastic syndrome using treosulfan based compared to other reduced-intensity or myeloablative conditioning regimens. A report of the chronic malignancies working party of the EBMT. Br J Haematol 2021; 195:417-428. [PMID: 34514596 DOI: 10.1111/bjh.17817] [Citation(s) in RCA: 3] [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: 06/24/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/20/2022]
Abstract
Allogeneic haematopoietic-cell transplantation (allo-HCT) is a potentially curative therapy for high-risk myelodysplastic syndrome (MDS). Reduced-intensity conditioning (RIC) is usually associated with lower non-relapse mortality (NRM), higher relapse rate and similar overall-survival (OS) as myeloablative-conditioning (MAC). Fludarabine/treosulfan (FT) is a reduced-toxicity regimen with intense anti-leukaemia activity and a favourable toxicity profile. We investigated post-transplant outcomes in 1722 MDS patients following allo-HCT with FT (n = 367), RIC (n = 687) or MAC (n = 668). FT and RIC recipients were older than MAC recipients, median age 59, 59 and 51 years, respectively (P < 0·001) but other disease characteristics were similar. The median follow-up was 64 months (1-171). Five-year relapse rates were 25% (21-30), 38% (34-42) and 25% (22-29), after FT, RIC and MAC, respectively, (P < 0·001). NRM was 30% (25-35), 27% (23-30) and 34% (31-38, P = 0·008), respectively. Five-year OS was 50% (44-55), 43% (38-47), and 43% (39-47), respectively (P = 0·03). In multivariate analysis, FT was associated with a lower risk of relapse (HR 0·55, P < 0·001) and better OS (HR 0·72, P = 0·01). MAC was associated with higher NRM (HR 1·44, P = 0·001). In conclusion, FT is associated with similar low relapse rates as MAC and similar low NRM as RIC, resulting in improved OS. FT may be the preferred regimen for allo-HCT in MDS.
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Affiliation(s)
- Avichai Shimoni
- Chaim Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel
| | - Marie Robin
- Hematology/Transplantation, Saint Louis Hospital, Paris, France
| | - Simona Iacobelli
- Interdipartimentale di Biostatistica e Bioinformatica, Universita tor Vergata, Rome, Italy
| | - Dietrich Beelen
- Clinic for Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - Ghulam J Mufti
- Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Scientific Institute, Milano, Italy
| | - Wolfgang Bethge
- Department of Hematology, Oncology, Immunology, University of Tübingen, Tübingen, Germany
| | - Liisa Volin
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Thomas Luft
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | - Rainer Schwerdtfeger
- Centre for Hematopoietic Cell Transplantation, German Diagnostic Clinic, Wiesbaden, Germany
| | - Linda Koster
- EBMT Data Office, University Medical Centre, Leiden, Netherlands
| | - Theo de Witte
- University Medical Centre St. Radboud, Nijmegen, Netherlands
| | - Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel
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9
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Kröger N, Sockel K, Wolschke C, Bethge W, Schlenk RF, Wolf D, Stadler M, Kobbe G, Wulf G, Bug G, Schäfer-Eckart K, Scheid C, Nolte F, Krönke J, Stelljes M, Beelen D, Heinzelmann M, Haase D, Buchner H, Bleckert G, Giagounidis A, Platzbecker U. Comparison Between 5-Azacytidine Treatment and Allogeneic Stem-Cell Transplantation in Elderly Patients With Advanced MDS According to Donor Availability (VidazaAllo Study). J Clin Oncol 2021; 39:3318-3327. [PMID: 34283629 DOI: 10.1200/jco.20.02724] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In contrast to 5-azacytidine (5-aza), allogeneic stem-cell transplantation (HSCT) represents a curative treatment strategy for patients with myelodysplastic syndromes (MDS), but therapy-related mortality (TRM) limits its broader use in elderly patients with MDS. The present prospective multicenter study compared HSCT following 5-aza pretreatment with continuous 5-aza treatment in patients with higher-risk MDS age 55-70 years. METHODS One hundred ninety patients with a median age of 63 years were enrolled. Patients received 4-6 cycles of 5-aza followed by HLA-compatible HSCT after reduced-intensity conditioning or by continuous 5-aza if no donor was identified. RESULTS Twenty-eight patients did not fulfill inclusion criteria (n = 20), died (n = 2) withdrew informed consent (n = 5), or were excluded for an unknown reason (n = 1). 5-aza induction started in 162 patients, but only 108 (67%) were eligible for subsequent allocation to HSCT (n = 81) or continuation of 5-aza (n = 27) because of disease progression (n = 26), death (n = 12), or other reasons (n = 16). Seven percent died during 5-aza before treatment allocation. The cumulative incidence of TRM after HSCT at 1 year was 19%. The event-free survival and overall survival after 5-aza pretreatment and treatment allocation at 3 years were 34% (95% CI, 22 to 47) and 50% (95% CI, 39 to 61) after allograft and 0% and 32% (95% CI, 14 to 52) after continuous 5-aza treatment (P < .0001 and P = .12), respectively. Fourteen patients progressing after continuous 5-aza received a salvage allograft from an alternative donor, and 43% were alive at last follow-up. CONCLUSION In older patients with MDS, reduced-intensity conditioning HSCT resulted in a significantly improved event-free survival in comparison with continuous 5-aza therapy. Bridging with 5-aza to HSCT before is associated with a considerable rate of dropouts because of progression, mortality, and adverse events.
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Affiliation(s)
- Nicolaus Kröger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katja Sockel
- Medical Clinic and Policlinic 1, University Hospital "Carl Gustav Carus" Dresden, Dresden, Germany
| | | | | | - Richard F Schlenk
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,NCT-Trial Center, National Center of Tumor Diseases Heidelberg, German Cancer Research Center, Heidelberg, Germany
| | - Dominik Wolf
- Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria.,Tyrolean Cancer Research Institute, Innsbruck, Austria.,Medical Clinic III, University Clinic Bonn, Bonn, Germany
| | | | - Guido Kobbe
- University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Gerald Wulf
- University Medical Center Göttingen, Göttingen, Germany
| | - Gesine Bug
- Department of Medicine 2, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Christof Scheid
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn, University of Cologne, Cologne Düsseldorf, Germany
| | - Florian Nolte
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | | | | | | | | | - Detlef Haase
- University Medical Center Göttingen, Göttingen, Germany
| | - Hannes Buchner
- Staburo München, Statistical Consulting, Munich, Germany
| | | | | | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, University Hospital "Carl Gustav Carus" Dresden, Dresden, Germany.,University of Leipzig Medical Center, Leipzig, Germany
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10
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Domingo-Domenech E, Duarte RF, Boumedil A, Onida F, Gabriel I, Finel H, Arcese W, Browne P, Beelen D, Kobbe G, Veelken H, Arranz R, Greinix H, Lenhoff S, Poiré X, Ribera JM, Thompson J, Zuckerman T, Mufti GJ, Cortelezzi A, Olavarria E, Dreger P, Sureda A, Montoto S. Allogeneic hematopoietic stem cell transplantation for advanced mycosis fungoides and Sézary syndrome. An updated experience of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2021; 56:1391-1401. [PMID: 33420392 DOI: 10.1038/s41409-020-01197-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment option in advanced-stage mycosis fungoides (MF) and Sézary syndrome (SS). This study presents an updated analysis of the initial experience of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation (EBMT) describing the outcomes after allo-HSCT for MF and SS, with special emphasis on the impact of the use of unrelated donors (URD). METHODS AND PATIENTS Eligible for this study were patients with advanced-stage MF or SS who underwent a first allo-HSCT from matched HLA-identical related or URD between January/1997 and December/2011. Sixty patients have been previously reported. RESULTS 113 patients were included [77 MF (68%)]; 61 (54%) were in complete or partial remission, 86 (76%) received reduced-intensity protocols and 44 (39%) an URD allo-HSCT. With a median follow up for surviving patients of 73 months, allo-HSCT resulted in an estimated overall survival (OS) of 38% at 5 years, and a progression-free survival (PFS) of 26% at 5 years. Multivariate analysis demonstrated that advanced-phase disease (complete remission/partial remission >3, primary refractory or relapse/progression in patients that had received 3 or more lines of systemic treatment prior to transplant or the number of treatment lines was not known), a short interval between diagnosis and transplant (<18 months) were independent adverse prognostic factors for PFS; advanced-phase disease and the use of URDs were independent adverse prognostic factors for OS. CONCLUSIONS This extended series supports that allo-HSCT is able to effectively rescue over one third of the population of patients with advanced-stage MF/SS. High relapse rate is still the major cause of failure and needs to be improved with better strategies before and after transplant. The negative impact of URD is a matter of concern and needs to be further elucidated in future studies.
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Affiliation(s)
- E Domingo-Domenech
- Hematology Department, Institut Català d'Oncologia. Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain.
| | - R F Duarte
- Hematology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - A Boumedil
- EBMT Central Registry Office, Paris, France
| | - F Onida
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico IRCCS, Milano, Italy
| | - I Gabriel
- Department of Hematology, Imperial College, Hammersmith Hospital, London, United Kingdom
| | - H Finel
- EBMT Central Registry Office, Paris, France
| | - W Arcese
- Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - P Browne
- St's James Hospital, Dublin, Ireland
| | - D Beelen
- University Hospital, Department of Bone Marrow Transplantation, Essen, Germany
| | - G Kobbe
- Heinrich Heine University, Medical F, Department of Hematology, Düsseldorf, Germany
| | - H Veelken
- Leiden University Medical Center, Leiden, The Netherlands
| | - R Arranz
- Hematology Department, Hospital La Princesa, Madrid, Spain
| | - H Greinix
- Division of Hematology, Medical University Graz, Graz, Austria
| | - S Lenhoff
- Skanes University Hospital, Department of Hematology, Lund, Sweden
| | - X Poiré
- Cliniques Universitaires St. Luc, Department of Hematology, Brussels, Belgium
| | - J M Ribera
- Hematology Department, Institut Català d'Oncologia, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - J Thompson
- Albert's Stem Cell Transplantation Center, Pretoria, South Africa
| | - T Zuckerman
- Ramban Medical Center, Department of Hematology and Bone Marrow Transplantation, Haifa, Israel
| | - G J Mufti
- GKT School of Medicine, Dept. of Haematological Medicine, King's Denmark Hill Campus, London, United Kingdom
| | - A Cortelezzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico IRCCS, Milano, Italy
| | - E Olavarria
- Department of Hematology, Imperial College, Hammersmith Hospital, London, United Kingdom
| | - P Dreger
- Universitaetsklinkum Heidelberg, Heidelberg, Germany
| | - A Sureda
- Hematology Department, Institut Català d'Oncologia. Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - S Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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11
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Polverelli N, Mauff K, Kröger N, Robin M, Beelen D, Beauvais D, Chevallier P, Mohty M, Passweg J, Rubio MT, Maertens J, Finke J, Bornhäuser M, Vrhovac R, Helbig G, Mear J, Castagna L, Reményi P, Angelucci E, Karakasis D, Rifòn J, Sirait T, Russo D, Wreede L, Czerw T, Hernández‐Boluda JC, Hayden P, McLornan D, Yakoub‐Agha I. Impact of spleen size and splenectomy on outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis: A retrospective analysis by the chronic malignancies working party on behalf of European society for blood and marrow transplantation (EBMT). Am J Hematol 2021; 96:69-79. [PMID: 33064301 DOI: 10.1002/ajh.26020] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
The role of spleen size and splenectomy for the prediction of post-allogeneic hematopoietic stem cell transplant (allo-HCT) outcome in myelofibrosis remains under debate. In EBMT registry, we identified a cohort of 1195 myelofibrosis patients transplanted between 2000-2017 after either fludarabine-busulfan or fludarabine-melphalan regimens. Overall, splenectomy was performed in 202 (16.9%) patients and its use decreased over time (28.3% in 2000-2009 vs 14.1% in 2010-2017 period). By multivariate analysis, splenectomy was associated with less NRM (HR 0.64, 95% CI 0.44-0.93, P = .018) but increased risk of relapse (HR 1.43, 95% CI 1.01-2.02, P = .042), with no significant impact on OS (HR 0.86, 95% CI 0.67-1.12, P = .274). However, in subset analysis comparing the impact of splenectomy vs specific spleen sizes, for patients with progressive disease, an improved survival was seen in splenectomised subjects compared to those patients with a palpable spleen length ≥ 15 cm (HR 0.44, 95% CI 0.28-0.69, P < .001), caused by a significant reduction in NRM (HR 0.26, 95% CI 0.14-0.49, P < .001), without significantly increased relapse risk (HR 1.47, 95% CI 0.87-2.49, P = .147). Overall, despite the possible biases typical of retrospective cohorts, this study highlights the potential detrimental effect of massive splenomegaly in transplant outcome and supports the role of splenectomy for myelofibrosis patients with progressive disease and large splenomegaly.
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Affiliation(s)
- Nicola Polverelli
- Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences University of Brescia ASST Spedali Civili of Brescia
| | | | - Nicolaus Kröger
- Department of Hematology University Hospital Eppendorf Hamburg Germany
| | - Marie Robin
- Department of Hematology Hôpital Saint‐Louis, APHP Paris France
| | - Dietrich Beelen
- Department of Hematology University Hospital of Essen Essen Germany
| | | | | | - Mohamad Mohty
- Sorbonne University Paris France
- Service d'Hématologie Clinique et Thérapie cellulaire Hopital Saint‐Antoine Paris France
- INSERM Paris France
| | - Jakob Passweg
- Department of Hematology University Hospital Basel Basel Switzerland
| | | | - Johan Maertens
- Department of Hematology University Hospital Gasthuisberg Leuven Belgium
| | - Jürgen Finke
- Department of Hematology University of Freiburg Freiburg Germany
| | - Martin Bornhäuser
- Department of Hematology University Hospital Dresded Dresden Germany
| | - Radovan Vrhovac
- Department of Hematology University Hospital Center Rebro Zagreb Croatia
| | - Grzegorz Helbig
- Department of Hematology Silesian Medical Academy Katowice Poland
| | - Jean‐Baptiste Mear
- Department of Hematology Centre Hospitalier Universitaire de Rennes Rennes France
| | - Luca Castagna
- Department of Hematology Centre de Recherche en Cancérologie de Marseille Marseille France
| | - Péter Reményi
- Department of Hematology Dél‐pesti Centrumkórház Budapest Hungary
| | - Emanuele Angelucci
- Hematology and Transplant Center IRCCS Ospedale Policlinico San Martino Genoa Italy
| | | | - Jose Rifòn
- Department of Hematology Clínica Universitaria de Navarra Pamplona Spain
| | | | - Domenico Russo
- Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences University of Brescia ASST Spedali Civili of Brescia
| | - Liesbeth Wreede
- Department of Biomedical Data Sciences LUMC Leiden Netherlands
| | - Tomasz Czerw
- Department of Bone Marrow Transplantation and Onco‐Hematology Maria Sklodowska‐Curie National Research Institute of Oncology Gliwice Poland
| | | | - Patrick Hayden
- Department of Hematology St. James's Hospital Dublin Ireland
| | - Donal McLornan
- Department of Hematology Guy's and St Thomas' NHS Foundation Trust and University College London Hospitals London UK
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12
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Schetelig J, Chevallier P, van Gelder M, Hoek J, Hermine O, Chakraverty R, Browne P, Milpied N, Malagola M, Socié G, Delgado J, Deconinck E, Damaj G, Maury S, Beelen D, Quoc SN, Shankara P, Brecht A, Mayer J, Hunault-Berger M, Bittenbring J, Thieblemont C, Lepretre S, Baldauf H, de Wreede LC, Tournilhac O, Yakoub-Agha I, Kröger N, Dreger P. Idelalisib treatment prior to allogeneic stem cell transplantation for patients with chronic lymphocytic leukemia: a report from the EBMT chronic malignancies working party. Bone Marrow Transplant 2020; 56:605-613. [PMID: 33004942 PMCID: PMC8589680 DOI: 10.1038/s41409-020-01069-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 01/28/2023]
Abstract
No studies have been reported so far on bridging treatment with idelalisib for patients with chronic lymphocytic leukemia (CLL) prior to allogeneic hematopoietic cell transplantation (alloHCT). To study potential carry-over effects of idelalisib and to assess the impact of pathway-inhibitor (PI) failure we performed a retrospective EBMT registry-based study. Patients with CLL who had a history of idelalisib treatment and received a first alloHCT between 2015 and 2017 were eligible. Data on 72 patients (median age 58 years) were analyzed. Forty percent of patients had TP53mut/del CLL and 64% had failed on at least one PI. No primary graft failure occurred. Cumulative incidences of acute GVHD °II–IV and chronic GVHD were 51% and 39%, respectively. Estimates for 2-year overall survival (OS), progression-free survival (PFS), and cumulative incidences of relapse/progression (CIR) and non-relapse mortality NRM were 59%, 44%, 25%, and 31%. In univariate analysis, drug sensitivity was a strong risk factor. For patients who had failed neither PI treatment nor chemoimmunotherapy (CIT) the corresponding 2-year estimates were 73%, 65%, 15%, and 20%, respectively. In conclusion, idelalisib may be considered as an option for bridging therapy prior to alloHCT. Owing to the high risk for acute GVHD intensified clinical monitoring is warranted.
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Affiliation(s)
- Johannes Schetelig
- Medical Clinic I, University Hospital, Dresden, Germany. .,DKMS, Dresden, Germany.
| | | | | | | | - Olivier Hermine
- Department of Hematology, Necker Hospital and INSERM U1163 Imagine Institute, University of Paris, Paris, France
| | - Ronjon Chakraverty
- Cancer Institute and Institute of Immunity and Transplantation, University College London Hospital, London, UK
| | | | | | - Michele Malagola
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | | | | | - Ghandi Damaj
- Centre Hospitalier-Universitaire, Institut d'Hématologie, Normandie University, Caen, France
| | - Sebastian Maury
- Service d'Hématologie Clinique et de Thérapie Cellulaire Creteil, CHU Henri Mondor, Créteil, France
| | | | | | | | - Arne Brecht
- Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Jiri Mayer
- University Hospital Brno, Brno, Czech Republic
| | | | | | | | - Stéphane Lepretre
- Inserm U1245 and Department of Hematology, Centre Henri Becquerel, Normandie University, Rouen, France
| | | | - Liesbeth C de Wreede
- Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Olivier Tournilhac
- Service Therapie Cellulaire & Hematologie Cliniquer, Centre Hospitalier Universitaire, Clermont Ferrand, France
| | - Ibrahim Yakoub-Agha
- Centre Hospitalier Universitaire de Lille, LIRIC, INSERM U995, Université de Lille, Lille, France
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13
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Bazarbachi A, Schmid C, Labopin M, Beelen D, Wolfgang Blau I, Potter V, Niittyvuopio R, Socié G, Blaise D, Sanz J, Ciceri F, Abou Dalle I, Spyridonidis A, Bug G, Esteve J, Savani BN, Nagler A, Mohty M. Evaluation of Trends and Prognosis Over Time in Patients with AML Relapsing After Allogeneic Hematopoietic Cell Transplant Reveals Improved Survival for Young Patients in Recent Years. Clin Cancer Res 2020; 26:6475-6482. [PMID: 32988970 DOI: 10.1158/1078-0432.ccr-20-3134] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Relapsed acute myeloid leukemia (AML) post allogeneic hematopoietic cell transplantation (allo-HCT) has a dismal prognosis. EXPERIMENTAL DESIGN To assess prognosis of patients with recurrent AML post allo-HCT over time, we analyzed European Society for Blood and Marrow Transplantation registry data of 8,162 adult patients with AML who relapsed between 2000 and 2018 after allo-HCT performed in first complete remission from matched sibling, unrelated, or haploidentical donors. RESULTS The 2-year overall survival (OS) rate from relapse was 17%. For 3,630 patients, <50 years of age, the 2-year OS continuously increased from 16% between 2000 and 2004 to 18% for 2005-2009, to 21% for 2010-2014, and to 26% for 2015-2018 (P = 0.001). Improvement over time was noted both after relapse within and beyond 6 months from allo-HCT. On multivariate analysis among patients <50 years of age, OS was positively affected by a later year of relapse (baseline: 2000-2004; HR, 0.82; P < 0.02 for 2010-2014 and HR, 0.72; P = 0.0002 for 2015-2018), good performance status, favorable cytogenetics, and longer time from transplant to relapse, but negatively affected by increasing age. In contrast, among 4,532 patients, >50 years of age, the year of relapse had no influence on OS (16% for 2000-2004 and 14% for 2015-2018; P = 0.56). Regarding treatment, encouraging results were observed after second allo-HCT, which was performed within 2 years after relapse in 17% of the entire cohort, resulting in a 2-year OS of 30.7%. CONCLUSIONS Outcome after posttransplant relapse among younger patients has improved significantly in recent years, likely reflecting, among other factors, the efficacy of posttransplant salvage including second allo-HCT.
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Affiliation(s)
- Ali Bazarbachi
- Bone marrow Transplant Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
| | - Christoph Schmid
- Department of Haematology and Oncology, Augsburg University Hospital and Medical Faculty, Augsburg, Germany.
| | - Myriam Labopin
- Department of Haematology and EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - Igor Wolfgang Blau
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Victoria Potter
- Department of Haematological Medicine, GKT School of Medicine, London, United Kingdom
| | - Riitta Niittyvuopio
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Gerard Socié
- Programme de Transplantation & Thérapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Didier Blaise
- Programme de Transplantation & Thérapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Jaime Sanz
- Department of Hematology (Torre F, Planta 7), University Hospital La Fe, Valencia, Spain
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Iman Abou Dalle
- Bone marrow Transplant Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Gesine Bug
- Goethe-Universitaet, Medizinische Klinik II, Hämatologie, Medizinische Onkologie, Frankfurt Main, Germany
| | - Jordi Esteve
- Department of Hematology, Hospital Clinic, Institute of Hematology & Oncology, Barcelona, Spain
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arnon Nagler
- Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, INSERM UMR 938 and Sorbonne University, Paris, France
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14
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Gran C, Wang J, Nahi H, Koster L, Gahrton G, Einsele H, Niittyvoupio R, Edinger M, Beelen D, Ciceri F, Bornhäuser M, Finke J, de Wreede LC, Ljungman P, Mielke S, Tischer J, Garderet L, Schönland S, Yakoub-Agha I, Kröger N. Treosulfan conditioning for allogeneic transplantation in multiple myeloma - improved overall survival in first line haematopoietic stem cell transplantation - a large retrospective study by the Chronic Malignancies Working Party of the EBMT. Br J Haematol 2020; 189:e213-e217. [PMID: 32301111 DOI: 10.1111/bjh.16642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Hareth Nahi
- Karolinska University Hospital, Stockholm, Sweden
| | - Linda Koster
- EBMT Data Office Leiden, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | - Per Ljungman
- Karolinska University Hospital, Stockholm, Sweden
| | - Stephan Mielke
- Karolinska University Hospital, Stockholm, Sweden.,Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Laurent Garderet
- Centre de Recherche Saint-Antoine- Team Proliferation and Differentiation of Stem Cells, Sorbonne Université, INSERM, UMR_S 938, Paris, France
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15
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Schmaelter AK, Labopin M, Socié G, Itälä-Remes M, Blaise D, Yakoub-Agha I, Forcade E, Cornelissen J, Ganser A, Beelen D, Labussière-Wallet H, Passweg J, Savani BN, Schmid C, Nagler A, Mohty M. Inferior outcome of allogeneic stem cell transplantation for secondary acute myeloid leukemia in first complete remission as compared to de novo acute myeloid leukemia. Blood Cancer J 2020; 10:26. [PMID: 32127519 PMCID: PMC7054545 DOI: 10.1038/s41408-020-0296-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 09/05/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022] Open
Abstract
Following chemotherapy, secondary acute myeloid leukemia (sAML), occurring after antecedent hematologic diseases, previous chemotherapy or radiation, has an inferior prognosis compared with de novo AML. To define the outcome of sAML in the context of allogeneic stem cell transplantation (alloSCT), a retrospective, registry-based comparison was performed, including 11,439 patients with de novo and 1325 with sAML. Among transplants in first complete remission (CR1) (n = 8,600), the 3-year cumulative incidence of relapse (RI) and non-relapse mortality (NRM) was 28.5% and 16.4% for de novo, and 35% and 23.4% for sAML. Three-year overall survival (OS), leukemia-free survival (LFS) and Graft-versus-Host Disease/relapse-free survival (GRFS) was 60.8%, 55.1%, and 38.6% for de novo, and 46.7%, 41.6%, and 28.4% for sAML, respectively. In multivariate analysis, sAML was associated with a lower OS (HR = 1.33 [95% CI = 1.21–1.48]; p < 10−5), LFS (HR = 1.32 [95% CI = 1.19–1.45]; p < 10−5) and GRFS (HR = 1.2 [95% CI = 1.1–1.31]; p < 10−4) and higher NRM (HR = 1.37 [95% CI = 1.17–1.59]; p < 10−4) and RI (HR = 1.27 [95% CI = 1.12–1.44]; p < 10−3). Results of the Cox model were confirmed in a matched-pair analysis. In contrast, results did not differ between de novo and sAML after alloSCT in induction failure or relapse. Hence, this analysis identified sAML as an independent risk factor for outcome after alloSCT in CR1.
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Affiliation(s)
| | - Myriam Labopin
- Department of Haematology, Saint Antoine Hospital, Université Pierre et Marie Curie, INSERM UMR 938, Paris, France.,EBMT Paris study office/ CEREST-TC, Paris, France
| | - Gerard Socié
- Hopital St. Louis, Dept.of Hematology - BMT, Paris, France
| | - Maija Itälä-Remes
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | | | | | - Jan Cornelissen
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, The Netherlands
| | - Arnold Ganser
- Hannover Medical School, Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | - Dietrich Beelen
- University Hospital, Department of Bone Marrow Transplantation, Essen, Germany
| | | | | | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christoph Schmid
- Department of Hematology and Oncology, Augsburg University Hospital, Augsburg, Germany.
| | - Arnon Nagler
- EBMT Paris study office/ CEREST-TC, Paris, France.,Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, Université Pierre et Marie Curie, INSERM UMR 938, Paris, France
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16
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Poiré X, Labopin M, Polge E, Volin L, Finke J, Ganser A, Blaise D, Yakoub‐Agha I, Beelen D, Forcade E, Lioure B, Socié G, Niederwieser D, Labussière‐Wallet H, Maertens J, Cornelissen J, Craddock C, Mohty M, Esteve J, Nagler A. The impact of concomitant cytogenetic abnormalities on acute myeloid leukemia with monosomy 7 or deletion 7q after HLA-matched allogeneic stem cell transplantation. Am J Hematol 2020; 95:282-294. [PMID: 31876307 DOI: 10.1002/ajh.25714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022]
Abstract
Monosomy 7 or deletion 7q (-7/7q-) is the most frequent adverse cytogenetic features reported in acute myeloid leukemia (AML), and is a common indication for allogeneic stem cell transplantation (SCT). Nevertheless, -7/7q- occurs frequently with other high-risk cytogenetic abnormalities such as complex karyotype (CK), monosomal karyotype (MK), monosomy 5 or deletion 5q (-5/5q-), 17p abnormalities (abn(17p)) or inversion of chromosome 3 (inv(3)), the presence of which may influence the outcomes after SCT. A total of 1109 patients were allocated to this study. Two-year probability of leukemia-free survival (LFS) and overall survival (OS) were 30% and 36%, respectively. Two-year probability of non-relapse mortality (NRM) was 20%. We defined five different cytogenetic subgroups: the "-7/7q- ± CK group- designated group1," the "MK group-designated group 2," the "-5/5q- group- designated group 3," the "abn(17p) group- designated group 4" and the "inv(3) group- designated group 5." The 2-year probability of LFS in first remission was 48% for group 1, 36.4% for group 2, 28.4% for group 3, 19.1% for group 4 and 17.3% for group 5, respectively (P < .001). Multivariate analysis confirmed those significant differences across groups. Note, SCT in -7/7q- AML provides durable responses in one third of the patients. The presence of -7/7q- with or without CK in the absence of MK, abn(17p) or inv(3) is associated with a better survival after SCT. On the contrary, addition of MK, -5/5q-, abn(17p) or inv(3) identifies a sub-group of patients with poor prognosis even after SCT.
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Affiliation(s)
- Xavier Poiré
- Section of HematologyCliniques Universitaires St‐Luc Brussels Belgium
| | - Myriam Labopin
- Acute Leukemia Working Party of the EBMT
- Sorbonne Université Paris France
- INSERM UMR 938 Paris France
- Service d'HématologieHôpital Saint‐Antoine Paris France
| | - Emmanuelle Polge
- Acute Leukemia Working Party of the EBMT
- Sorbonne Université Paris France
- INSERM UMR 938 Paris France
- Service d'HématologieHôpital Saint‐Antoine Paris France
| | - Liisa Volin
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit Helsinki Finland
| | - Jürgen Finke
- Department of Medicine‐Hematology‐OncologyUniversity of Freiburg Freiburg Germany
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell TransplantationHannover Medical School Hannover Germany
| | - Didier Blaise
- Institut Paoli Calmette, Programme de Transplantation & Therapie Cellulaire Marseille France
| | | | - Dietrich Beelen
- Department of Bone Marrow TransplantationUniversity Hospital Essen Germany
| | | | | | - Gérard Socié
- Department of Hematology, Bone Marrow TransplantationHôpital Saint‐Louis Paris France
| | - Dietger Niederwieser
- Division of Hematology, Oncology and HemostasiologyUniversity Hospital Leipzig Leipzig Germany
| | | | | | - Jan Cornelissen
- Department of HematologyErasmus MC Cancer Institute Rotterdam The Netherlands
| | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital Birmingham UK
| | - Mohamad Mohty
- Acute Leukemia Working Party of the EBMT
- Sorbonne Université Paris France
- INSERM UMR 938 Paris France
- Service d'HématologieHôpital Saint‐Antoine Paris France
| | - Jordi Esteve
- Hematology DepartmentHospital Clinic, IDIBAPS, Josep Carreras Leukemia Research Institute Barcelona Spain
| | - Arnon Nagler
- Acute Leukemia Working Party of the EBMT
- Chaim Sheba Medical Center Tel‐Hashomer Israël
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17
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McLornan DP, Malpassuti V, Lippinkhof‐Kozijn A, Potter V, Beelen D, Bunjes D, Sengeloev H, Radujkovic A, Passweg J, Chalandon Y, Kröger N, Wulf GG, Johansson J, Ciceri F, Bornhäuser M, Holler E, Guffroy B, Martin S, Neubauer A, Gramatski M, Robin M, Iacobelli S, Hayden P, Hernández Boluda JC, Czerw T, Yakoub‐Agha I. Outcome of allogeneic haematopoietic stem cell transplantation in myeloproliferative neoplasm, unclassifiable: a retrospective study by the Chronic Malignancies Working Party of the EBMT. Br J Haematol 2020; 190:437-441. [DOI: 10.1111/bjh.16537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Donal P. McLornan
- Department of Haematology Guy’s and St. Thomas’ NHS Foundation Trust London UK
| | - Vittoria Malpassuti
- Dipartimento di Biologia Università degli Studi di Roma Tor Vergata Rome Italy
| | | | - Victoria Potter
- Department of Haematological Medicine King’s College Hospital London UK
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation West German Cancer Centre University Hospital of Essen University of Duisburg Essen Germany
| | | | | | | | - Jakob Passweg
- Department of Haematology University Hospital Basel Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | - Marie Robin
- Service d’Hématologie‐Greffe Hôpital Saint‐Louis Paris France
| | - Simona Iacobelli
- Dipartimento di Biologia Università degli Studi di Roma Tor Vergata Rome Italy
| | | | | | - Tomasz Czerw
- Maria Sklodowska‐Curie Institute ‐ Oncology CenterGliwice Branch Gliwice Poland
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18
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Radujkovic A, Kordelas L, Dai H, Schult D, Majer-Lauterbach J, Beelen D, Müller-Tidow C, Dreger P, Luft T. Interleukin-18 and outcome after allogeneic stem cell transplantation: A retrospective cohort study. EBioMedicine 2019; 49:202-212. [PMID: 31680001 PMCID: PMC6945194 DOI: 10.1016/j.ebiom.2019.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/18/2019] [Revised: 10/07/2019] [Accepted: 10/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background Interleukin-18 (IL-18) is involved in endothelial activation and dysfunction, and in the pathogenesis and severity of acute graft-versus-host disease (aGVHD). Its relevance for patient outcome after allogeneic stem cell transplantation (alloSCT) has not yet been comprehensively addressed. Methods Pre-transplant serum levels of free IL-18 were retrospectively assessed in a cohort of 589 patients (training cohort). Results were validated in 688 patients allografted in a different centre. The primary endpoint was overall survival (OS). Secondary endpoints included incidences of non-relapse mortality (NRM), relapse, and aGVHD. Findings In the training cohort, higher pre-transplant levels of free IL-18 were significantly associated with worse OS (hazard ratio [HR] per 1-log2 increase, 1.25, P = 0.008) in multivariable models. This was due to a higher hazard of NRM (HR per 1-log2 increase, 1.39, P = 0.001), rather than relapse. The associations of pre-transplant free IL-18 with higher NRM (HR per 1-log2 increase, 1.24, P = 0.02) and shorter OS (HR per 1-log2 increase, 1.22, P = 0.006) were confirmed in the validation cohort. In both cohorts, the correlations of higher pre-transplant free IL-18 serum levels with increased NRM and worse OS were mainly driven by fatal infectious complications. No associations with incidence of aGVHD were observed. Interpretation Higher pre-transplant levels of free IL-18 were associated with non-relapse and overall mortality after alloSCT. Our results may provide a rationale for prospective studies evaluating IL-18 status and inhibition of IL-18 activity in patients undergoing allografting.
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Affiliation(s)
- Aleksandar Radujkovic
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg Germany
| | - Lambros Kordelas
- Department of Bone Marrow Transplantation, University Hospital Essen, Germany
| | - Hao Dai
- Department of Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - David Schult
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg Germany
| | - Joshua Majer-Lauterbach
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital Essen, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg Germany
| | - Peter Dreger
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg Germany
| | - Thomas Luft
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg Germany.
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19
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Shimoni A, Labopin M, Savani B, Byrne M, Volin L, Finke J, Niederwieser D, Ehninger G, Blaise D, Beelen D, Tabrizi R, Sengeloev H, Ganser A, Cornelissen JJ, Mohty M, Nagler A. Comparable Long-Term Outcome after Allogeneic Stem Cell Transplantation from Sibling and Matched Unrelated Donors in Patients with Acute Myeloid Leukemia Older Than 50 Years: A Report on Behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2019; 25:2251-2260. [DOI: 10.1016/j.bbmt.2019.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/30/2019] [Accepted: 06/26/2019] [Indexed: 01/18/2023]
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20
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Carré M, Porcher R, Finke J, Ehninger G, Koster L, Beelen D, Ganser A, Volin L, Lozano S, Friis L, Michallet M, Tischer J, Olavarria E, Cascon MJP, Iacobelli S, Koc Y, Jindra P, Arat M, de Witte T, Yakoub Agha I, Kröger N, Robin M. Role of Age and Hematopoietic Cell Transplantation-Specific Comorbidity Index in Myelodysplastic Patients Undergoing an Allotransplant: A Retrospective Study from the Chronic Malignancies Working Party of the European Group for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2019; 26:451-457. [PMID: 31647984 DOI: 10.1016/j.bbmt.2019.10.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 05/22/2019] [Revised: 09/14/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative option for myelodysplastic syndromes (MDSs) but is severely limited by nonrelapse mortality (NRM), especially in this mostly older population. Comorbidity assessment is crucial to predict NRM and often assessed with the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI). Moreover, the impact of age on NRM still remains a matter of debate. In recent years, the age at which transplants are made has been progressively increasing, and patients with comorbidities have become more common. Extricating the respective roles of age and comorbidities in toxic mortality is all the more important. This study by the European Group for Blood and Marrow Transplantation registry included 1245 adult patients who underwent a first allogeneic stem cell transplantation for MDSs between 2003 and 2014. Overall, 4-year NRM and overall survival were 32% and 47%, respectively. When considered as continuous predictors, HCT-CI score and age were associated with an increased hazard ratio (HR) for NRM. In multivariate analysis, age band (HR, 1.13; 95% CI, 1.02 to 1.25; P= .016), HCT-CI ≥3 (HR, 1.34; 95% CI, 1.04 to 1.73; P = .022), and Karnofsky Performance Status ≤80 (HR, 2.03; 95% CI, 1.52 to 2.73; P< .0001) were significantly predictive of a worse NRM. In our large cohort, both comorbidities, evaluated by the original HCT-CI score, and chronological age significantly affected NRM. Thus, age should be part of the transplant decision-making process and should be integrated in future scoring systems predicting outcomes of HSCT in MDSs.
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Affiliation(s)
| | | | | | | | - Linda Koster
- European Group for Blood and Marrow Transplantation Data Office, Leiden, The Netherlands
| | | | | | - Liisa Volin
- HUCH Comprehensive Cancer Center, Helsinki, Finland
| | - Sara Lozano
- Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | | | | | | | | | - Yener Koc
- Medical Park Hospitals, Antalya, Turkey
| | - Pavel Jindra
- Charles University Hospital, Pilsen, Czech Republic
| | - Mutlu Arat
- Florence Nightingale Sisli Hospital, Istanbul, Turkey
| | - Theo de Witte
- Radboud University Medical Centre-Nijmegen, Nijmegen, The Netherlands
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21
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Baron F, Labopin M, Savani BN, Beohou E, Niederwieser D, Eder M, Potter V, Kröger N, Beelen D, Socié G, Itälä‐Remes M, Bornhäuser M, Mohty M, Nagler A. Graft‐versus‐host disease and graft‐versus‐leukaemia effects in secondary acute myeloid leukaemia: a retrospective, multicentre registry analysis from the Acute Leukaemia Working Party of the EBMT. Br J Haematol 2019; 188:428-437. [DOI: 10.1111/bjh.16185] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/26/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Frédéric Baron
- Laboratory of Haematology GIGA‐I3 University of Liege Liege Belgium
| | - Myriam Labopin
- EBMT Paris Office Hospital Saint Antoine Paris France
- AP‐HP Hématologie Clinique et Thérapie Cellulaire Hôpital Saint‐Antoine Paris France
- Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint‐Antoine Université Pierre & Marie Curie and INSERM UMRs U938 Paris France
| | | | - Eric Beohou
- EBMT Paris Office Hospital Saint Antoine Paris France
| | | | - Matthias Eder
- Department of Haematology Haemostasis, Oncology and Stem Cell Transplantation Hannover Medical School Hannover Germany
| | - Victoria Potter
- Department of Haematological Medicine GKT School of Medicine London UK
| | - Nicolaus Kröger
- Bone Marrow Transplantation Centre University Hospital Eppendorf Hamburg Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation West German Cancer CenterUniversity Hospital of Essen Essen Germany
| | - Gerard Socié
- Department of Haematology – BMT Hopital St. Louis Paris France
| | - Maija Itälä‐Remes
- Stem Cell Transplantation Unit HUCH Comprehensive Cancer Centre Helsinki Finland
| | - Martin Bornhäuser
- Medizinische Klinik und Poliklinik I Universitaetsklinikum TU Dresden Dresden Germany
| | - Mohamad Mohty
- EBMT Paris Office Hospital Saint Antoine Paris France
- AP‐HP Hématologie Clinique et Thérapie Cellulaire Hôpital Saint‐Antoine Paris France
- Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint‐Antoine Université Pierre & Marie Curie and INSERM UMRs U938 Paris France
| | - Arnon Nagler
- EBMT Paris Office Hospital Saint Antoine Paris France
- Division of Haematology and Bone Marrow Transplantation The Chaim Sheba Medical Centre Tel‐Hashomer Ramat‐Gan Israel
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22
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Ringdén O, Boumendil A, Labopin M, Canaani J, Beelen D, Ehninger G, Niederwieser D, Finke J, Stelljes M, Gerbitz A, Ganser A, Kröger N, Kantz L, Brecht A, Savani B, Sadeghi B, Mohty M, Nagler A. Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in Patients Age >69 Years with Acute Myelogenous Leukemia: On Behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2019; 25:1975-1983. [DOI: 10.1016/j.bbmt.2019.05.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/30/2019] [Accepted: 05/29/2019] [Indexed: 11/15/2022]
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23
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Mannina D, Gagelmann N, Badbaran A, Ditschkowski M, Bogdanov R, Robin M, Cassinat B, Heuser M, Shahswar R, Thol F, Beelen D, Kröger N. Allogeneic stem cell transplantation in patients with myelofibrosis harboring the MPL mutation. Eur J Haematol 2019; 103:552-557. [PMID: 31446640 DOI: 10.1111/ejh.13318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/20/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Primary and post-ET/PV myelofibrosis are myeloproliferative neoplasms harboring in most cases driving mutations in JAK2, CALR or MPL, and a variable number of additional mutations in other genes. Molecular analysis represents a powerful tool to guide prognosis and clinical management. Only about 10% of patients with myelofibrosis harbor alterations in MPL gene. No data are available about the transplantation outcome in the specific MPL-mutated group. PATIENTS We collected the data of 18 myelofibrosis patients(primary: 14; post-ET: 4) transplanted in 4 EBMT centers (Hamburg, Paris, Essen, and Hannover) between 2005 and 2016. RESULTS Before the transplant, we explored the molecular profile by NGS and reported the frequency of mutations occurring in a panel of genes including JAK2, MPL, CALR, U2AF1, SRSF2, SF3B1, ASXL1, IDH1, IDH2, CBL, DNMT3A, TET2, EZH2, TP53, IKZF1, NRAS, KRAS, FLT3, SH2B3, and RUNX1. The 1-year transplant-related mortality was 16.5%, 5-years overall survival and 5-y relapse-free survival 83.5%. The only relapse occurred in a patient who harbored mutations in both ASXL1 and EZH2 genes. CONCLUSION These retrospective data suggest that MPL-mutated myelofibrosis patients have a favorable outcome after allogeneic transplantation with very low rate of disease relapse (5.5%) in comparison with the available historical controls regarding myelofibrosis in all.
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Affiliation(s)
- Daniele Mannina
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Hematology and Bone Marrow Transplantation, San Raffaele Hospital, Milan, Italy
| | - Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anita Badbaran
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Ditschkowski
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | - Rashit Bogdanov
- Department of Hematology, Saint-Louis Hospital, APHP. Paris, Paris, France
| | - Marie Robin
- Department of Hematology, Saint-Louis Hospital, APHP. Paris, Paris, France
| | - Bruno Cassinat
- Department of Hematology, Saint-Louis Hospital, APHP. Paris, Paris, France
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Rabia Shahswar
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Felicitas Thol
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gatwood KS, Labopin M, Savani BN, Finke J, Socie G, Beelen D, Yakoub-Agha I, Chevallier P, Ganser A, Blaise D, Milpied N, Bruno L, Mailhol A, Mohty M, Nagler A. Transplant outcomes for patients with therapy-related acute myeloid leukemia with prior lymphoid malignancy: an ALWP of EBMT study. Bone Marrow Transplant 2019; 55:224-232. [PMID: 31527819 DOI: 10.1038/s41409-019-0673-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/15/2019] [Accepted: 08/24/2019] [Indexed: 12/13/2022]
Abstract
Allogeneic hematopoietic cell transplant (HCT) is a curative therapy for patients with secondary acute myeloid leukemia (sAML), though the impact of conditioning regimens on HCT outcomes for patients with antecedent lymphoid malignancy is largely unknown. This multicenter, retrospective registry study of the ALWP of the EBMT assessed HCT outcomes in this population. In all, 549 patients ≥18 years with sAML following an antecedent lymphoid malignancy treated with first allograft between 2000-2016 were included. Myeloablative (MAC) and reduced intensity conditioning (RIC) was given in 258 (47%) and 291 (53%), respectively. At 2 years, leukemia-free survival (LFS) was 31.7% (95% CI, 27.5-35.9), overall survival (OS) was 37.4% (95% CI, 33-41.8), nonrelapse mortality (NRM) was 28.9% (95% CI, 25-33), and GVHD-free, relapse-free survival (GRFS) was 22.8% (95% CI, 19-26.6). In multivariate analysis, patients receiving RIC regimens had lower risk of NRM (HR: 0.58, CI: 0.40-0.83, p = 0.003), and improved LFS (HR: 0.67, CI: 0.52-0.85, p = 0.001). Patients with prior autologous HCT had inferior LFS (HR: 1.30, CI: 1.01-1.67, p = 0.01). This study demonstrates that sAML patients following prior lymphoid malignancy treated with RIC regimens have a lower risk of NRM and improved LFS, OS, and GFRS. Other variables associated with inferior outcomes include older age, active disease, adverse cytogenetics, and prior auto-HCT.
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Affiliation(s)
| | | | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jürgen Finke
- University of Freiburg Department of Medicine-Hematology, Oncology, Freiburg, Germany
| | - Gerard Socie
- Department of Hematology-BMT, Hospital St. Louis, Paris, France
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | | | | | - Arnold Ganser
- Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, Germany
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Noel Milpied
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Lioure Bruno
- Techniciens d'Etude Clinique suivi de patients greffes, Nouvel Hopital Civil, Strasbourg, France
| | | | - Mohamad Mohty
- Department of Hematology, Hopital Saint Antoine, Paris, France
| | - Arnon Nagler
- Department of Hematology, Hopital Saint Antoine, Paris, France.,Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
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25
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Halaburda K, Labopin M, Mailhol A, Socié G, Craddock C, Aljurf M, Beelen D, Cornelissen JJ, Bourhis JH, Labussière-Wallet H, Blaise D, Gedde-Dahl T, Gilleece M, Yakoub-Agha I, Mufti G, Esteve J, Mohty M, Nagler A. Allogeneic stem cell transplantation in second complete remission for core binding factor acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Haematologica 2019; 105:1723-1730. [PMID: 31439677 PMCID: PMC7271580 DOI: 10.3324/haematol.2019.222810] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/22/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Core binding factor acute myeloid leukemia (AML) comprises two subtypes with distinct cytogenetic abnormalities of either t(8;21)(q22;q22) or inv(16)(p13q22)/t(16;16)(p13;q22). Since long-term response to chemotherapy in these leukemias is relatively good, allogeneic hematopoietic stem cell transplantation is considered in patients who relapse and achieve second complete remission. To evaluate the outcomes of allogeneic transplantation in this indication, we studied 631 patients reported to the European Society for Blood and Marrow Transplantation Registry between the years 2000 and 2014. Leukemia-free survival probabilities at two and five years were 59.1% and 54.1%, while overall survival probabilities were 65% and 58.2%, respectively. The incidence of relapse and risk of non-relapse mortality at the same time points were 19.8% and 22.5% for relapse and 20.9% and 23.3% for non-relapse mortality, respectively. The most important adverse factors influencing leukemia-free and overall survival were: leukemia with t(8;21), presence of three or more additional chromosomal abnormalities, and Karnofsky performance score <80. Relapse risk was increased in t(8;21) leukemia and associated with additional cytogenetic abnormalities as well as reduced intensity conditioning. Measurable residual disease in molecular evaluation before transplantation was associated with increased risk of relapse and inferior leukemia-free survival.
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Affiliation(s)
| | - Myriam Labopin
- EBMT Paris Study Office, Paris, France.,Saint Antoine Hospital, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mohamad Mohty
- EBMT Paris Study Office, Paris, France.,Saint Antoine Hospital, Paris, France
| | - Arnon Nagler
- EBMT Paris Study Office, Paris, France.,Chaim Sheba Medical Center, Tel Hashomer, Israel
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26
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McLornan D, Szydlo R, Koster L, Chalandon Y, Robin M, Wolschke C, Beelen D, Socié G, Bornhäuser M, Angelucci E, Niederwieser D, Gerbitz A, Finke J, Vitek A, Itälä-Remes M, Radujkovic A, Kanz L, Potter V, Chevallier P, Stelljes M, Petersen E, Robinson S, Poiré X, Klyuchnikov E, Hernández-Boluda JC, Czerw T, Hayden P, Kröger N, Yakoub-Agha I. Myeloablative and Reduced-Intensity Conditioned Allogeneic Hematopoietic Stem Cell Transplantation in Myelofibrosis: A Retrospective Study by the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2019; 25:2167-2171. [PMID: 31284069 DOI: 10.1016/j.bbmt.2019.06.034] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 04/09/2019] [Revised: 06/18/2019] [Accepted: 06/28/2019] [Indexed: 11/25/2022]
Abstract
This retrospective study by the European Society for Blood and Marrow Transplantation analyzed the outcome of 2224 patients with myelofibrosis (MF) who underwent allogeneic stem cell transplantation (allo-SCT) between 2000 and 2014; 781 (35%) underwent myeloablative conditioning (MAC) and 1443 (65%) reduced-intensity conditioning (RIC). Median patient age was 52.9 years (range, 18 to 74 years) and 57.5 years (range, 21 to 76 years) in the MAC and RIC cohorts, respectively. Donor type was similar: matched sibling donors (MAC, 317 [41%]; RIC, 552 [38%]) and unrelated donors (MAC, 464 [59%]; RIC, 891 [62%]). Median time to both neutrophil and platelet (>20 × 109/L) engraftment did not differ between cohorts. Rates of grade II to IV acute GVHD were 28% (MAC) and 31% (RIC; P = NS). Cumulative chronic GVHD rates (limited/extensive) were 22%/27% (MAC) and 19%/31% (RIC; P = .10). Cumulative incidences of nonrelapse mortality (NRM) at 1, 3, and 5 years were 25.5%, 32.2%, and 34.6% (MAC) and 26.3%, 32.8%, and 34.4% (RIC), respectively. There was a trend toward a higher relapse rate with RIC regimens compared with MAC (P = .08); rates at 1, 3, and 5 years were 10.9%, 17.2%, and 20.1% (MAC) and 14%, 19.7%, and 23.2% (RIC), respectively. No significant difference in 5-year probabilities of overall survival (OS) was noted: MAC (53.0%; 95% confidence interval [CI], 49.1% to 56.9%) and RIC (51.0%; 95% CI, 48.3% to 53.7%); P = .78. Regarding the composite end point of GVHD-free/relapse-free survival (GRFS), the unadjusted Kaplan-Meier estimate of 5-year GRFS was 32.4% (95% CI, 29.0% to 36.1%) in the MAC group and 26.1% (95% CI, 23.9% to 28.2%) in the RIC group (P = .001). In the MAC cohort, multivariable analysis confirmed worse OS and NRM with older age (>50 years), using an unrelated donor and a Karnofsky Performance Status of 80 or less. For the RIC cohort, worse OS and NRM were associated with age 60 to 70 years compared with younger recipients, use of a mismatched donor, and poor performance status. In conclusion, although similar OS rates existed for both cohorts overall, this study suggests that MAC should still be used for younger individuals suitable for such an approach due to a trend toward less relapse and an overall suggested advantage of improved GRFS, albeit this should be examined in a more homogeneous cohort. RIC allo-SCT still offers significant survival advantage in the older, fitter MF allograft patient, and optimization to reduce significant relapse and NRM rates is required.
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Affiliation(s)
- Donal McLornan
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Richard Szydlo
- Department of Clinical Sciences, Imperial College, London, United Kingdom
| | - Linda Koster
- Department of Haematology, EBMT Data Office, Leiden, The Netherlands
| | - Yves Chalandon
- Division of Hematology, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Robin
- Department of Haematology, Service d'Hématologie-Greffe, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Christine Wolschke
- Division of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | | | - Gerard Socié
- Department of Haematology, Service d'Hématologie-Greffe, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Martin Bornhäuser
- Department of Haematology, Universitaetsklinikum Dresden, Dresden, Germany
| | | | | | - Arnim Gerbitz
- Department of Haematology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Finke
- Department of Haematology, University of Freiburg, Freiburg, Germany
| | - Antonin Vitek
- Department of Haematology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Maija Itälä-Remes
- Department of Haematology, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | | | - Lothar Kanz
- Department of Haematology, Universität Tübingen, Tübingen, Germany
| | - Victoria Potter
- Department of Haematology, King's College Hospital, London, United Kingdom
| | | | | | - Eefke Petersen
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Stephen Robinson
- Department of Stem Cell Transplantation, University Hospitals, Bristol, United Kingdom
| | - Xavier Poiré
- Department of Haematology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Evgeny Klyuchnikov
- Division of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | | | - Tomasz Czerw
- Department of Haematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Patrick Hayden
- Department of Haematology, St. James Hospital, Dublin, Ireland
| | - Nicolaus Kröger
- Division of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Ibrahim Yakoub-Agha
- Department of Haematology, CHU de Lille, LIRIC, INSERM U995, Universite de Lille, Lille, France
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27
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Robinson S, Boumendil A, Finel H, Khvedelidze I, Kanfer E, Peggs K, Fuesrt S, Ram R, Marjit E, Vandenberghe E, Afanasyev B, Wulf G, Maertens J, Tsolukani A, Schapp N, Beelen D, Chalandon Y, Gurman G, Finke J, Bron D, Tischer J, Corradini P, Caballero D, Potter V, Kroger N, Burney C, Schmitz N, Sureda A, Dreger P, Montoto S. DONOR LYMPHOCYTE INFUSIONS INDUCE DURABLE RESPONSES IN PATIENTS WITH FOLLICULAR, MANTLE AND T CELL LYMPHOMAS RELAPSING AFTER AN ALLOSCT. AN EBMT-LWP STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.125_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S. Robinson
- Haematology; University Hospital Bristol; Bristol United Kingdom
| | | | | | | | - E. Kanfer
- Haematology; Hammersmith Hospital; London United Kingdom
| | - K. Peggs
- Haematology; University College London Hospital; London United Kingdom
| | - S. Fuesrt
- Haematology; Paoli Calmettes; Marseille France
| | - R. Ram
- Haematology; Sourasky; Tel Aviv Israel
| | - E. Marjit
- Haematology; Leiden University; Leiden Netherlands
| | | | - B. Afanasyev
- Haematology; Pavlov Medical University; St Petersberg Russian Federation
| | - G. Wulf
- Haematology; University Hospital; Goettingen Germany
| | - J. Maertens
- Haematology; University Hospital; Leuven Netherlands
| | - A. Tsolukani
- Haematology; City Hospital; Nottingham United Kingdom
| | - N. Schapp
- Haematology; St Radboud Hospital; Nijmegen Netherlands
| | - D. Beelen
- Haematology; University Hospital; Essen Germany
| | - Y. Chalandon
- Haematology; University Hospital; Geneva Switzerland
| | - G. Gurman
- Haematology; Ankara University; Ankara Turkey
| | - J. Finke
- Haematology; University of Freiburg; Freiburg Germany
| | - D. Bron
- Haematology; Institute Jules Bordet; Brussels Belgium
| | - J. Tischer
- Haematology; Med Klinik Klinikum Grosshaderm; Munich Germany
| | - P. Corradini
- Haematology; Istituto Nazionale dei Tumori; Milan Italy
| | | | - V. Potter
- Haematology; Kings College hospital; London United Kingdom
| | - N. Kroger
- Haematology; University Hospital Eppendorf; Hamburg Germany
| | - C. Burney
- Haematology; University Hospital Bristol; Bristol United Kingdom
| | - N. Schmitz
- Haematology; University Hospital; Muenster Germany
| | - A. Sureda
- Haematology; Oncology Institute; Barcelona Spain
| | - P. Dreger
- Haematology; University of Heidelberg; Heidleberg Germany
| | - S. Montoto
- Haematology; St Bartholomew's Hospital; London United Kingdom
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28
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Nagler A, Labopin M, Dholaria B, Finke J, Brecht A, Schanz U, Niittyvuopio R, Neubauer A, Bornhäuser M, Santarone S, Beelen D, Shimoni A, Rösler W, Giebel S, Savani BN, Mohty M. Second allogeneic stem cell transplantation in patients with acute lymphoblastic leukaemia: a study on behalf of the Acute Leukaemia Working Party of the European Society for Blood and Marrow Transplantation. Br J Haematol 2019; 186:767-776. [DOI: 10.1111/bjh.15973] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/16/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Arnon Nagler
- Chaim Sheba Medical Centre Tel Aviv University Tel‐Hashomer Israel
- EBMT ALWP office Saint Antoine Hospital ParisFrance
| | - Myriam Labopin
- Department of Haematology and EBMT Paris study office/CEREST‐TC Saint Antoine Hospital Paris France
| | | | - Jürgen Finke
- Department of Medicine–Haematology Oncology University of Freiburg FreiburgGermany
| | - Arne Brecht
- Deutsche Klinik fuer Diagnostik KMT Zentrum Wiesbaden Germany
| | - Urs Schanz
- Clinic of Haematology University Hospital Zurich Switzerland
| | - Riitta Niittyvuopio
- Stem Cell Transplantation Unit HUCH Comprehensive Cancer Centre Helsinki Finland
| | - Andreas Neubauer
- Philipps Universitaet MarburgUniversity Hospital Giessen and Marburg MarburgGermany
| | - Martin Bornhäuser
- Medizinische Klinik und Poliklinik I Universitaetsklinikum Dresden Dresden Germany
| | - Stella Santarone
- Dipartimento di Ematologia Medicina Trasfusionale e BiotecnologieOspedale Civile Pescara Italy
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation University Hospital Essen Germany
| | - Avichai Shimoni
- Department of Bone Marrow Transplantation Chaim Sheba Medical Centre Chaim Sheba Medical Centre Tel Hashomer Israel
| | - Wolf Rösler
- Department of Internal Medicine 5 University Hospital Erlangen Erlangen Germany
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Oncohaematology Maria Sklodowska‐Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch Gliwice Poland
| | - Bipin N. Savani
- Department of Hematology‐Oncology Vanderbilt University Medical Center Nashville TN USA
| | - Mohamad Mohty
- AService d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP, Sorobonne University, INSERM UMR 938 and Université Pierre et Marie Curie Paris France
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29
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Cremers EM, de Witte T, de Wreede L, Eikema DJ, Koster L, van Biezen A, Finke J, Socié G, Beelen D, Maertens J, Nagler A, Kobbe G, Ziagkos D, Itälä-Remes M, Gedde-Dahl T, Sierra J, Niederwieser D, Ljungman P, Beguin Y, Ozkurt ZN, Anagnostopoulos A, Jindra P, Robin M, Kröger N. A prospective non-interventional study on the impact of transfusion burden and related iron toxicity on outcome in myelodysplastic syndromes undergoing allogeneic hematopoietic cell transplantation. Leuk Lymphoma 2019; 60:2404-2414. [DOI: 10.1080/10428194.2019.1594215] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Eline M.P. Cremers
- Department of Hematology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Theo de Witte
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Linda Koster
- EBMT Data Office Leiden, Leiden, The Netherlands
| | | | - Jürgen Finke
- Department of Hematology/Oncology & Stem Cell Transplantation, University of Freiburg, Freiburg, Germany
| | | | | | | | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine Universitaet, Düsseldorf, Germany
| | - Dimitris Ziagkos
- EBMT Statistical Unit Data Office Leiden, Leiden, The Netherlands
| | | | | | - Jorge Sierra
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Per Ljungman
- Karolinska University Hospital, Stockholm, Sweden
| | - Yves Beguin
- Departmrnt of Hematology and Oncology, University of Liège, Liege, Belgium
| | | | | | - Pavel Jindra
- Charles University Hospital, Pilsen, Czech Republic
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30
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Canaani J, Beohou E, Labopin M, Ghavamzadeh A, Beelen D, Hamladji RM, Niederwieser D, Volin L, Markiewicz M, Arnold R, Mufti G, Ehninger G, Socié G, Kröger N, Mohty M, Nagler A. Trends in patient outcome over the past two decades following allogeneic stem cell transplantation for acute myeloid leukaemia: an ALWP/EBMT analysis. J Intern Med 2019; 285:407-418. [PMID: 30372796 DOI: 10.1111/joim.12854] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Outcomes for patients with acute myeloid leukaemia (AML) undergoing allogeneic stem cell transplantation (allo-SCT) have significantly improved in recent years. OBJECTIVES To assess the incremental improvement of transplanted AML patients in the last two decades. METHODS Patients included in this analysis were adult AML patients who underwent allo-SCT from an HLA-matched sibling donor (MSD) or HLA-matched unrelated donor (MUD) in first remission. Patient outcomes were assessed between three cohorts according to the year of transplant (1993-2002, 2003-2007 and 2008-2012). RESULTS The analysis comprised a total of 20 187 patients of whom 4763 were transplanted between 1993 and 2002, 5835 in 2003 and 2007, and 9589 in 2008 and 2012. In multivariate analysis, leukaemia-free survival (LFS) rates were significantly improved in more recently transplanted patients compared to patients transplanted in 1993-2002 [Hazard ratio (HR) = 0.84, confidence interval (CI) 95%, 0.77-0.92; P = 0.003], a benefit which also extended to improved overall survival (OS; HR = 0.8, CI 95%, 0.73-0.89; P < 0.0001), and decreased nonrelapse mortality (NRM) rates (HR = 0.65, CI 95%, 0.56-0.75; P < 0.0001). Subset analysis revealed that in MSD, the rates of LFS, NRM and OS significantly improved in patients in the more recent cohort with similar results also seen in MUD. Finally, the incidence of acute graft-versus-host disease (GVHD) was significantly reduced leading to improved GVHD-free/relapse-free survival (GRFS) rates in more recently transplanted patients. CONCLUSION Outcome of allo-SCT for AML patients has markedly improved in the last two decades owing to decreased nonrelapse mortality and improved rates of leukaemia-free survival resulting in significantly longer survival.
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Affiliation(s)
- J Canaani
- Hematology Division, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - E Beohou
- Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France
| | - M Labopin
- Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France
| | - A Ghavamzadeh
- Hematology-Oncology and BMT Research, Shariati Hospital, Teheran, Iran
| | - D Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - R-M Hamladji
- Service Hématologie Greffe de Moëlle, Centre Pierre et Marie Curie, Alger, Algeria
| | - D Niederwieser
- Division of Haematology & Oncology, University Hospital Leipzig, Leipzig, Germany
| | - L Volin
- Stem Cell Transplantation Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - M Markiewicz
- Department of Haematology and BMT, Medical University of Silesia, Katowice, Poland
| | - R Arnold
- Medizinische Klinik m. S. Hämatologie/Onkologie, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - G Mufti
- Department of Haematological Medicine, GKT School of Medicine, London, UK
| | - G Ehninger
- Universitaetsklinikum Dresden Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - G Socié
- Department of Hematology - BMT, Hȏpital St. Louis, Paris, France
| | - N Kröger
- Bone Marrow Transplantation Centre, University Hospital Eppendorf, Hamburg, Germany
| | - M Mohty
- Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel.,Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France
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31
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Lee CJ, Labopin M, Beelen D, Finke J, Blaise D, Ganser A, Itälä‐Remes M, Chevallier P, Labussière‐Wallet H, Maertens J, Yakoub‐Agha I, Bourhis J, Mailhol A, Mohty M, Savani BN, Nagler A. Comparative outcomes of myeloablative and reduced-intensity conditioning allogeneic hematopoietic cell transplantation for therapy-related acute myeloid leukemia with prior solid tumor: A report from the acute leukemia working party of the European society for blood and bone marrow transplantation. Am J Hematol 2019; 94:431-438. [PMID: 30597620 DOI: 10.1002/ajh.25395] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 01/20/2023]
Abstract
Therapy-related acute myeloid leukemia (t-AML) arises as a late complication following antecedent solid tumors or hematologic diseases and their associated treatments. There are limited data regarding risk factors and outcomes following allogeneic hematopoietic cell transplantation (HCT) for t-AML following a prior solid tumor, and furthermore, the impact of myeloablative (MAC) vs reduced-intensity conditioning (RIC) on survival is unknown. The acute leukemia working party (ALWP) of the European society for blood and bone marrow transplantation (EBMT) performed a large registry study that included 535 patients with t-AML and prior solid tumor who underwent first MAC or RIC allogeneic HCT from 2000-2016. The primary endpoints of the study were OS and LFS. Patients receiving RIC regimens had an increase in relapse incidence (hazard ratio [HR], 1.52; 95% confidence interval [CI] 1.02-2.26; P = 0.04), lower LFS (HR, 1.52; 95% CI 1.12-2.05, P = 0.007), and OS (HR, 1.51; CI 1.09-2.09; P = 0.012). There were no differences in NRM and GRFS. Importantly, LFS and OS were superior in patients receiving ablative regimens due to a decrease in relapse. As NRM continues to decline in the current era, it is conceivable that outcomes of HCT for t-AML with prior solid tumor may be improved by careful patient selection for myeloablative regimens.
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Affiliation(s)
- Catherine J. Lee
- Utah Blood and Marrow Transplantation Program Huntsman Cancer Institute Salt Lake City Utah
| | - Myriam Labopin
- EBMT Paris study office/CEREST‐TC Paris France
- Department of Haematology Saint Antoine Hospital, Université Pierre & Marie Curie, INSERM Paris France
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation West German Cancer Center, University Hospital of Essen, University of Duisburg‐Essen Germany
| | - Jürgen Finke
- Department of Medicine‐Hematology, Oncology University of Freiburg Germany
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes Marseille France
| | - Arnold Ganser
- Department of Hematology, Hemostasis, and Oncology Hannover Medical School Germany
| | - Maija Itälä‐Remes
- Division of Medicine, Department of Hematology and Stem Cell Transplantation Unit Turku University Hospital Turku Finland
| | | | | | - Johan Maertens
- Department of Haematology University Hospital Gasthuisberg Leuven Belgium
| | | | | | | | - Mohamad Mohty
- Department of Haematology Saint Antoine Hospital, Université Pierre & Marie Curie, INSERM Paris France
| | - Bipin N. Savani
- Division of Hematology/Oncology Vanderbilt University Medical Center Nashville Tennessee
| | - Arnon Nagler
- EBMT Paris study office/CEREST‐TC Paris France
- Hematology Division Chaim Sheba Medical Center Tel Hashomer Israel
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32
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Gagelmann N, Ditschkowski M, Bogdanov R, Cassinat B, Robin M, Heuser M, Thol F, Shahswar R, Beelen D, Badbaran A, Kröger N. Comprehensive Clinical-Molecular Transplant Risk Model for Myelofibrosis Undergoing Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.381] [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: 10/27/2022]
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33
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Kröger N, Eikema DJ, Köster L, Beelen D, de Wreede LC, Finke J, Koenecke C, Niederwieser D, Bornhäuser M, Schoenland S, Potter V, Wolschke C, Maertens J, Theobald M, Kobbe G, Itälä-Remes M, Wulf G, Kahls P, Forcade E, Greinix H, Masszi T, Yakoub-Agha I, Chalandon Y, Robin M. Impact of primary disease on outcome after allogeneic stem cell transplantation for transformed secondary acute leukaemia. Br J Haematol 2019; 185:725-732. [PMID: 30820933 DOI: 10.1111/bjh.15819] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/25/2018] [Accepted: 01/04/2019] [Indexed: 01/22/2023]
Abstract
Myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN) and chronic myelomonocytic leukaemia (CMML) can progress to secondary acute myeloid leukaemia (sAML). We compared the outcome of 4214 sAML patients who received allogeneic haematopoietic stem cell transplantation (allo-HSCT) from an unrelated (62%) or human leucocyte antigen (HLA)-identical sibling donor (38%) according the underlying disease: MDS (n = 3541), CMML (n = 251) or MPN (n = 422). After a median follow up of 46·5 months, the estimated 3-year progression-free (PFS) and overall survival (OS) for the entire group was 36% (34-37%) and 41% (40-43%), respectively. The cumulative incidence of relapse and non-relapse mortality (NRM) was 37% (35-39%) and 27% (26-29%), respectively. In a multivariable analysis for OS, besides age (P < 0·001), unrelated donor (P = 0·011), cytomegalovirus ± constellation (P = 0·007), Karnofsky index ≤ 80 (P < 0·001), remission status (P < 0·001), peripheral blood as stem cell source (P = 0·009), sAML from MPN (P = 0·003) remained a significant factor in comparison to sAML from MDS, while worse outcome of sAML from CMML did not reach statistical significance (P = 0·06). This large registry study demonstrates a major impact of the underlying disease on outcome of sAML after allo-HSCT.
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Affiliation(s)
- Nicolaus Kröger
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Liesbeth C de Wreede
- Dept of Biomedical Data Science, Leiden, the Netherlands.,DKMS, German Bone Marrow Donor Registry, Dresden, Germany
| | | | | | | | | | | | | | | | | | | | - Guido Kobbe
- University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Gerald Wulf
- University Hospital Göttingen, Göttingen, Germany
| | - Peter Kahls
- Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - Yves Chalandon
- Faculty of Medicine of Geneva, University Hospital Geneva, Geneva, Switzerland
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34
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Robin M, de Wreede LC, Wolschke C, Schetelig J, Eikema DJ, Van Lint MT, Knelange NS, Beelen D, Brecht A, Niederwieser D, Vitek A, Bethge W, Arnold R, Finke J, Volin L, Yakoub-Agha I, Nagler A, Poiré X, Einsele H, Chevallier P, Holler E, Ljungman P, Robinson S, Radujkovic A, McLornan D, Chalandon Y, Kröger N. Long-term outcome after allogeneic hematopoietic cell transplantation for myelofibrosis. Haematologica 2019; 104:1782-1788. [PMID: 30733269 PMCID: PMC6717573 DOI: 10.3324/haematol.2018.205211] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 08/24/2018] [Accepted: 01/31/2019] [Indexed: 12/25/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplant remains the only curative treatment for myelofibrosis. Most post-transplantation events occur during the first two years and hence we aimed to analyze the outcome of 2-year disease-free survivors. A total of 1055 patients with myelofibrosis transplanted between 1995 and 2014 and registered in the registry of the European Society for Blood and Marrow Transplantation were included. Survival was compared to the matched general population to determine excess mortality and the risk factors that are associated. In the 2-year survivors, disease-free survival was 64% (60-68%) and overall survival was 74% (71-78%) at ten years; results were better in younger individuals and in women. Excess mortality was 14% (8-21%) in patients aged <45 years and 33% (13-53%) in patients aged ≥65 years. The main cause of death was relapse of the primary disease. Graft-versus-host disease (GvHD) before two years decreased the risk of relapse. Multivariable analysis of excess mortality showed that age, male sex recipient, secondary myelofibrosis and no GvHD disease prior to the 2-year landmark increased the risk of excess mortality. This is the largest study to date analyzing long-term outcome in patients with myelofibrosis undergoing transplant. Overall it shows a good survival in patients alive and in remission at two years. However, the occurrence of late complications, including late relapses, infectious complications and secondary malignancies, highlights the importance of screening and monitoring of long-term survivors.
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Affiliation(s)
- Marie Robin
- Hôpital Saint-Louis, APHP, Université Paris 7, Paris, France
| | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, LUMC, Leiden, the Netherlands and DKMS CTU, Dresden, Germany
| | | | - Johannes Schetelig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany
| | | | | | | | | | | | | | - Antonin Vitek
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | | | - Jürgen Finke
- Division of Medicine I, Hematology, Oncology and Stem Cell Transplantation, University of Freiburg, Freiburg, Germany
| | - Liisa Volin
- HUCH Comprehensive Cancer Center, Helsinki, Finland
| | | | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Per Ljungman
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Donal McLornan
- Comprehensive Cancer Centre, Department of Haematology, Kings College, London, UK
| | - Yves Chalandon
- Hôpitaux Universitaires de Genève and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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35
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Gagelmann N, Eikema DJ, Stelljes M, Beelen D, de Wreede L, Mufti G, Knelange NS, Niederwieser D, Friis LS, Ehninger G, Nagler A, Yakoub-Agha I, Meijer E, Ljungman P, Maertens J, Kanz L, Lopez-Corral L, Brecht A, Craddock C, Finke J, Cornelissen JJ, Bernasconi P, Chevallier P, Sierra J, Robin M, Kröger N. Optimized EBMT transplant-specific risk score in myelodysplastic syndromes after allogeneic stem-cell transplantation. Haematologica 2019; 104:929-936. [PMID: 30655377 PMCID: PMC6518902 DOI: 10.3324/haematol.2018.200808] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/02/2018] [Accepted: 01/09/2019] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to develop and validate a clinical and transplant-specific prognostic score using data from a large cohort of patients with myelodysplastic syndromes reported to the European Society for Blood and Marrow Transplantation registry. A Cox model was fitted to detect clinical and transplant-related variables prognostic of outcome. Then, cross-validation was performed to evaluate the validity and consistency of the model. Seven independent risk factors for survival were identified: age ≥50 years, matched unrelated donor, Karnofsky Performance Status <90%, very poor cytogenetics or monosomal karyotype, positive cytomegalovirus status of the recipient, blood blasts >1%, and platelet count ≤50 × 109/L prior to transplantation. Incorporating these factors into a four-level risk score yielded hazard ratios for death, with low-risk (score of 0-1) as reference, of 2.02 (95% CI: 1.41-2.90) for the intermediate-risk group (score of 2-3), 3.49 (95% CI: 2.45-4.97) for the high-risk group (score of 4-5), and 5.90 (95% CI: 4.01-8.67) for the very high-risk group (score of >5). The score was predictive of survival, relapse-free survival, relapse, and non-relapse mortality (P<0.001, respectively). Cross-validation yielded significant and reproducible improvement in prognostic ability with C-statistics being 0.609 (95% CI: 0.588-0.629) versus 0.555 for the Gruppo Italiano Trapianto di Midollo Osseo registry and 0.579 for the Center for Blood and Marrow Transplant Research registry. Prediction was even further augmented after applying a nomogram using age and platelets as continuous variables showing C-statistics of 0.628 (95% CI: 0.616-0.637). In conclusion, compared to existing prognostic systems, this proposed transplant-specific risk score offers improved performance with respect to post-transplant risk stratification in myelodysplastic syndromes.
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Affiliation(s)
- Nico Gagelmann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Dietrich Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Germany
| | | | | | | | | | | | | | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Ellen Meijer
- VU University Medical Center, Amsterdam, the Netherlands
| | - Per Ljungman
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Arne Brecht
- Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | | | | | - Jan J Cornelissen
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Jorge Sierra
- Hospital Santa Creu i Sant Pau, Jose Carreras Leukemia Research Institute, Barcelona, Spain
| | | | - Nicolaus Kröger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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36
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Samarasinghe S, Clesham K, Iacobelli S, Sbianchi G, Knol C, Hamladji RM, Socié G, Aljurf M, Koh M, Sengeloev H, Dalle JH, Robinson S, Van Lint MT, Halkes CJM, Beelen D, Mufti GJ, Snowden J, Blaise D, de Latour RP, Marsh J, Dufour C, Risitano AM. Impact of T-cell depletion strategies on outcomes following hematopoietic stem cell transplantation for idiopathic aplastic anemia: A study on behalf of the European blood and marrow transplant severe aplastic anemia working party. Am J Hematol 2019; 94:80-86. [PMID: 30328134 DOI: 10.1002/ajh.25314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/02/2018] [Accepted: 10/15/2018] [Indexed: 12/11/2022]
Abstract
We retrospectively analyzed the outcomes of 1837 adults and children with severe aplastic anemia (SAA) who underwent matched sibling donor (MSD) and matched unrelated donor (MUD) hemopoietic stem cell transplantation (HSCT) between 2000 and 2013. Patients were grouped by transplant conditioning containing either anti-thymocyte globulin (ATG) (n = 1283), alemtuzumab (n = 261), or no serotherapy (NS) (n = 293). The risks of chronic GvHD were significantly reduced when ATG or alemtuzumab were compared with NS (P = .021 and .003, respectively). Acute GVHD was significantly reduced in favor of alemtuzumab compared with ATG (P = .012) and NS (P < .001). By multivariate analysis, when compared with ATG, alemtuzumab was associated with a lower risk of developing acute (OR 0.262; 95% CI 0.14-0.47; P < .001) and chronic GVHD (HR 0.58; 95% CI 0.35-0.94; P = .027). OS was significantly better in ATG and alemtuzumab patients compared with NS (P = .010 and .025). Our data shows inclusion of serotherapy in MSD and MUD HSCT for patients with SAA reduces chronic GVHD and provides a survival advantage over patients not receiving serotherapy. Notably, alemtuzumab reduced the risk of acute and chronic GvHD compared with ATG and indicates that alemtuzumab might be the serotherapy of choice for MSD and MUD transplants for SAA.
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Affiliation(s)
| | - Katherine Clesham
- UCL Great Ormond Street Hospital for Children; London United Kingdom
| | - Simona Iacobelli
- Dipartimento di Biologia; Tor Vergata Università di Roma; Rome Italy
| | - Giulia Sbianchi
- Dipartimento di Biologia; Tor Vergata Università di Roma; Rome Italy
| | - Cora Knol
- EBMT Data Office; Leiden The Netherlands
| | | | | | - Mahmoud Aljurf
- King Faisal Hospital & Research Centre; Riyadh Saudi Arabia
| | - Mickey Koh
- St. George's Hospital; London United Kingdom
| | | | | | | | | | | | | | - Ghulam J. Mufti
- King's College Hospital/King's College London; London United Kingdom
| | - John Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield United Kingdom
| | | | | | - Judith Marsh
- King's College Hospital/King's College London; London United Kingdom
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37
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Radujkovic A, Dai H, Kordelas L, Beelen D, Rachakonda SP, Müller-Tidow C, Kumar R, Dreger P, Luft T. Asymmetric dimethylarginine serum levels are associated with early mortality after allogeneic stem cell transplantation. Haematologica 2018; 104:827-834. [PMID: 30514796 PMCID: PMC6442976 DOI: 10.3324/haematol.2018.202267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/19/2018] [Accepted: 11/23/2018] [Indexed: 12/26/2022] Open
Abstract
Increasing evidence suggests that endothelial cell distress is associated with mortality after allogeneic stem cell transplantation and acute graft-versus-host disease. Asymmetric dimethylarginine is an endogenous nitric oxide synthase inhibitor that induces endothelial cell dysfunction. We analyzed the impact of pre-transplant serum levels of asymmetric dimethylarginine on outcome after allogeneic stem cell transplantation. Since acute graft-versus-host disease and its treatment are major contributors to post-transplant mortality, the effect of asymmetric dimethylarginine on outcome measures was also assessed after onset of acute graft-versus-host disease. A total of 938 patients allografted at two centers between 2002 and 2013 were included in the retrospective study. In multivariable models, higher pre-transplant asymmetric dimethylarginine levels were significantly associated with an increased risk of non-relapse mortality (hazard ratio 1.43 per 1-log2 increase, P=0.005) but not with relapse (hazard ratio 1.21, P=0.109) within the first year after transplantation. This translated into worse overall survival (hazard ratio 1.45, P<0.0001) and shorter progression-free survival (hazard ratio 1.30, P=0.002) in the first year after transplantation. Higher pre-transplant asymmetric dimethylarginine levels were also associated with shorter overall survival (hazard ratio 1.46, P=0.001) and progression-free survival (hazard ratio 1.32, P=0.010) and higher non-relapse mortality (hazard ratio 1.36, P=0.042) within 1 year after the onset of acute graft-versus-host disease. Taken together, our data indicate an association between pre-transplant asymmetric dimethylarginine status and early non-relapse mortality in allografted patients, both overall and after the onset of acute graft-versus-host disease. These findings underline the relevance of endothelial dysfunction for transplant complications.
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Affiliation(s)
| | - Hao Dai
- Department of Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg
| | - Lambros Kordelas
- Department of Bone Marrow Transplantation, University Hospital Essen, Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital Essen, Germany
| | - Sivaramakrishna P Rachakonda
- Department of Internal Medicine V, University Hospital Heidelberg.,Department of Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg
| | | | - Rajiv Kumar
- Department of Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg
| | - Peter Dreger
- Department of Internal Medicine V, University Hospital Heidelberg
| | - Thomas Luft
- Department of Internal Medicine V, University Hospital Heidelberg
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38
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Braess J, Amler S, Kreuzer KA, Spiekermann K, Lindemann HW, Lengfelder E, Graeven U, Staib P, Ludwig WD, Biersack H, Ko YD, Uppenkamp MJ, De Wit M, Korsten S, Peceny R, Gaska T, Schiel X, Behringer DM, Kiehl MG, Zinngrebe B, Meckenstock G, Roemer E, Medgenberg D, Spaeth-Schwalbe E, Massenkeil G, Hindahl H, Schwerdtfeger R, Trenn G, Sauerland C, Koch R, Lablans M, Faldum A, Görlich D, Bohlander SK, Schneider S, Dufour A, Buske C, Fiegl M, Subklewe M, Braess B, Unterhalt M, Baumgartner A, Wörmann B, Beelen D, Hiddemann W. Sequential high-dose cytarabine and mitoxantrone (S-HAM) versus standard double induction in acute myeloid leukemia-a phase 3 study. Leukemia 2018; 32:2558-2571. [PMID: 30275528 PMCID: PMC6286323 DOI: 10.1038/s41375-018-0268-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/16/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 01/17/2023]
Abstract
Dose-dense induction with the S-HAM regimen was compared to standard double induction therapy in adult patients with newly diagnosed acute myeloid leukemia. Patients were centrally randomized (1:1) between S-HAM (2nd chemotherapy cycle starting on day 8 = “dose-dense”) and double induction with TAD-HAM or HAM(-HAM) (2nd cycle starting on day 21 = “standard”). 387 evaluable patients were randomly assigned to S-HAM (N = 203) and to standard double induction (N = 184). The primary endpoint overall response rate (ORR) consisting of complete remission (CR) and incomplete remission (CRi) was not significantly different (P = 0.202) between S-HAM (77%) and double induction (72%). The median overall survival was 35 months after S-HAM and 25 months after double induction (P = 0.323). Duration of critical leukopenia was significantly reduced after S-HAM (median 29 days) versus double induction (median 44 days)—P < 0.001. This translated into a significantly shortened duration of hospitalization after S-HAM (median 37 days) as compared to standard induction (median 49 days)—P < 0.001. In conclusion, dose-dense induction therapy with the S-HAM regimen shows favorable trends but no significant differences in ORR and OS compared to standard double induction. S-HAM significantly shortens critical leukopenia and the duration of hospitalization by 2 weeks.
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Affiliation(s)
- Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany. .,Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany.
| | - Susanne Amler
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany.,Friedrich Löffler Institute, Federal Research Centre, Greifswald-Insel Riems, Germany
| | - Karl-Anton Kreuzer
- Department of Internal Medicine I, University Hospital, Cologne, Germany
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | | | - Eva Lengfelder
- Department of Medicine III, University Hospital, Mannheim, Germany
| | - Ullrich Graeven
- Department of Medicine I, Hospital Maria Hilf, Mönchengladbach, Germany
| | - Peter Staib
- Department of Hematology and Medical Oncology, St. Antonius Hospital, Eschweiler, Germany
| | - Wolf-Dieter Ludwig
- Department of Hematology and Oncology and Tumor Immunology, Helios Hospital, Berlin-Buch, Germany
| | - Harald Biersack
- Department of Medicine I, University Hospital, Lübeck, Germany
| | - Yon-Dschun Ko
- Department of Medicine I, Johanniter Hospital, Bonn, Germany
| | | | - Maike De Wit
- Department of Hematology, Oncology and Palliative Care, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Stefan Korsten
- Department of Medicine, Vinzenz Pallotti Hospital, Bergisch-Gladbach, Germany
| | - Rudolf Peceny
- Department of Hematology and Oncology, Klinikum Osnabrück, Osnabrück, Germany
| | - Tobias Gaska
- Department of Hematology and Oncology, St. Josef Hospital, Paderborn, Germany
| | - Xaver Schiel
- Department of Hematology and Oncology, Klinikum Harlaching, Munich, Germany
| | - Dirk M Behringer
- Department of Hematology, Oncology and Palliative Care, Augusta Hospital, Bochum, Germany
| | - Michael G Kiehl
- Department of Medicine I, Klinikum Frankfurt/Oder, Frankfurt/Oder, Germany
| | - Bettina Zinngrebe
- Department of Hematology, Oncology and Palliative Care, Evangelisches Krankenhaus, Bielefeld, Germany
| | - Gerald Meckenstock
- Department of Medical Oncology, Radiooncology, Hematology and Palliative Care, St. Josef Hospital, Gelsenkirchen, Germany
| | - Eva Roemer
- Department of Hematology and Oncology, Klinikum Idar-Oberstein, Idar-Oberstein, Germany
| | - Dirk Medgenberg
- Department of Medicine III, Klinikum Leverkusen, Leverkusen, Germany
| | | | - Gero Massenkeil
- Department of Medicine II, Klinikum Gütersloh, Gütersloh, Germany
| | - Heidrun Hindahl
- Department of Medicine I, St. Johannes Hospital, Dortmund, Germany
| | - Rainer Schwerdtfeger
- Department for Bone Marrow and Blood Stem Cell Transplantation, DKD Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Guido Trenn
- Department of Medicine I, Knappschaftskrankenhaus, Bottrop, Germany
| | - Cristina Sauerland
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Raphael Koch
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Martin Lablans
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany.,Division of Medical Informatics in Translational Oncology, DKFZ German Cancer Research Center, Heidelberg, Germany
| | - Andreas Faldum
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Dennis Görlich
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Stefan K Bohlander
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Stephanie Schneider
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Annika Dufour
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Christian Buske
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany.,Institute of Experimental Cancer Research, University Hospital, Ulm, Germany
| | - Michael Fiegl
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Birgit Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany.,Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Michael Unterhalt
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Anja Baumgartner
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | | | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
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39
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Sengsayadeth S, Labopin M, Boumendil A, Finke J, Ganser A, Stelljes M, Ehninger G, Beelen D, Niederwieser D, Blaise D, Dreger P, Mufti G, Chevallier P, Mailhol A, Gatwood KS, Gorin N, Esteve J, Ciceri F, Baron F, Schmid C, Giebel S, Mohty M, Savani BN, Nagler A. Transplant Outcomes for Secondary Acute Myeloid Leukemia: Acute Leukemia Working Party of the European Society for Blood and Bone Marrow Transplantation Study. Biol Blood Marrow Transplant 2018; 24:1406-1414. [DOI: 10.1016/j.bbmt.2018.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022]
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40
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Fasslrinner F, Schetelig J, Burchert A, Kramer M, Trenschel R, Hegenbart U, Stadler M, Schäfer-Eckart K, Bätzel M, Eich H, Stuschke M, Engenhart-Cabillic R, Krause M, Dreger P, Neubauer A, Ehninger G, Beelen D, Berdel WE, Siepmann T, Stelljes M, Bornhäuser M. Long-term efficacy of reduced-intensity versus myeloablative conditioning before allogeneic haemopoietic cell transplantation in patients with acute myeloid leukaemia in first complete remission: retrospective follow-up of an open-label, randomised phase 3 trial. The Lancet Haematology 2018; 5:e161-e169. [DOI: 10.1016/s2352-3026(18)30022-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/24/2018] [Accepted: 02/07/2018] [Indexed: 01/25/2023]
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41
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Garderet L, Ziagkos D, van Biezen A, Iacobelli S, Finke J, Maertens J, Volin L, Ljungman P, Chevallier P, Passweg J, Schaap N, Beelen D, Nagler A, Blaise D, Poiré X, Yakoub-Agha I, Lenhoff S, Craddock C, Schots R, Rambaldi A, Sanz J, Jindra P, Mufti GJ, Robin M, Kröger N. Allogeneic Stem Cell Transplantation for Myelodysplastic Syndrome Patients with a 5q Deletion. Biol Blood Marrow Transplant 2018; 24:507-513. [DOI: 10.1016/j.bbmt.2017.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/12/2017] [Indexed: 01/22/2023]
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Mathew NR, Baumgartner F, Braun L, O’Sullivan D, Thomas S, Waterhouse M, Müller TA, Hanke K, Taromi S, Apostolova P, Illert AL, Melchinger W, Duquesne S, Schmitt-Graeff A, Osswald L, Yan KL, Weber A, Tugues S, Spath S, Pfeifer D, Follo M, Claus R, Lübbert M, Rummelt C, Bertz H, Wäsch R, Haag J, Schmidts A, Schultheiss M, Bettinger D, Thimme R, Ullrich E, Tanriver Y, Vuong GL, Arnold R, Hemmati P, Wolf D, Ditschkowski M, Jilg C, Wilhelm K, Leiber C, Gerull S, Halter J, Lengerke C, Pabst T, Schroeder T, Kobbe G, Rösler W, Doostkam S, Meckel S, Stabla K, Metzelder SK, Halbach S, Brummer T, Hu Z, Dengjel J, Hackanson B, Schmid C, Holtick U, Scheid C, Spyridonidis A, Stölzel F, Ordemann R, Müller LP, Sicre-de-Fontbrune F, Ihorst G, Kuball J, Ehlert JE, Feger D, Wagner EM, Cahn JY, Schnell J, Kuchenbauer F, Bunjes D, Chakraverty R, Richardson S, Gill S, Kröger N, Ayuk F, Vago L, Ciceri F, Müller AM, Kondo T, Teshima T, Klaeger S, Kuster B, Kim D(DH, Weisdorf D, van der Velden W, Dörfel D, Bethge W, Hilgendorf I, Hochhaus A, Andrieux G, Börries M, Busch H, Magenau J, Reddy P, Labopin M, Antin JH, Henden AS, Hill GR, Kennedy GA, Bar M, Sarma A, McLornan D, Mufti G, Oran B, Rezvani K, Sha O, Negrin RS, Nagler A, Prinz M, Burchert A, Neubauer A, Beelen D, Mackensen A, von Bubnoff N, Herr W, Becher B, Socié G, Caligiuri MA, Ruggiero E, Bonini C, Häcker G, Duyster J, Finke J, Pearce E, Blazar BR, Zeiser R. Sorafenib promotes graft-versus-leukemia activity in mice and humans through IL-15 production in FLT3-ITD-mutant leukemia cells. Nat Med 2018; 24:282-291. [PMID: 29431743 PMCID: PMC6029618 DOI: 10.1038/nm.4484] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 01/05/2018] [Indexed: 12/28/2022]
Abstract
Individuals with acute myeloid leukemia (AML) harboring an internal tandem duplication (ITD) in the gene encoding Fms-related tyrosine kinase 3 (FLT3) who relapse after allogeneic hematopoietic cell transplantation (allo-HCT) have a 1-year survival rate below 20%. We observed that sorafenib, a multitargeted tyrosine kinase inhibitor, increased IL-15 production by FLT3-ITD+ leukemia cells. This synergized with the allogeneic CD8+ T cell response, leading to long-term survival in six mouse models of FLT3-ITD+ AML. Sorafenib-related IL-15 production caused an increase in CD8+CD107a+IFN-γ+ T cells with features of longevity (high levels of Bcl-2 and reduced PD-1 levels), which eradicated leukemia in secondary recipients. Mechanistically, sorafenib reduced expression of the transcription factor ATF4, thereby blocking negative regulation of interferon regulatory factor 7 (IRF7) activation, which enhanced IL-15 transcription. Both IRF7 knockdown and ATF4 overexpression in leukemia cells antagonized sorafenib-induced IL-15 production in vitro. Human FLT3-ITD+ AML cells obtained from sorafenib responders following sorafenib therapy showed increased levels of IL-15, phosphorylated IRF7, and a transcriptionally active IRF7 chromatin state. The mitochondrial spare respiratory capacity and glycolytic capacity of CD8+ T cells increased upon sorafenib treatment in sorafenib responders but not in nonresponders. Our findings indicate that the synergism of T cells and sorafenib is mediated via reduced ATF4 expression, causing activation of the IRF7-IL-15 axis in leukemia cells and thereby leading to metabolic reprogramming of leukemia-reactive T cells in humans. Therefore, sorafenib treatment has the potential to contribute to an immune-mediated cure of FLT3-ITD-mutant AML relapse, an otherwise fatal complication after allo-HCT.
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Affiliation(s)
- Nimitha R. Mathew
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, Albert-Ludwigs-University, Freiburg, Germany
| | - Francis Baumgartner
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Braun
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David O’Sullivan
- Max Planck Institute for Immunobiology and Epigenetics, Freiburg, Germany
| | - Simone Thomas
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Germany
| | - Miguel Waterhouse
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tony A. Müller
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Hanke
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, Albert-Ludwigs-University, Freiburg, Germany
| | - Sanaz Taromi
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Petya Apostolova
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna L. Illert
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Melchinger
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sandra Duquesne
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Lena Osswald
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kai-Li Yan
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arnim Weber
- Department of Medical Microbiology and Hygiene, University Medical Center Freiburg, Freiburg, Germany
| | - Sonia Tugues
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Sabine Spath
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Dietmar Pfeifer
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marie Follo
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rainer Claus
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Lübbert
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Rummelt
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Bertz
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Wäsch
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johanna Haag
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Schmidts
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Evelyn Ullrich
- University Hospital Frankfurt, Department for Children and Adolescents Medicine, Division of Stem Cell Transplantation and Immunology, Goethe-University, Frankfurt, Germany
| | - Yakup Tanriver
- Department of Medical Microbiology and Hygiene, University Medical Center Freiburg, Freiburg, Germany
- Department of Nephrology, University Medical Center Freiburg, Freiburg, Germany
| | - Giang Lam Vuong
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Germany
| | - Renate Arnold
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Germany
| | - Philipp Hemmati
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Germany
| | - Dominik Wolf
- Medical Clinic III, Oncology, Hematology, Immunooncology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - Markus Ditschkowski
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Germany
| | - Cordula Jilg
- Department of Urology, University Medical Center Freiburg, Freiburg, Germany
| | - Konrad Wilhelm
- Department of Urology, University Medical Center Freiburg, Freiburg, Germany
| | - Christian Leiber
- Department of Urology, University Medical Center Freiburg, Freiburg, Germany
| | - Sabine Gerull
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Jörg Halter
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Claudia Lengerke
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Thomas Pabst
- Inselspital/Universitätsspital Bern, CH-3010 Bern, Switzerland
| | - Thomas Schroeder
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Wolf Rösler
- Department of Hematology and Oncology, University of Erlangen, Germany
| | | | - Stephan Meckel
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Kathleen Stabla
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - Stephan K. Metzelder
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - Sebastian Halbach
- Institute of Molecular Medicine and Cell Research (IMMZ), Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Tilman Brummer
- Institute of Molecular Medicine and Cell Research (IMMZ), Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
- German Cancer Consortium (DKTK), partner site Freiburg; and German Cancer Research Center (DKFZ), Heidelberg, Germany, Freiburg, Germany
- Center for Biological signaling studies (BIOSS) - University of Freiburg, Germany
| | - Zehan Hu
- Department of Dermatology, Medical Center - University of Freiburg, Germany; and Department of Biology, University of Fribourg, Fribourg, Switzerland
| | - Joern Dengjel
- Department of Dermatology, Medical Center - University of Freiburg, Germany; and Department of Biology, University of Fribourg, Fribourg, Switzerland
| | - Björn Hackanson
- Interdisziplinäres Cancer Center Augsburg (ICCA), II. Medizinische Klinik, Augsburg, Germany
| | - Christoph Schmid
- Interdisziplinäres Cancer Center Augsburg (ICCA), II. Medizinische Klinik, Augsburg, Germany
| | - Udo Holtick
- Department of Internal Medicine I, University Hospital Cologne, Germany
| | - Christof Scheid
- Department of Internal Medicine I, University Hospital Cologne, Germany
| | | | - Friedrich Stölzel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Germany
| | - Rainer Ordemann
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Germany
| | - Lutz P. Müller
- Department of Hematology and Oncology, Universitätsklinikum Halle, Halle, Germany
| | - Flore Sicre-de-Fontbrune
- APHP, Saint Louis Hospital, Hematology Stem cell transplantation, & Inserm UMR 1160, Paris, France
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine and Medical Center - University of Freiburg, Germany
| | - Jürgen Kuball
- Department of Hematology, University Medical Center Utrecht, The Netherlands
| | | | | | - Eva-Maria Wagner
- Dept. of Hematology and Oncology, Universitaetsmedizin Mainz, Mainz, Germany
| | - Jean-Yves Cahn
- Clinique Universitaire Hématologie, Université Grenoble Alpes, France
| | - Jacqueline Schnell
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Florian Kuchenbauer
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Donald Bunjes
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Ronjon Chakraverty
- Cancer Institute and Institute of Immunity and Transplantation, Royal Free Hospital, London, UK
| | - Simon Richardson
- Cancer Institute and Institute of Immunity and Transplantation, Royal Free Hospital, London, UK
| | - Saar Gill
- Hospital of the University of Pennsylvania, Smilow Translational Research Center, Philadelphia, PA, USA
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Germany
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Germany
| | - Luca Vago
- Unit of Immunogenetics, Leukemia Genomics and Immunobiology, Unit of Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, and University Vita-Salute San Raffaele Milano, Italy
| | - Fabio Ciceri
- Unit of Immunogenetics, Leukemia Genomics and Immunobiology, Unit of Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, and University Vita-Salute San Raffaele Milano, Italy
| | - Antonia M. Müller
- Department of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Takeshi Kondo
- Department of Hematology, Hokkaido University, Sapporo, Japan
| | | | - Susan Klaeger
- German Cancer Consortium (DKTK), partner site Freiburg; and German Cancer Research Center (DKFZ), Heidelberg, Germany, Freiburg, Germany
- Proteomics and Bioanalytics, Technische Universitaet Muenchen, Partner Site of the German Cancer Consortium, Freising, Germany
| | - Bernhard Kuster
- Proteomics and Bioanalytics, Technische Universitaet Muenchen, Partner Site of the German Cancer Consortium, Freising, Germany
| | - Dennis (Dong Hwan) Kim
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Daniel Weisdorf
- Hematology, Oncology and Transplantation University of Minnesota, Minneapolis, USA
| | | | - Daniela Dörfel
- Medizinische Klinik II, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Wolfgang Bethge
- Medizinische Klinik II, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Geoffroy Andrieux
- Systems Biology of the Cellular Microenvironment Group, IMMZ, ALU, Freiburg, Germany. German Cancer Consortium (DKTK), Freiburg, Germany. German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Börries
- Systems Biology of the Cellular Microenvironment Group, IMMZ, ALU, Freiburg, Germany. German Cancer Consortium (DKTK), Freiburg, Germany. German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hauke Busch
- Systems Biology of the Cellular Microenvironment Group, IMMZ, ALU, Freiburg, Germany. German Cancer Consortium (DKTK), Freiburg, Germany. German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - John Magenau
- Department of Hematology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Pavan Reddy
- Department of Hematology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Myriam Labopin
- EBMT Statistical Unit, Hôpital Saint Antoine Paris, France
| | - Joseph H. Antin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrea S. Henden
- Bone Marrow Transplant Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia & Department of Haematology, Royal Brisbane Hospital, Brisbane, Australia
| | - Geoffrey R. Hill
- Bone Marrow Transplant Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia & Department of Haematology, Royal Brisbane Hospital, Brisbane, Australia
- Department of Haematology, Royal Brisbane and Womens Hospital, Brisbane, Australia
| | - Glen A. Kennedy
- Department of Haematology, Royal Brisbane and Womens Hospital, Brisbane, Australia
| | - Merav Bar
- Division of Blood and Marrow Transplantation, Fred Hutchinson Cancer Research Center, University of WA Seattle, USA
| | - Anita Sarma
- Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Donal McLornan
- Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Ghulam Mufti
- Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Betul Oran
- Division of BMT, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Omid Sha
- Division of Blood and Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - Robert S. Negrin
- Division of Blood and Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - Arnon Nagler
- Division of Hematology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Marco Prinz
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
- Center for Biological signaling studies (BIOSS) - University of Freiburg, Germany
| | - Andreas Burchert
- Institute of Molecular Medicine and Cell Research (IMMZ), Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Andreas Neubauer
- Institute of Molecular Medicine and Cell Research (IMMZ), Faculty of Medicine, Albert-Ludwigs-University Freiburg, Germany
| | - Dietrich Beelen
- Department of Urology, University Medical Center Freiburg, Freiburg, Germany
| | | | - Nikolas von Bubnoff
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Germany
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Gerard Socié
- APHP, Saint Louis Hospital, Hematology Stem cell transplantation, & Inserm UMR 1160, Paris, France
| | | | - Eliana Ruggiero
- Unit of Immunogenetics, Leukemia Genomics and Immunobiology, Unit of Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, and University Vita-Salute San Raffaele Milano, Italy
| | - Chiara Bonini
- Unit of Immunogenetics, Leukemia Genomics and Immunobiology, Unit of Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, and University Vita-Salute San Raffaele Milano, Italy
| | - Georg Häcker
- Department of Medical Microbiology and Hygiene, University Medical Center Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erika Pearce
- Max Planck Institute for Immunobiology and Epigenetics, Freiburg, Germany
| | - Bruce R. Blazar
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert Zeiser
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Biological signaling studies (BIOSS) - University of Freiburg, Germany
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Ciurea SO, Labopin M, Socie G, Volin L, Passweg J, Chevallier P, Beelen D, Milpied N, Blaise D, Cornelissen JJ, Fegueux N, Polge E, Kongtim P, Rondon G, Esteve J, Mohty M, Savani BN, Champlin RE, Nagler A. Relapse and survival after transplantation for complex karyotype acute myeloid leukemia: A report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation and the University of Texas MD Anderson Cancer Center. Cancer 2018; 124:2134-2141. [DOI: 10.1002/cncr.31311] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/18/2017] [Accepted: 12/28/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Stefan O. Ciurea
- Department of Stem Cell Transplant and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Texas
| | - Myriam Labopin
- Acute Leukemia Working Party, European Society for Blood and Marrow Transplantation; Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy; Paris France
- Institute of Hematology and Oncology, Department of Hematology, Hospital Clinic, August Pi I Sunyer Institute for Biomedical Investigation (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Gerard Socie
- Department of Hematology; St. Louis Hospital; Paris France
| | - Liisa Volin
- Department of Medicine; Helsinki University Central Hospital; Helsinki Finland
| | - Jakob Passweg
- Department of Hematology; University Hospital Basel; Basel Switzerland
| | - Patrice Chevallier
- Department of Hematology; Hotel-Dieu University Hospital Center; Nantes France
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation; University Hospital, Essen; Essen Germany
| | - Noel Milpied
- Department of Hematology and Cellular Therapy; Bordeaux University Hospital Center, Haut-Leveque Hospital; Pessac France
| | - Didier Blaise
- Transplantation and Cellular Therapy Program, Marseille Center for Oncology Research; Paoli Calmettes Institute; Marseille France
| | - Jan J. Cornelissen
- Department of Hematology, Erasmus Medical Center Cancer Institute; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Nathalie Fegueux
- Department of Clinical Hematology; Lapeyronie University Hospital Center; Montpellier France
| | - Emmanuelle Polge
- Acute Leukemia Working Party, European Society for Blood and Marrow Transplantation; Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy; Paris France
- Institute of Hematology and Oncology, Department of Hematology, Hospital Clinic, August Pi I Sunyer Institute for Biomedical Investigation (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Piyanuch Kongtim
- Department of Stem Cell Transplant and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplant and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Texas
| | - Jordi Esteve
- Institute of Hematology and Oncology, Department of Hematology, Hospital Clinic, August Pi I Sunyer Institute for Biomedical Investigation (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Mohamad Mohty
- Hematology and Cellular Therapy Department, Saint-Antoine Hospital; Pierre and Marie Curie University; Paris France
| | - Bipin N. Savani
- Acute Leukemia Working Party, European Society for Blood and Marrow Transplantation; Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy; Paris France
- Long-Term Transplantation Clinic; Vanderbilt University Medical Center; Nashville Tennessee
| | - Richard E. Champlin
- Department of Stem Cell Transplant and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Texas
| | - Arnon Nagler
- Acute Leukemia Working Party, European Society for Blood and Marrow Transplantation; Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy; Paris France
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer; Tel Aviv University; Tel Aviv Israel
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Ringdén O, Labopin M, Sadeghi B, Mailhol A, Beelen D, Fløisand Y, Ghavamzadeh A, Finke J, Ehninger G, Volin L, Socié G, Kröger N, Stuhler G, Ganser A, Schmid C, Giebel S, Mohty M, Nagler A. What is the outcome in patients with acute leukaemia who survive severe acute graft-versus-host disease? J Intern Med 2018; 283:166-177. [PMID: 29027756 DOI: 10.1111/joim.12695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute graft-versus-host disease (aGVHD) is a major complication of allogeneic haematopoietic stem cell transplantation (HSCT). With new promising therapies, survival may improve for severe aGVHD. OBJECTIVES We wanted to analyze the long-term outcome in patients who survive severe aGVHD. METHODS This study was a landmark analysis of 23 567 patients with acute Leukaemia who survived for more than 6 months after HSCT, 2002-2014. Patients alive after severe aGVHD (n = 1738) were compared to controls. RESULTS Patients with severe aGVHD had higher non-relapse mortality (NRM) and higher rate of extensive chronic GVHD (cGVHD) than the controls (P < 10-5 ). The probability of relapse was significantly lower in the severe aGVHD group, but Leukaemia-free survival (LFS) and overall survival were significantly lower than for the controls (P < 10-5 ). Five-year LFS in patients with severe aGVHD was 49%, as opposed to 61% in controls with no or mild GVHD and 59% in patients with moderate GVHD. CONCLUSIONS HSCT patients who survive severe aGVHD have higher risk of developing extensive cGVHD, a higher NRM, a lower relapse probability, and lower LFS than other HSCT patients. This study is a platform for outcome analysis in patients treated with novel therapies for acute GVHD.
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Affiliation(s)
- O Ringdén
- Division of Therapeutic Immunology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - M Labopin
- Hôpital Saint Antoine, Paris, France
| | - B Sadeghi
- Division of Therapeutic Immunology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - A Mailhol
- Hôpital Saint Antoine, Paris, France
| | - D Beelen
- University of Essen, Duisburg, Germany
| | - Y Fløisand
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - A Ghavamzadeh
- Shariati Hospital, Hematology-Oncology and BMT Research, Tehran, Iran
| | - J Finke
- Department of Medicine-Hematology, Oncology, University of Freiburg, Freiburg, Germany
| | - G Ehninger
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Dresden, Dresden, Germany
| | - L Volin
- Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki University Hospital, Helsinki, Finland
| | - G Socié
- Department of Hematology - BMT, Hopital St. Louis, Paris, France
| | - N Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - G Stuhler
- Deutsche Klinik für Diagnostik, KMT Zentrum, Wiesbaden, Germany
| | - A Ganser
- Medical University Hannover, Hannover, Germany
| | - C Schmid
- University of Munich, Munich, Germany
| | - S Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - M Mohty
- Hôpital Saint Antoine, Paris, France
| | - A Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
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45
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Schmid C, de Wreede LC, van Biezen A, Finke J, Ehninger G, Ganser A, Volin L, Niederwieser D, Beelen D, Alessandrino P, Kanz L, Schleuning M, Passweg J, Veelken H, Maertens J, Cornelissen JJ, Blaise D, Gramatzki M, Milpied N, Yakoub-Agha I, Mufti G, Rovira M, Arnold R, de Witte T, Robin M, Kröger N. Outcome after relapse of myelodysplastic syndrome and secondary acute myeloid leukemia following allogeneic stem cell transplantation: a retrospective registry analysis on 698 patients by the Chronic Malignancies Working Party of the European Society of Blood and Marrow Transplantation. Haematologica 2017; 103:237-245. [PMID: 29101205 PMCID: PMC5792268 DOI: 10.3324/haematol.2017.168716] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [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: 03/13/2017] [Accepted: 10/30/2017] [Indexed: 11/09/2022] Open
Abstract
No standard exists for the treatment of myelodysplastic syndrome relapsing after allogeneic stem cell transplantation. We performed a retrospective registry analysis of outcomes and risk factors in 698 patients, treated with different strategies. The median overall survival from relapse was 4.7 months (95% confidence interval: 4.1-5.3) and the 2-year survival rate was 17.7% (95% confidence interval: 14.8-21.2%). Shorter remission after transplantation (P<0.001), advanced disease (P=0.001), older age (P=0.007), unrelated donor (P=0.008) and acute graft-versus-host disease before relapse (P<0.001) adversely influenced survival. At 6 months from relapse, patients had received no cellular treatment, (i.e. palliative chemotherapy or best supportive care, n=375), donor lymphocyte infusion (n=213), or a second transplant (n=110). Treatment groups were analyzed separately because of imbalanced characteristics and difficulties in retrospectively evaluating the reason for individual treatments. Of the patients who did not receive any cellular therapy, 109 were alive at 6 months after relapse, achieving a median overall survival from this landmark of 8.9 months (95% confidence interval: 5.1-12.6). Their 2-year survival rate was 29.7%. Recipients of donor lymphocytes achieved a median survival from first infusion of 6.0 months (95% confidence interval: 3.7-8.3) with a 2-year survival rate of 27.6%. Longer remission after first transplantation (P<0.001) and younger age (P=0.009) predicted better outcome. Among recipients of a second transplant, the median survival from second transplantation was 4.2 months (95% confidence interval: 2.5-5.9), and their 2-year survival rate was 17.0%. Longer remission after first transplantation (P<0.001), complete remission at second transplant (P=0.008), no prior chronic graft-versus-host disease (P<0.001) and change to a new donor (P=0.04) predicted better outcome. The data enabled identification of patients benefiting from donor lymphocyte infusion and second transplantation, and may serve as a baseline for prospective trials.
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Affiliation(s)
- Christoph Schmid
- Department of Hematology and Oncology, Klinikum Augsburg, University of Munich, Augsburg, Germany
| | - Liesbeth C de Wreede
- Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, the Netherlands.,DKMS, German Bone Marrow Donor Center, Germany
| | - Anja van Biezen
- Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, the Netherlands
| | - Jürgen Finke
- Department of Medicine 1, Hematology and Oncology, University of Freiburg, Germany
| | - Gerhard Ehninger
- Medizinische Klinik und Poliklinik I, Universitaets-Klinikum Dresden, Germany
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Germany
| | - Liisa Volin
- Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | - Dietger Niederwieser
- Division of Hematology, Oncology and Hemostaseology, University Hospital Leipzig, Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - Paolo Alessandrino
- Clinica Ematologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lothar Kanz
- Medizinische Klinik II, Universität Tübingen, Germany
| | | | - Jakob Passweg
- Department of Hematology, University Hospital, Basel, Switzerland
| | - Hendrik Veelken
- BMT Center Leiden, Leiden University Hospital, the Netherlands
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Jan J Cornelissen
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Didier Blaise
- Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Martin Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University Hospital Schleswig-Holstein Campus, Kiel, Germany
| | - Noel Milpied
- CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France
| | | | - Ghulam Mufti
- Department of Hematological Medicine, GKT School of Medicine, London, UK
| | - Montserrat Rovira
- Institute of Hematology & Oncology, Hospital Clinic, Barcelona, Spain
| | - Renate Arnold
- Medizinische Klinik m. S. Hämatologie/Onkologie, Charité Universitätsmedizin Berlin, Germany
| | - Theo de Witte
- Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marie Robin
- Department of Hematology - BMT, Hôspital St. Louis, Paris, France
| | - Nikolaus Kröger
- Department of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
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46
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Eder S, Canaani J, Beohou E, Labopin M, Sanz J, Arcese W, Or R, Finke J, Cortelezzi A, Beelen D, Passweg J, Socié G, Gurman G, Aljurf M, Stelljes M, Giebel S, Mohty M, Nagler A. Thiotepa-based conditioning versus total body irradiation as myeloablative conditioning prior to allogeneic stem cell transplantation for acute lymphoblastic leukemia: A matched-pair analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Am J Hematol 2017; 92:997-1003. [PMID: 28614903 DOI: 10.1002/ajh.24823] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 12/13/2022]
Abstract
The optimal conditioning regimen to employ before hematopoietic stem cell transplantation in acute lymphoblastic leukemia (ALL) is still undecided, and while cyclophosphamide/total body irradiation (Cy/TBI) is the most commonly used myeloablative regimen, there are concerns regarding long-term toxicity for patients conditioned with this regimen. Thiotepa-based conditioning is an emerging radiation-free regimen with recent publications indicative of comparable clinical outcomes to TBI-based conditioning. In this analysis of the acute leukemia working party of the EBMT, we performed a retrospective matched-pair analysis, evaluating the outcome of adult patients with ALL who received thiotepa-based conditioning (n = 180) with those receiving Cy/TBI conditioning (n = 540). The 2-year leukemia-free survival and overall survival (OS) rates of both conditioning regimens were comparable, 33% for thiotepa [95% confidence interval (CI): 26.4-42.8] versus 39% for Cy/TBI (95% CI: 34.8-44.5] (P = .33) and 46.5% [95% CI: 38.6-56.1] versus 48.8% [95% CI: 44.2-54] (P = .9), respectively. There was no significant difference between the two regimens in the incidence of either acute graft versus host disease (GVHD) or chronic GVHD. Multivariate analysis demonstrated increased relapse incidence for thiotepa conditioning compared to Cy/TBI (HR = 1.78, 95% CI, 1.07-2.95; P = .03) which did not affect OS. Our results indicate that thiotepa-based conditioning may not be inferior to Cy/TBI for adult patients with ALL.
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Affiliation(s)
- Sandra Eder
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
| | - Jonathan Canaani
- Hematology Division, Chaim Sheba Medical Center; Tel Aviv University; Tel-Hashomer Israel
| | - Eric Beohou
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
| | | | - Jaime Sanz
- Hospital Universitario La Fe, Servicio de Hematologia; Valencia Spain
| | - William Arcese
- Stem Cell Transplant Unit; Tor Vergata University of Rome, Policlinico Universitario Tor Vergata; Rome Italy
| | - Reuven Or
- Department of Bone Marrow Transplantation; Hadassah University Hospital; Jerusalem Israel
| | - Juergen Finke
- Department of Medicine; Hematology, Oncology, University of Freiburg; Freiburg Germany
| | - Agostino Cortelezzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico IRCCS; Milano Italy
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation; University Hospital; Essen Germany
| | - Jakob Passweg
- Department of Hematology; University Hospital, Hematology; Basel Switzerland
| | - Gerard Socié
- Department of Hematology-BMT; Hopital St. Louis; Paris France
| | - Gunhan Gurman
- Transplantation Unit; Department of Hematology Adult Stem Cell, Ankara University Faculty of Medicine; Ankara Turkey
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Oncology (Section of Adult Haematolgy/BMT); Riyadh Saudi Arabia
| | - Matthias Stelljes
- Department of Hematology/Oncology; University of Münster; Münster Germany
| | - Sebastian Giebel
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology; Gliwice Poland
| | - Mohamad Mohty
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
| | - Arnon Nagler
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
- Hematology Division, Chaim Sheba Medical Center; Tel Aviv University; Tel-Hashomer Israel
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47
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Nagler A, Labopin M, Beelen D, Ciceri F, Volin L, Shimoni A, Foá R, Milpied N, Peccatori J, Polge E, Mailhol A, Mohty M, Savani BN. Long-term outcome after a treosulfan-based conditioning regimen for patients with acute myeloid leukemia: A report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Cancer 2017; 123:2671-2679. [DOI: 10.1002/cncr.30646] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Arnon Nagler
- Acute Leukemia Working Party; European Society for Blood and Marrow Transplantation Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy (CEREST-TC); Paris France
- Hematology Division; Chaim Sheba Medical Center; Tel Hashomer Israel
| | - Myriam Labopin
- Acute Leukemia Working Party; European Society for Blood and Marrow Transplantation Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy (CEREST-TC); Paris France
- Department of Hematology; St. Antoine Hospital; Paris France
- INSERM UMR 938; Paris France
- Pierre and Marie Curie University; Paris France
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation; University Hospital; Essen Germany
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit; San Raffaele Scientific Institute; Milano Italy
| | - Liisa Volin
- Stem Cell Transplantation Unit, Comprehensive Cancer Center; Helsinki University Central Hospital; Helsinki Finland
| | - Avichai Shimoni
- Hematology Division; Chaim Sheba Medical Center; Tel Hashomer Israel
| | - Roberto Foá
- Department of Cellular Biotechnology and Hematology; University La Sapienza; Rome Italy
| | - Noel Milpied
- CHU Bordeaux, Hôpital Haut-Leveque; Pessac France
| | - Jacopo Peccatori
- Hematology and Bone Marrow Transplantation Unit; San Raffaele Scientific Institute; Milano Italy
| | - Emmanuelle Polge
- Acute Leukemia Working Party; European Society for Blood and Marrow Transplantation Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy (CEREST-TC); Paris France
| | - Audrey Mailhol
- Acute Leukemia Working Party; European Society for Blood and Marrow Transplantation Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy (CEREST-TC); Paris France
| | - Mohamad Mohty
- Acute Leukemia Working Party; European Society for Blood and Marrow Transplantation Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy (CEREST-TC); Paris France
- Department of Hematology; St. Antoine Hospital; Paris France
- INSERM UMR 938; Paris France
- Pierre and Marie Curie University; Paris France
| | - Bipin N. Savani
- Acute Leukemia Working Party; European Society for Blood and Marrow Transplantation Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy (CEREST-TC); Paris France
- Long-Term Transplantation Clinic; Vanderbilt University Medical Center; Nashville Tennessee
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48
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Robin M, Porcher R, Zinke-Cerwenka W, van Biezen A, Volin L, Mufti G, Craddock C, Finke J, Richard C, Passweg J, Peniket A, Maertens J, Sucak G, Gedde-Dahl T, Vitek A, Nagler A, Blaise D, Beelen D, Maillard N, Schwerdtfeger R, de Witte T, Kroger N. Allogeneic haematopoietic stem cell transplant in patients with lower risk myelodysplastic syndrome: a retrospective analysis on behalf of the Chronic Malignancy Working Party of the EBMT. Bone Marrow Transplant 2017; 52:1081. [PMID: 28677682 DOI: 10.1038/bmt.2017.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This corrects the article DOI: 10.1038/bmt.2016.266.
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49
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Schetelig J, de Wreede LC, Andersen NS, Moreno C, van Gelder M, Vitek A, Karas M, Michallet M, Machaczka M, Gramatzki M, Beelen D, Finke J, Delgado J, Volin L, Passweg J, Dreger P, Schaap N, Wagner E, Henseler A, van Biezen A, Bornhäuser M, Iacobelli S, Putter H, Schönland SO, Kröger N. Centre characteristics and procedure-related factors have an impact on outcomes of allogeneic transplantation for patients with CLL: a retrospective analysis from the European Society for Blood and Marrow Transplantation (EBMT). Br J Haematol 2017; 178:521-533. [DOI: 10.1111/bjh.14791] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Johannes Schetelig
- Medical Department I; University Hospital of the Technical University Dresden; Dresden Germany
- DKMS Clinical Trials Unit; Dresden Germany
| | - Liesbeth C. de Wreede
- DKMS Clinical Trials Unit; Dresden Germany
- Department of Medical Statistics & Bioinformatics; Leiden University Medical Centre; Leiden The Netherlands
| | - Niels S. Andersen
- BMT Unit Department of Haematology; Rigshospitalet; Copenhagen Denmark
| | - Carol Moreno
- Hematologia; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | | | - Antonin Vitek
- Department of Haematology; Institute of Haematology and Blood Transfusion; Prague Czech Republic
| | - Michal Karas
- Department of Haematology/Oncology; Charles University Hospital; Pilsen Czech Republic
| | | | - Maciej Machaczka
- Haematology Centre Karolinska and Department of Medicine at Huddinge; Karolinska Institutet; Stockholm Sweden
| | - Martin Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy; University Hospital Schleswig-Holstein; Kiel Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation; University Hospital; Essen Germany
| | - Jürgen Finke
- Department of Medicine - Haematology, Oncology; University of Freiburg; Freiburg Germany
| | - Julio Delgado
- Institute of Haematology & Oncology; Department of Haematology; Hospital Clinic; Barcelona Spain
| | - Liisa Volin
- Stem Cell Transplantation Unit; Helsinki University Hospital Comprehensive Cancer Centre; Helsinki Finland
| | - Jakob Passweg
- Department for Haematology; University Hospital; Basel Switzerland
| | - Peter Dreger
- Medizinische Klinik u. Poliklinik V; University of Heidelberg; Heidelberg Germany
| | | | - Eva Wagner
- University Medical Centre Mainz; Mainz Germany
| | - Anja Henseler
- Department of Medical Statistics & Bioinformatics; Leiden University Medical Centre; Leiden The Netherlands
| | - Anja van Biezen
- Department of Medical Statistics & Bioinformatics; Leiden University Medical Centre; Leiden The Netherlands
| | - Martin Bornhäuser
- Medical Department I; University Hospital of the Technical University Dresden; Dresden Germany
| | | | - Hein Putter
- Department of Medical Statistics & Bioinformatics; Leiden University Medical Centre; Leiden The Netherlands
| | - Stefan O. Schönland
- Department of Haematology; Institute of Haematology and Blood Transfusion; Prague Czech Republic
| | - Nicolaus Kröger
- Bone Marrow Transplantation Centre; University Hospital Eppendorf; Hamburg Germany
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50
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Schetelig J, de Wreede LC, van Gelder M, Andersen NS, Moreno C, Vitek A, Karas M, Michallet M, Machaczka M, Gramatzki M, Beelen D, Finke J, Delgado J, Volin L, Passweg J, Dreger P, Henseler A, van Biezen A, Bornhäuser M, Schönland SO, Kröger N. Risk factors for treatment failure after allogeneic transplantation of patients with CLL: a report from the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2017; 52:552-560. [PMID: 28112746 DOI: 10.1038/bmt.2016.329] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/23/2016] [Accepted: 08/31/2016] [Indexed: 11/09/2022]
Abstract
For young patients with high-risk CLL, BTK-/PI3K-inhibitors or allogeneic stem cell transplantation (alloHCT) are considered. Patients with a low risk of non-relapse mortality (NRM) but a high risk of failure of targeted therapy may benefit most from alloHCT. We performed Cox regression analyses to identify risk factors for 2-year NRM and 5-year event-free survival (using EFS as a surrogate for long-term disease control) in a large, updated EBMT registry cohort (n= 694). For the whole cohort, 2-year NRM was 28% and 5-year EFS 37%. Higher age, lower performance status, unrelated donor type and unfavorable sex-mismatch had a significant adverse impact on 2-year NRM. Two-year NRM was calculated for good- and poor-risk reference patients. Predicted 2-year-NRM was 11 and 12% for male and female good-risk patients compared with 42 and 33% for male and female poor-risk patients. For 5-year EFS, age, performance status, prior autologous HCT, remission status and sex-mismatch had a significant impact, whereas del(17p) did not. The model-based prediction of 5-year EFS was 55% and 64%, respectively, for male and female good-risk patients. Good-risk transplant candidates with high-risk CLL and limited prognosis either on or after failure of targeted therapy should still be considered for alloHCT.
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Affiliation(s)
- J Schetelig
- Medical Department I, University Hospital, Technische Universität Dresden, Dresden, Germany.,Clinical Trials Unit, DKMS, gemeinnützige GmbH, Tübingen, Germany
| | - L C de Wreede
- Clinical Trials Unit, DKMS, gemeinnützige GmbH, Tübingen, Germany.,Department Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - M van Gelder
- Department of Internal Medicine, Division of Hematology, University Medical Center Maastricht, The Netherlands
| | - N S Andersen
- BMT Unit, Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - C Moreno
- Hematologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Vitek
- Department of Hematology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - M Karas
- Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | - M Michallet
- Hématologie, Center Hospitalier Lyon-Sud, Lyon, France
| | - M Machaczka
- Department of Medicine at Huddinge, Hematology Center Karolinska and Karolinska Institutet, Stockholm, Sweden
| | - M Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - D Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - J Finke
- Department of Medicine-Hematology, University of Freiburg, Oncology, Freiburg, Germany
| | - J Delgado
- Department of Hematology, Hospital Clinic, Institute of Hematology & Oncology, Barcelona, Spain
| | - L Volin
- Stem Cell Transplantation Unit, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - J Passweg
- Department for Hematology, University Hospital, Basel, Switzerland
| | - P Dreger
- Medizinische Klinik und Poliklinik V, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - A Henseler
- Department Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - A van Biezen
- Department Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Bornhäuser
- Medical Department I, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - S O Schönland
- Medizinische Klinik und Poliklinik V, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - N Kröger
- Bone Marrow Transplantation Center, University Hospital Eppendorf, Hamburg, Germany
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