1
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Ahmadi P, Ghandili S, Jakobs F, Konnopka C, Morgner-Miehlke A, Kröger N, Ayuk F. Cost analysis of patients undergoing allogeneic stem cell transplantation or chimeric antigen receptor T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma from a German healthcare payer perspective. Bone Marrow Transplant 2024; 59:572-574. [PMID: 38321270 PMCID: PMC10994829 DOI: 10.1038/s41409-024-02228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
MESH Headings
- Humans
- Receptors, Chimeric Antigen
- Lymphoma, Non-Hodgkin
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Immunotherapy, Adoptive
- Hematopoietic Stem Cell Transplantation
- Costs and Cost Analysis
- Delivery of Health Care
- Receptors, Antigen, T-Cell
- Antigens, CD19
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Affiliation(s)
- P Ahmadi
- Controlling University Medical Center Hamburg, Hamburg, Germany
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Ghandili
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Jakobs
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - C Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Morgner-Miehlke
- Center for Oncology, University Medical Center Hamburg, Hamburg, Germany
| | - N Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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2
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Rejeski K, Perez A, Sesques P, Berger C, Jentzsch L, Mougiakakos D, Frölich L, Ackermann J, Bücklein V, Blumenberg V, Schmidt C, Jallades L, Fehse B, Faul C, Karschnia P, Weigert O, Dreyling M, Hoster E, Locke F, Bergwelt‐Baildon M, Mackensen A, Bethge W, Ayuk F, Bachy E, Salles G, Jain M, Subklewe M. CAR‐HEMATOTOX: A DISCRIMINATIVE MODEL FOR CAR T‐CELL RELATED HEMATOTOXICITY IN RELAPSED/REFRACTORY LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.82_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- K. Rejeski
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - A. Perez
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center, Tampa, USA Tampa USA
| | - P. Sesques
- Hospices Civils de Lyon Institut National de la Santé et de la Recherche Médicale (INSERM) Lyon France
| | - C. Berger
- University Hospital Hamburg‐Eppendorf Department of Hematology, Oncology and Pulmonology Hamburg Germany
| | - L. Jentzsch
- University Hospital Tübingen Department of Hematology, Oncology, Immunology and Rheumatology Tübingen Germany
| | - D. Mougiakakos
- University Hospital of Erlangen Department of Internal Medicine 5, Hematology and Oncology Erlangen Germany
| | - L. Frölich
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - J. Ackermann
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - V. Bücklein
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - V. Blumenberg
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - C. Schmidt
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - L. Jallades
- Hospices Civils de Lyon Institut National de la Santé et de la Recherche Médicale (INSERM) Lyon France
| | - B. Fehse
- University Hospital Hamburg‐Eppendorf Department of Hematology, Oncology and Pulmonology Hamburg Germany
| | - C. Faul
- University Hospital Tübingen Department of Hematology, Oncology, Immunology and Rheumatology Tübingen Germany
| | - P. Karschnia
- University Hospital of the LMU Munich Department of Neurosurgery Munich Germany
| | - O. Weigert
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - M. Dreyling
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - E. Hoster
- LMU Munich Institute for Medical Informatics Biometry and Epidemiology Munich Germany
| | - F. Locke
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center, Tampa, USA Tampa USA
| | - M. Bergwelt‐Baildon
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - A. Mackensen
- University Hospital of Erlangen Department of Internal Medicine 5, Hematology and Oncology Erlangen Germany
| | - W. Bethge
- University Hospital Tübingen Department of Hematology, Oncology, Immunology and Rheumatology Tübingen Germany
| | - F. Ayuk
- University Hospital Hamburg‐Eppendorf Department of Hematology, Oncology and Pulmonology Hamburg Germany
| | - E. Bachy
- Hospices Civils de Lyon Institut National de la Santé et de la Recherche Médicale (INSERM) Lyon France
| | - G. Salles
- MSKCC, Lymphoma Service Department of Medicine NYC New York USA
| | - M. Jain
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center, Tampa, USA Tampa USA
| | - M. Subklewe
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
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3
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Dreger P, Martus P, Holtick U, Ayuk F, Wagner‐Drouet EM, Wulf G, Marks R, Penack O, Koenecke C, von Bonin M, von Tresckow B, Stelljes M, Baldus C, Vucinic V, Mougiakakos D, Topp M, Wolff D, Schroers R, Schmitt M, Schmitt T, Lengerke C, Thomas S, Beelen DW, Bethge W. OUTCOME DETERMINANTS OF COMMERCIAL CAR‐T CELL THERAPY FOR LARGE B‐CELL LYMPHOMA: RESULTS OF THE GLA/DRST REAL WORLD ANALYSIS. Hematol Oncol 2021. [DOI: 10.1002/hon.186_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- P. Dreger
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - P. Martus
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - U. Holtick
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - F. Ayuk
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - E. M. Wagner‐Drouet
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - G. Wulf
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - R. Marks
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - O. Penack
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - C. Koenecke
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - M. von Bonin
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - B. von Tresckow
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - M. Stelljes
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - C. Baldus
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - V. Vucinic
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - D. Mougiakakos
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - M. Topp
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - D. Wolff
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - R. Schroers
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - M. Schmitt
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - T. Schmitt
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - C. Lengerke
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - S. Thomas
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
| | - D. W. Beelen
- German Registry for Stem Cell Transplantation DRST Essen Germany
| | - W. Bethge
- German Lymphoma Alliance Working Group Hematopoietic Cell Therapy Muenster Germany
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4
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Wolschke C, Badbaran A, Zabelina T, Christopeit M, Ayuk F, Triviai I, Zander A, Alchalby H, Bacher U, Fehse B, Kröger N. Impact of molecular residual disease post allografting in myelofibrosis patients. Bone Marrow Transplant 2017; 52:1526-1529. [PMID: 28714945 DOI: 10.1038/bmt.2017.157] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/09/2017] [Accepted: 04/29/2017] [Indexed: 01/13/2023]
Abstract
We screened 136 patients with myelofibrosis and a median age of 58 years who underwent allogeneic stem cell transplantation (AHSCT) for molecular residual disease for JAKV617F (n=101), thrombopoietin receptor gene (MPL) (n=4) or calreticulin (CALR) (n=31) mutation in peripheral blood on day +100 and +180 after AHSCT. After a median follow-up of 78 months, the 5-year estimated overall survival was 60% (95% confidence interval (CI): 50-70%) and the cumulative incidence of relapse at 5 years was 26% (95% CI: 18-34%) for the entire study population. The percentage of molecular clearance on day 100 was higher in CALR-mutated patients (92%) in comparison with MPL- (75%) and JAKV617F-mutated patients (67%). Patients with detectable mutation at day +100 or at day +180 had a significant higher risk of clinical relapse at 5 years than molecular-negative patients (62% vs 10%, P<0.001) and 70% vs 10%, P<0.001, respectively) irrespectively of the underlying mutation. In a multivariate analysis, high-risk diseases status (hazard ratio (HR) 2.5; 95% CI: 1.18-5.25, P=0.016) and detectable MRD at day 180 (HR 8.36, 95% CI: 2.76-25.30, P<0.001) were significant factors for a higher risk of relapse.
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Affiliation(s)
- C Wolschke
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Badbaran
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Zabelina
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Triviai
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Zander
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Alchalby
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U Bacher
- Department of Hematology and Oncology, University Hospital Göttingen, Göttingen, Germany
| | - B Fehse
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Christopeit M, Grundhoff A, Rohde H, Belmar-Campos C, Grzyska U, Fiehler J, Wolschke C, Ayuk F, Kröger N, Fischer N. Suspected encephalitis with Candida tropicalis and Fusarium detected by unbiased RNA sequencing. Ann Hematol 2016; 95:1919-21. [PMID: 27468852 DOI: 10.1007/s00277-016-2770-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- M Christopeit
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - A Grundhoff
- Department Virus Genomics, Heinrich-Pette Institute, Leibniz Institute for Experimental Virology, 20252, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - H Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - C Belmar-Campos
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - U Grzyska
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Wolschke
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - F Ayuk
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - N Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Nicole Fischer
- German Center for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck, Hamburg, Germany. .,Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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6
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Zeiser R, Burchert A, Lengerke C, Verbeek M, Maas-Bauer K, Metzelder SK, Spoerl S, Ditschkowski M, Ecsedi M, Sockel K, Ayuk F, Ajib S, de Fontbrune FS, Na IK, Penter L, Holtick U, Wolf D, Schuler E, Meyer E, Apostolova P, Bertz H, Marks R, Lübbert M, Wäsch R, Scheid C, Stölzel F, Ordemann R, Bug G, Kobbe G, Negrin R, Brune M, Spyridonidis A, Schmitt-Gräff A, van der Velden W, Huls G, Mielke S, Grigoleit GU, Kuball J, Flynn R, Ihorst G, Du J, Blazar BR, Arnold R, Kröger N, Passweg J, Halter J, Socié G, Beelen D, Peschel C, Neubauer A, Finke J, Duyster J, von Bubnoff N. Ruxolitinib in corticosteroid-refractory graft-versus-host disease after allogeneic stem cell transplantation: a multicenter survey. Leukemia 2015; 29:2062-8. [PMID: 26228813 DOI: 10.1038/leu.2015.212] [Citation(s) in RCA: 384] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 12/15/2022]
Abstract
Despite major improvements in allogeneic hematopoietic cell transplantation over the past decades, corticosteroid-refractory (SR) acute (a) and chronic (c) graft-versus-host disease (GVHD) cause high mortality. Preclinical evidence indicates the potent anti-inflammatory properties of the JAK1/2 inhibitor ruxolitinib. In this retrospective survey, 19 stem cell transplant centers in Europe and the United States reported outcome data from 95 patients who had received ruxolitinib as salvage therapy for SR-GVHD. Patients were classified as having SR-aGVHD (n=54, all grades III or IV) or SR-cGVHD (n=41, all moderate or severe). The median number of previous GVHD-therapies was 3 for both SR-aGVHD (1-7) and SR-cGVHD (1-10). The overall response rate was 81.5% (44/54) in SR-aGVHD including 25 complete responses (46.3%), while for SR-cGVHD the ORR was 85.4% (35/41). Of those patients responding to ruxolitinib, the rate of GVHD-relapse was 6.8% (3/44) and 5.7% (2/35) for SR-aGVHD and SR-cGVHD, respectively. The 6-month-survival was 79% (67.3-90.7%, 95% confidence interval (CI)) and 97.4% (92.3-100%, 95% CI) for SR-aGVHD and SR-cGVHD, respectively. Cytopenia and cytomegalovirus-reactivation were observed during ruxolitinib treatment in both SR-aGVHD (30/54, 55.6% and 18/54, 33.3%) and SR-cGVHD (7/41, 17.1% and 6/41, 14.6%) patients. Ruxolitinib may constitute a promising new treatment option for SR-aGVHD and SR-cGVHD that should be validated in a prospective trial.
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Affiliation(s)
- R Zeiser
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - A Burchert
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - C Lengerke
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - M Verbeek
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - K Maas-Bauer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - S K Metzelder
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - S Spoerl
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - M Ditschkowski
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Ecsedi
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - K Sockel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - F Ayuk
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Ajib
- Department of Internal Medicine II, University Hospital, Frankfurt/Main, Germany
| | - F S de Fontbrune
- Hematology Stem cell transplant Unit, Saint Louis Hospital, APHP, Paris, France
| | - I-K Na
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - L Penter
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - U Holtick
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - D Wolf
- Medical Clinic III, Oncology, Hematology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - E Schuler
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - E Meyer
- Department of Bone Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - P Apostolova
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - H Bertz
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - R Marks
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - M Lübbert
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - R Wäsch
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - C Scheid
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - F Stölzel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - R Ordemann
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - G Bug
- Department of Internal Medicine II, University Hospital, Frankfurt/Main, Germany
| | - G Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - R Negrin
- Department of Bone Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - M Brune
- Department of Internal Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - A Spyridonidis
- Department of Bone Marrow Transplantation, Patras University Medical School, Patras, Greece
| | - A Schmitt-Gräff
- Department of Pathology, Freiburg University Medical Center, Freiburg, Germany
| | | | - G Huls
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Mielke
- Department of Hematology and Oncology, University Medical Centre Würzburg, Würzburg, Germany
| | - G U Grigoleit
- Department of Hematology and Oncology, University Medical Centre Würzburg, Würzburg, Germany
| | - J Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Flynn
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - G Ihorst
- Clinical Trials Unit, Department of Hematology, Freiburg University Medical Center, Freiburg, Germany
| | - J Du
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - B R Blazar
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - R Arnold
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - J Passweg
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - J Halter
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - G Socié
- Hematology Stem cell transplant Unit, Saint Louis Hospital, APHP, Paris, France
| | - D Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - C Peschel
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - A Neubauer
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - J Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - J Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - N von Bubnoff
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
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7
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Ayuk F, Zabelina T, Wortmann F, Alchalby H, Wolschke C, Lellek H, Bacher U, Zander A, Kröger N. Donor choice according to age for allo-SCT for AML in complete remission. Bone Marrow Transplant 2013; 48:1028-32. [PMID: 23419435 DOI: 10.1038/bmt.2013.14] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/30/2012] [Accepted: 01/15/2013] [Indexed: 11/09/2022]
Abstract
In a retrospective study of 168 patients with AML in CR who underwent allo-SCT, we compare the impact of young unrelated donors (UD) vs older matched related donors (MRD) on 5-year OS (5-yr OS). Median follow-up was 59 months and median donor age was 39 years, which was used as cutoff for young vs older donors. Kaplan-Meier-estimated 5-yr OS was better with UD ≤39 years vs MRD >39 years (66% vs 34%, P=0.001). In multivariate analysis, only donor age and cytogenetic risk impacted 5-yr OS. Compared with UD ≤39 years, both MRD >39 years (relative risk (RR): 4.31, P=0.001) and UD >39 years (RR: 2.14, P=0.03) were associated with poorer 5-yr OS. Standard-risk cytogenetics was associated with better 5-yr OS compared with bad-risk cytogenetics, (RR: 0.53, P=0.02). Subgroup analyses of patients ≥50 years (n=76) revealed similar results, with 5-yr OS of 62% for UD ≤39 yrs and 26% for MRD >39 yrs (P=0.022). In patients undergoing allo-HSCT for AML, young UD may improve outcome as compared with older MRD.
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Affiliation(s)
- F Ayuk
- Clinic for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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8
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Kröger N, Zabelina T, Klyuchnikov E, Kropff M, Pflüger KH, Burchert A, Stübig T, Wolschke C, Ayuk F, Hildebrandt Y, Bacher U, Badbaran A, Schilling G, Hansen T, Atanackovic D, Zander AR. Toxicity-reduced, myeloablative allograft followed by lenalidomide maintenance as salvage therapy for refractory/relapsed myeloma patients. Bone Marrow Transplant 2012; 48:403-7. [DOI: 10.1038/bmt.2012.142] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Christopeit M, Miersch K, Klyuchnikov E, Haferlach T, Binder M, Zabelina T, Ayuk F, Schafhausen P, Zander AR, Bokemeyer C, Kröger N, Bacher U. Evaluation of BM cytomorphology after allo-SCT in patients with AML. Bone Marrow Transplant 2012; 47:1538-44. [DOI: 10.1038/bmt.2012.70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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10
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Kröger N, Zabelina T, Berger J, Duske H, Klyuchnikov E, Binder T, Stübig T, Hilde-brandt Y, Atanackovic D, Alchalby H, Ayuk F, Zander AR, Bacher U, Eiermann T. Donor KIR haplotype B improves progression-free and overall survival after allogeneic hematopoietic stem cell transplantation for multiple myeloma. Leukemia 2011; 25:1657-61. [PMID: 21647155 DOI: 10.1038/leu.2011.138] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Choschzick M, Bacher U, Ayuk F, Lebeau A. Immunohistochemistry and molecular analyses in myeloid sarcoma of the breast in a patient with relapse of NPM1-mutated and FLT3-mutated AML after allogeneic stem cell transplantation. J Clin Pathol 2010; 63:558-61. [DOI: 10.1136/jcp.2009.071357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Shimoni A, Hardan I, Ayuk F, Schilling G, Atanackovic D, Zeller W, Shem-Tov N, Rand A, Yerushalmi R, Zander A, Kröger N, Nagler A. Allogeneic Hematopoietic Stem Cell Transplantation With Reduced-Intensity Conditioning In Patients With Refractory And Relapsing Multiple Myeloma: Long-Term Follow-Up. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.241] [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: 10/19/2022]
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13
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Lioznov M, El-Cheikh J, Hoffmann F, Hildebrandt Y, Ayuk F, Wolschke C, Atanackovic D, Schilling G, Badbaran A, Bacher U, Fehse B, Zander AR, Blaise D, Mohty M, Kröger N. Lenalidomide as salvage therapy after allo-SCT for multiple myeloma is effective and leads to an increase of activated NK (NKp44+) and T (HLA-DR+) cells. Bone Marrow Transplant 2009; 45:349-53. [DOI: 10.1038/bmt.2009.155] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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14
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Klyuchnikov E, Osanmaz O, Schafhausen P, Asenova S, Zabelina T, Ayuk F, Bruemmendorf T, Zander A, Kroeger N, Bacher U. Application of Second Generation Tyrosine Kinase Inhibitors in BCR-ABL Positive Malignancies in the Post-Transplant Period. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.310] [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: 10/21/2022]
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15
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Schilling G, Hansen T, Shimoni A, Zabelina T, Pérez-Simón JA, Gutierrez NC, Bethge W, Liebisch P, Schwerdtfeger R, Bornhäuser M, Otterstetter S, Penas EMM, Dierlamm J, Ayuk F, Atanackovic D, Bacher U, Bokemeyer C, Zander A, San Miguel J, Nagler A, Kröger N. Erratum: Impact of genetic abnormalities on survival after allogeneic hematopoietic stem cell transplantation in multiple myeloma. Leukemia 2008. [DOI: 10.1038/leu.2008.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Ayuk F, Perez-Simon JA, Shimoni A, Sureda A, Zabelina T, Schwerdtfeger R, Martino R, Sayer HG, Alegre A, Lahuerta JJ, Atanackovic D, Wolschke C, Nagler A, Zander AR, San Miguel JF, Kroger N. Clinical impact of human Jurkat T-cell-line-derived antithymocyte globulin in multiple myeloma patients undergoing allogeneic stem cell transplantation. Haematologica 2008; 93:1343-50. [DOI: 10.3324/haematol.12665] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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17
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Ocheni S, Kroeger N, Zabelina T, Sobottka I, Ayuk F, Wolschke C, Muth A, Lellek H, Petersen L, Erttmann R, Kabisch H, Zander AR, Bacher U. EBV reactivation and post transplant lymphoproliferative disorders following allogeneic SCT. Bone Marrow Transplant 2008; 42:181-6. [PMID: 18516079 DOI: 10.1038/bmt.2008.150] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fatal problems encountered in allogeneic stem cell transplantation include EBV reactivation and post transplant lymphoproliferative disorders (PTLDs) with high mortality rates. We performed a retrospective analysis in all consecutive adult and pediatric EBV reactivations and PTLD during a period of 8.5 years. There were 26 patients with EBV reactivation/PTLD out of a total of 854 transplantations giving an overall incidence of 3.0%. Specifically, the incidence of EBV-PTLD was 1.3%, whereas that of EBV reactivation was 1.8%. Median age was 46.0 and 11.0 years in the adult and pediatric patients, respectively. There were high rates (54%) of concomitant bacterial, viral, fungal and parasitic infections at the time of EBV manifestation. Variable treatment regimens were applied including in most cases an anti-CD20 regimen often in combination with virustatic compounds, polychemotherapy or donor lymphocytes. The mortality rates were 9 of 11 (82%) in patients with EBV-PTLD and 10 of 15 (67%) in patients with reactivation. Only 7 of 26 patients (27%) are alive after a median follow-up of 758 days (range 24-2751). The high mortality rates of EBV reactivation and of EBV-PTLD irrespective of multimodal treatment approaches emphasize standardization and optimization of post transplant surveillance and treatment strategies to improve control of these often fatal complications.
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Affiliation(s)
- S Ocheni
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Schilling G, Hansen T, Shimoni A, Zabelina T, Pérez-Simón JA, Simon-Perez JA, Gutierrez NC, Bethge W, Liebisch P, Schwerdtfeger R, Bornhäuser M, Otterstetter S, Penas EMM, Dierlamm J, Ayuk F, Atanackovic D, Bacher U, Bokemeyer C, Zander A, San Miguel J, Miguel JS, Nagler A, Kröger N. Impact of genetic abnormalities on survival after allogeneic hematopoietic stem cell transplantation in multiple myeloma. Leukemia 2008; 22:1250-5. [PMID: 18418408 DOI: 10.1038/leu.2008.88] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We analyzed the prognostic impact of the most frequent genetic abnormalities detected by fluorescence in situ hybridization in 101 patients with multiple myeloma, who underwent allogeneic hematopoietic stem cell transplantation (HSCT) after melphalan/fludarabine-based reduced conditioning. The incidences of abnormalities in the present analysis were as follows: del(13q14) (61%), t(11;14)(q13;q32) (14%), t(4;14)(p16.3;q32) (19%), MYC-gain gains (8q24) (21%), del(17p13) (16%) and t(14;16)(q32;q23) (5%). None of the patients had t(6;14)(p25;q32). The overall complete remission (CR) rate was 50% with no differences between the genetic abnormalities except for patients with del(17p13) who achieved less CR (7 vs 56%; P=0.001). Univariate analysis revealed a higher relapse rate in patients aged >50 years (P=0.002), patients with del(13q14) (P=0.006) and patients with del(17p13) (P=0.003). In multivariate analyses, only del(13q14) (HR: 2.34, P=0.03) and del(17p13) (HR: 2.24; P=0.04) significantly influenced the incidence of relapse, whereas for event-free survival, only age (HR 2.8; P=0.01) and del(17p13) (HR: 2.05; P=0.03) retained their negative prognostic value. These data show that del(17p13) is a negative prognostic factor for achieving CR as well as for event-free survival after HSCT. Translocation t(4;14) might be overcome by allogeneic HSCT, which will have implication for risk-adapted strategies.
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Affiliation(s)
- G Schilling
- Department of Oncology and Hematology, Medical Clinic II, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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19
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Kröger N, Shimoni A, Zabelina T, Schieder H, Panse J, Ayuk F, Wolschke C, Renges H, Dahlke J, Atanackovic D, Nagler A, Zander A. Reduced-toxicity conditioning with treosulfan, fludarabine and ATG as preparative regimen for allogeneic stem cell transplantation (alloSCT) in elderly patients with secondary acute myeloid leukemia (sAML) or myelodysplastic syndrome (MDS). Bone Marrow Transplant 2006; 37:339-44. [PMID: 16415898 DOI: 10.1038/sj.bmt.1705259] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated a dose-reduced conditioning regimen consisting of treosulfan and fludarabine followed by allogeneic stem cell transplantation (SCT) in 26 patients with secondary AML or MDS. Twenty patients were transplanted from matched or mismatched unrelated donors and six from HLA-identical sibling donors. The median age of the patients was 60 years (range, 44-70). None of the patients was eligible for a standard myeloablative preparative regimen. No graft-failure was observed, and leukocyte and platelet engraftment were observed after a median of 16 and 17 days, respectively. Acute graft-versus-host disease (GvHD) grade II-IV was seen in 23% and severe grade III GvHD in 12% of the patients. No patients experienced grade IV acute GvHD. Chronic GvHD was noted in 36% of the patients, which was extensive disease in 18%. The 2-year cumulative incidence of relapse was 21%. The relapse rate was higher in patients beyond CR1 or with intermediate two or high risk MDS (P = 0.02). The treatment-related mortality at day 100 was 28%. The 2-year estimated overall and disease-free survival was 36-34%, respectively. No difference in survival was seen between unrelated and related SCT.
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Affiliation(s)
- N Kröger
- Department of Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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20
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Oyekunle A, Koehl U, Schieder H, Ayuk F, Renges H, Fehse N, Zabelina T, Fehse B, Klingebiel T, Sputtek A, Zander A, Kröger N. CD34+-selected stem cell boost for delayed or insufficient engraftment after allogeneic stem cell transplantation. Cytotherapy 2006; 8:375-80. [PMID: 16923613 DOI: 10.1080/14653240600735784] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Poor graft function without rejection may occur after stem cell transplantation (SCT). CD34(+) stem cell boost (SCB) can restore marrow function but may induce or exacerbate GvHD. We therefore investigated the feasibility and efficacy of CD34(+)-selected SCB in some patients with poor graft function. We present the results for eight patients (median age 46 years) transplanted initially for myelofibrosis, acute leukemia, myeloma and NHL. Six patients had received HLA-matched and two mismatched grafts (PB, BM; n=5, 3). After a median of 128 days post-transplant, the median leukocyte and platelet counts were, respectively, 2.05/nL and 18/nL. None had achieved platelet counts >50/nL even though donor chimerism was >95% in seven recipients. METHODS Positive selection of CD34(+) stem cells was performed on a CliniMACS device, observing GMP and achieving a median of 98.5% purity. The patients received a median of 1.7 x 10(6)/kg CD34(+) cells and 2.5 x 10(3)/kg CD3(+) T lymphocytes. RESULTS Hemograms at days +30, +60 and +90, respectively, showed steadily increasing median leukocyte (2.55, 3.15 and 4.20/nL) and platelet (29, 39 and 95/nL) counts. After a median follow-up of 144 days, five patients remained alive. No patient had developed acute or chronic GvHD. One patient died of leukemic relapse and two others of systemic mycosis. DISCUSSION These preliminary results point to the possibility of safely improving graft function using CD34(+) positively selected stem cells without necessarily increasing the incidence of GvHD in patients with poor graft function post-SCT. Experience with more patients and longer follow-up should clarify the optimal role for this procedure.
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Affiliation(s)
- Aa Oyekunle
- Department of BM Transplantation, University Hospital Hamburg, University of Hamburg, Hamburg, Germany
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21
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Dahlke J, Kröger N, Zabelina T, Ayuk F, Fehse N, Wolschke C, Waschke O, Schieder H, Renges H, Krüger W, Kruell A, Hinke A, Erttmann R, Kabisch H, Zander AR. Comparable results in patients with acute lymphoblastic leukemia after related and unrelated stem cell transplantation. Bone Marrow Transplant 2005; 37:155-63. [PMID: 16284608 DOI: 10.1038/sj.bmt.1705221] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report the results of 84 patients with ALL after related (n = 46) or unrelated (n = 38) allogeneic SCT. Mean recipient age was 23 years (range: 1-60) and median follow-up was 18 months (range: 1-133). Forty-three patients were transplanted in CR1; 25 in CR2 or CR3; four were primary refractory; four in PR; eight in relapse. The conditioning regimen consisted of TBI/VP16/CY (n = 76), TBI/VP16 (n = 2), TBI/CY (n = 2), Bu/VP16/CY (n = 4). The OS at 3 years was 45% (44% unrelated, 46% related). Univariate analysis showed a significantly better OS for patients <18 years (P=0.03), mismatched sex-combination (P = 0.03), both with a stronger effect on increasing OS after unrelated SCT. Factors decreasing TRM were patient age <18 years (P = 0.004), patient CMV-seronegativity (P = 0.014), female recipient (P = 0.04). There was no significant difference in TRM and the relapse rate was similar in both donor type groups. Multivariate analysis showed that factors for increased OS which remained significant were mismatched sex-combination (RR: 0.70,95% CI: 0.51-0.93, P = 0.015), patient age < 18 years (RR: 0.66, 95% CI: 0.47-0.93, P = 0.016). A decreased TRM was found for female patients (RR: 0.56, 95% CI: 0.33-0.98, P=0.042), negative CMV status of the patient (RR: 0.57, 95% CI: 0.36-0.90, P = 0.015). Unrelated stem cell transplantation for high-risk ALL patients with no HLA-compatible family donor is justifiable.
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Affiliation(s)
- J Dahlke
- Department of Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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22
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Oyekunle AA, Kröger N, Zabelina T, Ayuk F, Schieder H, Renges H, Fehse N, Waschke O, Fehse B, Kabisch H, Zander AR. Allogeneic stem-cell transplantation in patients with refractory acute leukemia: a long-term follow-up. Bone Marrow Transplant 2005; 37:45-50. [PMID: 16258531 DOI: 10.1038/sj.bmt.1705207] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We examined retrospectively 44 patients with refractory acute leukemia (acute myeloid leukemia (AML)/acute lymphoblastic leukemia=25/19) who underwent allogeneic transplantation at our center between 11/1990 and 04/2004. The median leukemic blasts was 25% and age 28 years (range, 3-56). Twenty-one patients had untreated relapse, 13 failed reinduction, eight in partial remission and two aplastic. Conditioning was myeloablative using cyclophosphamide, busulfan, total-body irradiation and etoposide (Bu/Cy/VP, n=22; TBI/Cy/VP, n=17; others, n=5) followed by marrow or peripheral blood transplant (n=23/21) from unrelated or related donors (n=28/16). All patients had graft-versus-host disease (GVHD) prophylaxis with cyclosporin and methotrexate. One patient experienced late graft failure. Severe acute-GVHD and chronic-GVHD appeared in eight and 14 patients, respectively. Thirteen patients (30%) remain alive after a median of 25.3 months (range, 2.4-134.1); with 31 deaths, mostly from relapse (n=15) and infections (n=12). Overall survival (OS) and progression-free survival (PFS) at 5 years was 28 and 26%, respectively. OS and PFS were significantly better with blasts < or =20% and time to transplant < or =1 year while transplant-related mortality was less with the use of TBI. We conclude that patients with refractory leukemia can benefit from allogeneic BMT, especially with < or =20% marrow blast.
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MESH Headings
- Adolescent
- Adult
- Blast Crisis/complications
- Blast Crisis/mortality
- Blast Crisis/pathology
- Blast Crisis/therapy
- Busulfan/administration & dosage
- Child
- Child, Preschool
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Female
- Graft vs Host Disease/etiology
- Graft vs Host Disease/prevention & control
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Myeloablative Agonists/administration & dosage
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Retrospective Studies
- Stem Cell Transplantation
- Transplantation Conditioning
- Transplantation, Homologous
- Whole-Body Irradiation/methods
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Affiliation(s)
- A A Oyekunle
- Department of Bone Marrow Transplantation, University-Hospital Hamburg-Eppendorf, Hamburg, Germany.
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23
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Shimoni A, Kröger N, Zabelina T, Ayuk F, Hardan I, Yeshurun M, Shem-Tov N, Avigdor A, Ben-Bassat I, Zander AR, Nagler A. Hematopoietic stem-cell transplantation from unrelated donors in elderly patients (age>55 years) with hematologic malignancies: older age is no longer a contraindication when using reduced intensity conditioning. Leukemia 2004; 19:7-12. [PMID: 15526016 DOI: 10.1038/sj.leu.2403591] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic stem cell transplantation (SCT) is a potentially curative approach for patients with hematological malignancies. Reduced-intensity conditioning regimens allow SCT in elderly patients; however, there are only limited data on the feasibility and outcomes of unrelated donor SCT in these patients. In this study, we analyzed, retrospectively, data of 36 patients with various hematological malignancies and median age 58 years (range, 55-66), who were given unrelated donor SCT after reduced-intensity conditioning. The preparative regimen consisted of fludarabine combined with oral busulfan (8 mg/kg, n=8), intravenous busulfan (6.4 mg/kg, n=11), treosulfan (30 g/m(2), n=5) or melphalan (100-150 mg/m(2), n=12). Patients were also given serotherapy, ATG (n=32), or alemtuzumab (n=4). The probabilities of overall survival, disease-free survival, and nonrelapse mortality at 1 year after SCT were 52, 43, and 39%, respectively. Acute graft-versus-host disease (GVHD) grade II-IV and chronic GVHD occurred in 31 and 45%, respectively. Multivariable analysis determined that survival rates were higher in patients with chemosensitive disease (HR 4.5), and patients conditioned with intravenous busulfan or treosulfan (HR 3.9). Unrelated donor SCT is feasible in elderly patients, with outcomes that are similar to younger patients. Favorable outcome was observed in patients with myeloid malignancies, and those transplanted in remission and early in the course of disease. Age alone should not be considered a contraindication to unrelated donor SCT.
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Affiliation(s)
- A Shimoni
- The Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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24
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Schieder H, Kröger N, Zabelina T, Ayuk F, Kratochwille A, Fehse B, Fehse N, Stute N, Renges H, Zander AR. Allogeneic hematopoetic stem cell transplantation after reduced intensity conditioning for patients with indolent or mantle cell lymphoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6628] [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: 11/20/2022] Open
Affiliation(s)
- H. Schieder
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - N. Kröger
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - T. Zabelina
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - F. Ayuk
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | | | - B. Fehse
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - N. Fehse
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - N. Stute
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - H. Renges
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - A. R. Zander
- University Hospital Hamburg Eppendorf, Hamburg, Germany
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25
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Ayuk F, Shimoni A, Nagler A, Schwerdtfeger R, Kiehl M, Sayer HG, Zabelina T, Zander AR, Kröger N. Efficacy and toxicity of low-dose escalating donor lymphocyte infusion given after reduced intensity conditioning allograft for multiple myeloma. Leukemia 2004; 18:659-62. [PMID: 14671630 DOI: 10.1038/sj.leu.2403252] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Kroger N, Perez-Simon J, Myint H, Klingemann H, Shimoni A, Nagler A, Martino R, Allegre A, Tomas J, Schwerdtfeger R, Kiehl M, Fauser A, Sayer H, Leon A, Beyer J, Zabelina T, Ayuk F, San Miguel J, Brand R, Zander A. Risk-factors of melphalan/fludarabine dose-reduced allogeneic stem cell transplantation in patients with multiple myeloma. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Kröger N, Zabelina T, Renges H, Krüger W, Kordes U, Rischewski J, Schrum J, Horstmann M, Ayuk F, Erttmann R, Kabisch H, Zander AR. Long-term follow-up of allogeneic stem cell transplantation in patients with severe aplastic anemia after conditioning with cyclophosphamide plus antithymocyte globulin. Ann Hematol 2002; 81:627-31. [PMID: 12454700 DOI: 10.1007/s00277-002-0566-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2002] [Accepted: 10/08/2002] [Indexed: 10/27/2022]
Abstract
We investigated the efficacy of an antithymocyte globulin/cyclophosphamide preparative regimen prior to allogeneic stem cell transplantation from HLA-identical siblings in patients with severe aplastic anemia. Since 1990, 21 patients, 6 males and 15 females, with a median age of 25 years (range: 7-43) have been enrolled in the protocol consisting of 200 mg/kg cyclophosphamide and 90-120 mg/kg antithymocyte globulin (ATG, rabbit, Fresenius, Bad Homburg, Germany). For further graft-versus-host disease (GVHD) prophylaxis all patients received cyclosporin A and a short course of methotrexate (MTX). Only one patient had a primary graft failure (5%). All other patients engrafted with a leukocyte count >1.0 x 10(9)/l and a platelet count >20 x 10(9)/l after a median of 19 (range: 11-28) and 26 days (range: 13-67), respectively. No late graft failure or relapse was observed. Two patients experienced mild acute GVHD grade I (10%), and one patient developed grade II GVHD (5%). No severe grade III/IV GVHD was observed; 17% of the patients developed limited chronic GVHD. The treatment-related mortality was 14% and mainly due to fungal infection. After a median follow-up of 70 months (range: 2-139), the estimated overall and event-free survival at 10 years for all patients is 86% (95% confidence interval: 70-100%). We conclude that ATG plus cyclophosphamide is an effective conditioning regimen in patients with aplastic anemia undergoing stem cell transplantation with a low treatment-related mortality, resulting in an excellent outcome.
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Affiliation(s)
- N Kröger
- Department of Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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28
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Kröger N, Zabelina T, Krüger W, Renges H, Stute N, Rischewski J, Sonnenberg S, Ayuk F, Tögel F, Schade U, Fiegel H, Erttmann R, Löliger C, Zander AR. In vivo T cell depletion with pretransplant anti-thymocyte globulin reduces graft-versus-host disease without increasing relapse in good risk myeloid leukemia patients after stem cell transplantation from matched related donors. Bone Marrow Transplant 2002; 29:683-9. [PMID: 12180114 DOI: 10.1038/sj.bmt.1703530] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
One-hundred and two patients with good risk myeloid leukemia (CML first chronic phase or AML first CR) were transplanted from HLA-related donors after conditioning with (n = 45) or without anti-thymocyte globulin (ATG) (n = 57). One graft failure was observed in the non-ATG and none in the ATG group. The median time to leukocyte engraftment (> 1 x 10(9)/l) was 16 (range 12-33) in the ATG group and 17 days (range 11-29) in the non-ATG group (NS) and for platelet engraftment (> 20 x 10(9)/l) 24 and 19 days (P = 0.002), respectively. Acute GVHD grade II-IV was observed in 47% of the non-ATG and in 20% of the ATG group (P = 0.004). Grade III/IV GVHD occurred in 7% of the ATG and in 32% of the non-ATG group (P = 0.002). Chronic GVHD was seen in 36% and 67% (P = 0.005), respectively. After a median follow-up of 48 months (range 2-128), the 5-year estimated OS is 66% (95% KI: 51-81%) for the ATG group and 59% (95% KI: 46-72%) for the non-ATG group (NS). The 5-year estimated DFS is 64% (95% KI: 50-78%) for ATG and 55% (95% KI: 43-67%) for the non-ATG regimen (NS). The 5-year probability of relapse was 5% in the ATG and 15% in the non-ATG group (NS). ATG as part of the conditioning regimen leads to a significant reduction in GVHD without increase of relapse in patients with myeloid leukemia after stem cell transplantation from HLA-related donors.
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Affiliation(s)
- N Kröger
- Bone Marrow Transplantation, University Hospital, Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
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Eckert H, Fehse B, Lindemann C, Ayuk F, Fauser A, Zander A, Kühlcke K. Highly efficient retroviral gene transfer based on centrifugation-mediated vector preloading of tissue culture vessels. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ayuk F, Li Z, Kühlcke K, Lindemann C, Schade U, Eckert HG, Zander A, Fehse B. Establishment of an optimised gene transfer protocol for human primary T lymphocytes according to clinical requirements. Gene Ther 1999; 6:1788-92. [PMID: 10516731 DOI: 10.1038/sj.gt.3300999] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current gene therapeutic protocols directed towards the treatment of inherited disorders (eg ADA-SCID) and viral infections (eg AIDS), as well as adoptive immunotherapy approaches are based on the use of genetically modified lymphocytes. Since only insufficient transduction of T cells is obtained using existing techniques, the development of more efficient gene transfer protocols into these cells is of great importance. We present here a protocol for the highly efficient transduction of human primary T cells at high densities (1 x 106/ml) by retroviral infection. Using retroviral vectors encoding a truncated human low-affinity nerve growth factor receptor (DeltaLNGFR) as a gene transfer marker, we obtained transduction frequencies of more than 70% of CD3+ cells after two cycles of infection. Our protocol is based on the use of FBS-free media for both the production of retrovirus-containing supernatant and the cultivation of the primary T cells. Since the protocol presented here works just as efficiently under large-scale conditions, it may be easily adapted to clinical needs and 'good manufacturing practice' (GMP) standards.
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Affiliation(s)
- F Ayuk
- Bone Marrow Transplantation, University Hospital Eppendorf, Hamburg, Germany
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