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Gasanz Garicochea M, Martínez-Romera I, Osuna-Marco MP, López-Ibor Aliño B. Clinical experience with immunotherapy in patients with diffuse intrinsic pontine glioma. Eur J Hosp Pharm 2023:ejhpharm-2022-003511. [PMID: 37940368 DOI: 10.1136/ejhpharm-2022-003511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
The objective of the article is to report the case of three patients with diffuse intrinsic pontine glioma (DIPG) treated with immunotherapy. In particular we report the data related to the treatments' efficacy and tolerance.To achieve this, we review the medical records in the Paediatric Oncology and Haematology Unit of HM Hospitales/Centro Integral Oncológico Clara Campal (CIOCC). We focused on patients diagnosed with DIPG who were administered oncolytic viruses followed by immune checkpoint inhibitors (ICI) (pembrolizumab, anti PD-1) plus a concomitant antiangiogenic agent (bevacizumab).The results we obtained showed the three paediatric DIPG patients studied presented good tolerance, with disease stabilisation for approximately 5 months after immunotherapy. However, subsequent clinical worsening required clinicians to change the patients' treatment.In conclusion, immunotherapy combined with other conventional antineoplastic treatments (chemotherapy, radiotherapy) is postulated as a very promising future therapeutic option. However, further research is warranted in the paediatric population to demonstrate safety and effectiveness.
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Affiliation(s)
| | - Isabel Martínez-Romera
- Pediatric Oncology and Hematology Unit, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Marta Pilar Osuna-Marco
- Pediatric Oncology and Hematology Unit, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
| | - Blanca López-Ibor Aliño
- Pediatric Oncology and Hematology Unit, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
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Martínez-Romera I, Galán-Gómez V, González-Martínez B, Guerra García P, San Román Pacheco S, Corral Sánchez D, Mozo del Castillo Y, Bueno Sánchez D, Sisinni L, González Guerrero A, Castellano Dámaso S, Sánchez Zapardiel E, Ruz Caracuel B, Balas Pérez A, Pérez-Martínez A. CD19+ lineage chimerism, an early biomarker after anti-CD19 CAR-T cell therapy in patients previously receiving a hematopoietic stem cell transplantation. Front Immunol 2022; 13:960412. [PMID: 36003375 PMCID: PMC9393474 DOI: 10.3389/fimmu.2022.960412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Treatment targeting CD19 by a chimeric antigen receptor expressed on T cells (anti-CD19 CAR-T) has led to a breakthrough in the management and treatment of relapsed and refractory B- cell acute lymphoblastic leukemia (B-ALL). After infusion, the efficacy of anti-CD19 CAR-T is monitored by bone marrow negative minimal residual disease and the absence of peripheral CD19+ B lymphocytes (B-cell aplasia). In patients who have received an allogenic Hematopoietic Stem Cell Transplantation (HSCT) prior to treatment with anti-CD19 CAR-T, monitoring lineage-specific chimerism could be helpful. We found that on 4 patients who received anti-CD19 CAR-T cells after HSCT and achieved early complete response, CD19+ lineage mixed chimerism but not CD3+ lineage mixed chimerism monitored by molecular techniques anticipated earlier than B-cell aplasia determined by flow cytometry, lack of effectiveness of anti-CD19 CAR-T and leukemia relapse. Donor lymphocyte infusions (DLIs) did not prevent relapse but recovered CD3+ full donor chimerism. We suggest that continuous lineage chimerism analysis should be done routinely in patients who receive anti-CD19 CAR-T cells after HSCT and achieve complete remission because it can support early treatment intervention. However, the role of DLI in this setting is unclear, so further prospective studies should be developed.
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Affiliation(s)
- Isabel Martínez-Romera
- Pediatric Hematology and Oncology Department, La Paz University Hospital, Madrid, Spain
- *Correspondence: Isabel Martínez-Romera,
| | - Víctor Galán-Gómez
- Pediatric Hematology and Oncology Department, La Paz University Hospital, Madrid, Spain
| | | | - Pilar Guerra García
- Pediatric Hematology and Oncology Department, La Paz University Hospital, Madrid, Spain
| | | | | | | | - David Bueno Sánchez
- Pediatric Hematology and Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Luisa Sisinni
- Pediatric Hematology and Oncology Department, La Paz University Hospital, Madrid, Spain
| | | | | | | | - Beatriz Ruz Caracuel
- Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Madrid, Spain
| | | | - Antonio Pérez-Martínez
- Pediatric Hematology and Oncology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
- Pediatric Department, Universidad Autónoma, Madrid, Spain
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Fernández A, Pérez-Martínez A, Escudero A, Mirones I, González B, de Paz R, Matamala N, Clares L, Navarro A, Galán V, Martínez-Romera I, Martínez-López J, Leivas A, Valés-Gómez M, Ferreras C, Fernández L. Infusion of haploidentical NKG2D-CAR-T CD45RA- cells in two pediatric patients with advanced relapsed and refractory acute leukemia was safe but achieved no clinical benefits. Leuk Lymphoma 2022; 63:1970-1974. [DOI: 10.1080/10428194.2022.2057490] [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: 10/18/2022]
Affiliation(s)
- Adrián Fernández
- Hematological Malignancies Lab-H12O Clinical Research Unit, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Antonio Pérez-Martínez
- Pediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain
- Translational Research Group in Pediatric Oncology Hematopoietic Transplantation and Cell Therapy, La Paz University Hospital Institute for Health Research-IdiPAZ, Madrid, Spain
- Pediatric Department, Autonomous University of Madrid, Madrid, Spain
| | - Adela Escudero
- Pediatric Molecular Hemato-Oncology Department, Medical and Molecular Genetics Institute (INGEMM), La Paz University Hospital, Madrid, Spain
| | - Isabel Mirones
- Advanced Therapy Medicinal Products Production Unit, Pediatric Hemato-Oncology Service and Pharmacy Service, La Paz University Hospital, Madrid, Spain
| | - Berta González
- Pediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Raquel de Paz
- Hematology and Hemotherapy Department, La Paz University Hospital, Madrid, Spain
| | - Nerea Matamala
- Pediatric Molecular Hemato-Oncology Department, Medical and Molecular Genetics Institute (INGEMM), La Paz University Hospital, Madrid, Spain
| | - Laura Clares
- Translational Research Group in Pediatric Oncology Hematopoietic Transplantation and Cell Therapy, La Paz University Hospital Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Alfonso Navarro
- Translational Research Group in Pediatric Oncology Hematopoietic Transplantation and Cell Therapy, La Paz University Hospital Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Victor Galán
- Pediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | | | - Joaquín Martínez-López
- Hematological Malignancies Lab-H12O Clinical Research Unit, Spanish National Cancer Research Center (CNIO), Madrid, Spain
- Hematology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Alejandra Leivas
- Hematological Malignancies Lab-H12O Clinical Research Unit, Spanish National Cancer Research Center (CNIO), Madrid, Spain
- Hematology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Mar Valés-Gómez
- Tumor Immune Activation and Evasion Group, National Biotechnology Center, Madrid, Spain
| | - Cristina Ferreras
- Translational Research Group in Pediatric Oncology Hematopoietic Transplantation and Cell Therapy, La Paz University Hospital Institute for Health Research-IdiPAZ, Madrid, Spain
| | - Lucía Fernández
- Hematological Malignancies Lab-H12O Clinical Research Unit, Spanish National Cancer Research Center (CNIO), Madrid, Spain
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Villa-Alcázar M, Aboitiz J, Bengoechea C, Martínez-Romera I, Martínez-Naranjo C, López-Ibor B. Coping With Incongruence: Mirror Therapy to Manage the Phantom Limb Phenomenon in Pediatric Amputee Patients. J Pain Symptom Manage 2019; 57:e1-e3. [PMID: 30347223 DOI: 10.1016/j.jpainsymman.2018.10.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Marta Villa-Alcázar
- Department of Pediatric Hematology and Oncology, Hospital HM Montepríncipe, Boadilla del Monte, Madrid, Spain.
| | - Juan Aboitiz
- Department of Pediatric Hematology and Oncology, Hospital HM Montepríncipe, Boadilla del Monte, Madrid, Spain
| | - Camino Bengoechea
- Department of Pediatric Hematology and Oncology, Hospital HM Montepríncipe, Boadilla del Monte, Madrid, Spain
| | - Isabel Martínez-Romera
- Department of Pediatric Hematology and Oncology, Hospital HM Montepríncipe, Boadilla del Monte, Madrid, Spain
| | - Cristina Martínez-Naranjo
- Department of Pediatric Hematology and Oncology, Hospital HM Montepríncipe, Boadilla del Monte, Madrid, Spain
| | - Blanca López-Ibor
- Department of Pediatric Hematology and Oncology, Hospital HM Montepríncipe, Boadilla del Monte, Madrid, Spain
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Escudero A, Martínez-Romera I, Fernández L, Valentín J, González-Vicent M, Vicario JL, Madero-Jarabo R, Diaz MÁ, Pérez-Martínez A. Donor KIR Genotype Impacts on Clinical Outcome after T Cell-Depleted HLA Matched Related Allogeneic Transplantation for High-Risk Pediatric Leukemia Patients. Biol Blood Marrow Transplant 2018; 24:2493-2500. [PMID: 30145228 DOI: 10.1016/j.bbmt.2018.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
Abstract
Preliminary data suggest that ex vivo T cell-depleted matched related donor (MRD) hematopoietic stem cell transplantation (HSCT) is feasible and confers a clinically beneficial reduction in graft-versus-host disease. Classically, T cell-depleted grafts were associated with reduction of the graft-versus-leukemia (GVL) effect because of delayed T cell immune reconstitution. However, natural killer (NK) cell alloreactivity is also critical for an early GVL effect as well as for lymphocyte immune reconstitution. Here, we study the role of NK cells in MRD T cell-depleted HSCT, which is still poorly understood. Given that MRD ligands for inhibitory killer cell immunoglobulin-like receptors (KIRs) are matched, we focused on activating KIR receptors. We retrospectively analyzed KIR genotyping in patients and MRDs in 40 ex vivo T cell-depleted pediatric HSCTs. The log-rank test and Cox proportional risk test were performed to correlate genotype with clinical outcome (relapse rate, disease-free survival, and overall survival) and immune reconstitution. The statistical analysis revealed poorer overall survival when donors have a KIR-B content score of ≥2, a best/better subtype, or present the KIR2DS1 gene. The patient's relapse rate was higher when donors present the KIR2DL5A gene, as well as a poorer probability of disease-free survival when the donor is classified with a best/better subtype. Regarding immune reconstitution, donor KIR haplotype A or the presence of inhibitory KIR genes promote best recovery of T lymphocytes, whereas donor KIR haplotype B or the presence of activating KIR genes confer better expansion of NK cells. These findings suggest that the selection of MRDs with an inhibitory KIR phenotype improve T cell expansion as well as the clinical outcome after pediatric ex vivo T cell-depleted HSCT.
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Affiliation(s)
- Adela Escudero
- Traslational Research in Pediatric Oncology, Hematopoietic Stem Cell Transplantation, Cell Therapy, INGEMM-IdiPAZ, La Paz University Hospital, Madrid, Spain
| | | | - Lucía Fernández
- Hematological Research Program, Cancer Research National Centre, Madrid, Spain
| | - Jaime Valentín
- Traslational Research in Pediatric Oncology, Hematopoietic Stem Cell Transplantation, Cell Therapy, INGEMM-IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Marta González-Vicent
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Miguel Ángel Diaz
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Antonio Pérez-Martínez
- Traslational Research in Pediatric Oncology, Hematopoietic Stem Cell Transplantation, Cell Therapy, INGEMM-IdiPAZ, La Paz University Hospital, Madrid, Spain; Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, La Paz University Hospital. Madrid, Spain.
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Pérez-Martínez A, Fernández L, Valentín J, Martínez-Romera I, Corral MD, Ramírez M, Abad L, Santamaría S, González-Vicent M, Sirvent S, Sevilla J, Vicario JL, de Prada I, Diaz MÁ. A phase I/II trial of interleukin-15--stimulated natural killer cell infusion after haplo-identical stem cell transplantation for pediatric refractory solid tumors. Cytotherapy 2015; 17:1594-603. [PMID: 26341478 DOI: 10.1016/j.jcyt.2015.07.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/16/2015] [Accepted: 07/18/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND AIMS Preliminary data suggest that T-cell-depleted haplo-identical stem cell transplantation (haplo-SCT) has a clinically beneficial allograft-versus-tumor effect associated with natural killer (NK) cell immune reconstitution. METHODS This phase I/II trial descriptively evaluates the feasibility of interleukin (IL)-15-stimulated NK cell infusion after haplo-SCT in pediatric patients with refractory solid tumors. RESULTS Six patients received an IL-15-stimulated NK cell infusion at 30 days after haplo-SCT. The mean number of infused NK cells per product was 11.3 × 10(6)/kg (range, 3-27 × 10(6)/kg). The T-cell count was <1 × 10(3)/kg in all patients (range, 0-0.75 × 10(3)/kg). No toxic effects related to IL-15--stimulated NK cell infusion were observed. Four of the six patients showed a clinical response (one achieved very good partial remission, two achieved partial remission and one had stable disease). One patient had progressive disease, and the response was not evaluated in the remaining patient. After a median follow-up period of 310 days, all patients had died: four of cancer relapse, one of cancer-associated thrombotic micro-angiopathy and one of acute graft-versus-host disease. CONCLUSIONS The adoptive transfer of allogeneic IL-15--stimulated NK cells might be feasible and safe in heavily pretreated pediatric patients with refractory solid tumors, though the advanced stage of disease and toxic effects of haplo-SCT may limit the efficacy of NK cell infusion in this population.
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Affiliation(s)
- Antonio Pérez-Martínez
- Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario La Paz, Madrid, Spain.
| | - Lucía Fernández
- Clinical Research Program, Cancer Research National Centre, Madrid, Spain
| | | | | | | | - Manuel Ramírez
- GMP Facility, Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lorea Abad
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sandra Santamaría
- GMP Facility, Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marta González-Vicent
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sara Sirvent
- Department of Radiology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Julián Sevilla
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Inmaculada de Prada
- Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Miguel Ángel Diaz
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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de Lama Caro-Patón G, García-Salido A, Iglesias-Bouzas MI, Guillén M, Cañedo-Villaroya E, Martínez-Romera I, Serrano-González A, Casado-Flores J. [Extreme reactive thrombocytosis in a healthy 6 year-old child]. An Pediatr (Barc) 2013; 81:318-21. [PMID: 24315421 PMCID: PMC7105075 DOI: 10.1016/j.anpedi.2013.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 09/26/2013] [Accepted: 10/07/2013] [Indexed: 10/31/2022] Open
Abstract
Thrombocytosis is usually a casual finding in children. Reactive or secondary thrombocytosis is the more common form, being the infections diseases the most prevalent cause of it. Regarding the number of platelets there are four degrees of thrombocytosis; in its extreme degree the number of platelets exceeds 1,000,000/mm(3). We describe a case of extreme reactive thrombocytosis in a healthy 6-year-old child. He required critical care admission for diagnosis and treatment (maximum number of platelets 7,283,000/mm(3)). We review the different causes of thrombocytosis in childhood, the differential diagnosis, and the available treatments in case of extreme thrombocytosis.
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Affiliation(s)
- G de Lama Caro-Patón
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A García-Salido
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España; Unidad de Cuidados Paliativos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - M I Iglesias-Bouzas
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M Guillén
- Unidad de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - E Cañedo-Villaroya
- Unidad de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - I Martínez-Romera
- Unidad de Oncohematología Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A Serrano-González
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - J Casado-Flores
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
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