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Jarisch A, Salzmann-Manrique E, Soerensen J, Sach G, Rettinger E, Willasch A, Bakhtiar S, Klarmann D, Bräuninger S, Moser L, Fekadu J, Hutter M, Klingebiel T, Klusmann JH, Bader P, Bonig H. Donor-type red blood cell transfusion to deplete isoagglutinins prior to allogeneic stem cell transplantation from ABO major incompatible bone marrow donors. Br J Haematol 2023; 201:1159-1168. [PMID: 36949601 DOI: 10.1111/bjh.18761] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
ABO incompatibility affects approximately 40% of allogeneic stem cell transplants in Caucasian patient populations. Because bone marrow (BM), the preferred graft from paediatric sibling donors and for non-malignant diseases, has a red blood cell (RBC) content similar to blood, anti-donor isoagglutinins must either be depleted from the recipient or RBCs removed from the graft. To achieve tolerability of unmanipulated BM grafts, we used controlled infusions of donor ABO-type RBC units to deplete isoagglutinins before the transplant. This retrospective study evaluates the outcomes of 52 ABO major incompatible BM transplants performed at our centre between 2007 and 2019. The use of donor-type RBC transfusions was well tolerated. They effectively reduced isoagglutinins levels, typically achieving target titres after one (60%) or two (29%) transfusions. The approach allowed for successful and uneventful infusions of unmanipulated BM which provided timely engraftment. The transplant outcomes were not inferior to those of a matched-pair control group of patients with ABO-identical donors.
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Affiliation(s)
- Andrea Jarisch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Emilia Salzmann-Manrique
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Jan Soerensen
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Gudrun Sach
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Andre Willasch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Shahrzad Bakhtiar
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Dieter Klarmann
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Susanne Bräuninger
- Institute of Transfusion Medicine and Immunohematology, Goethe University Frankfurt, Frankfurt, Germany
- Red Cross Blood Donor Service, Baden Württemberg-Hessen, Frankfurt, Germany
| | - Laura Moser
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Julia Fekadu
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Martin Hutter
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Jan-Henning Klusmann
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University Frankfurt, University Hospital, Frankfurt/Main, Germany
| | - Halvard Bonig
- Institute of Transfusion Medicine and Immunohematology, Goethe University Frankfurt, Frankfurt, Germany
- Red Cross Blood Donor Service, Baden Württemberg-Hessen, Frankfurt, Germany
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2
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Jarisch A, Wiercinska E, Huenecke S, Bremm M, Cappel C, Hauler J, Rettinger E, Soerensen J, Hellstern H, Klusmann JH, Ciesek S, Bonig H, Bader P. Immune Responses to SARS-CoV-2 Vaccination in Young Patients with Anti-CD19 Chimeric Antigen Receptor T Cell-Induced B Cell Aplasia. Transplant Cell Ther 2022; 28:366.e1-366.e7. [PMID: 35472554 PMCID: PMC9040419 DOI: 10.1016/j.jtct.2022.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 01/06/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are capable of inducing combined humoral and cellular immunity. Which effect is more relevant for their potent protective effects is unclear, but isolated T cell responses without seroconversion in healthy household members of individuals with Coronavirus disease 19 (COVID-19) suggest that T cell responses effectively protect against clinical infection. Oncologic patients have an outsize risk of unfavorable outcomes after SARS-CoV-2 infection and therefore were prioritized when vaccines first became available, although the quality of their immune response to vaccination was expected to be suboptimal, as has been confirmed in subsequent studies. Inherently, patients with anti-CD19 chimeric antigen receptor (CAR) T cell therapy-mediated B cell aplasia would be incapable of generating humoral responses, so that assessment of the vaccine-induced cellular immunity is all the more important to gauge whether the vaccine can induce meaningful protection. A salient difference between T cell and humoral responses is the former's relative impassiveness to mutations of the antigen, which is more relevant than ever since the advent of the omicron variant. The objective of this study was to assess the immune cell composition and spike protein-specific T cell responses before and after the first and second doses of SARS-CoV-2 mRNA vaccine in a cohort of juvenile CD19 CAR T cell therapy recipients with enduring B cell aplasia. The prospective study included all patients age >12 years diagnosed with multiply relapsed B cell precursor acute lymphoblastic leukemia and treated with anti-CD19 CAR T cell (CAR-T19) therapy in our center. The primary endpoint was the detection of cell-mediated and humoral responses to vaccine (flow cytometry and anti-S immunoglobulin G, respectively). Secondary endpoints included the incidence of vaccine-related grade 3 or 4 adverse events, exacerbation of graft-versus-host disease (GVHD), relapse, and the influence of the vaccine on CAR T cells and lymphocyte subsets. Even though one-half of the patients exhibited subnormal lymphocyte counts and marginal CD4/CD8 ratios, after 2 vaccinations all showed brisk T-cell responsiveness to spike protein, predominantly in the CD4 compartment, which quantitatively was well within the range of healthy controls. No severe vaccine-related grade 3 or 4 adverse events, GVHD exacerbation, or relapse was observed in our cohort. We posit that SARS-CoV-2 mRNA vaccines induce meaningful cellular immunity in patients with isolated B cell deficiency due to CAR-T19 therapy.
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Affiliation(s)
- Andrea Jarisch
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
| | - Eliza Wiercinska
- German Red Cross Blood Service, Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Sabine Huenecke
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Melanie Bremm
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Claudia Cappel
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Julian Hauler
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Eva Rettinger
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Jan Soerensen
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Helen Hellstern
- German Red Cross Blood Service, Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Jan-Henning Klusmann
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany; Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Sandra Ciesek
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Halvard Bonig
- German Red Cross Blood Service, Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany; Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Service, Baden-Württemberg-Hessen, Frankfurt am Main, Germany; Department of Medicine/Hematology, University of Washington, Seattle, Washington
| | - Peter Bader
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Child and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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3
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Bremm M, Krastel T, Cappel C, Zimmermann O, Pfeffermann LM, Katzki V, Bonig H, Schäfer R, Rettinger E, Merker M, Bremm S, Schaefer K, Klingebiel T, Soerensen J, Bader P, Huenecke S. Depletion of CD45RA + T cells: Advantages and disadvantages of different purification methods. J Immunol Methods 2021; 492:112960. [PMID: 33417916 DOI: 10.1016/j.jim.2021.112960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 12/03/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, new advances were made regarding the depletion of CD45RA+ naïve T cells from haploidentical grafts as they are suspected to be the most alloreactive. METHODS Within this project we investigated CD45RA-depletion from G-CSF mobilized PBSC by two different purification strategies according to GMP, specifically direct depletion of CD45RA+ cells (one-step approach), or CD34-positive selection followed by CD45RA-depletion (two-step approach). RESULTS With log -3.9 and - 3.8 the depletion quality of CD45RA+ T cells was equally for both approaches together with a close to complete CD19+ B cell depletion. However, due to a high expression of CD45RA the majority of NK cells were lost within both CD45RA depletion strategies. Stem cell recovery after one-step CD45RA-depletion was at median 52.0% (range: 49.7-67.2%), which was comparable to previously published recovery data received from direct CD34 positive selection. Memory T cell recovery including CD4+ and CD8+ memory T cell subsets was statistically not differing between both purification approaches. The recovery of CD4+ and CD8+ T cells was as well similar, but overall a higher amount of cytotoxic than T-helper cells were lost as indicated by an increase of the CD4/CD8 ratio. CONCLUSIONS CD45RA-depletion from G-CSF mobilized PBSC is feasible as one- and two-step approach and results in sufficient reduction of CD45RA+ T cells as well as B cells, but also to a co-depletion of NK cells. However, by gaining two independent cell products, the two-step approach enables the highest clinical flexibility in regard to individual graft composition with precise dosage of stem cells and T cells.
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Affiliation(s)
- Melanie Bremm
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany.
| | - Theresa Krastel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Claudia Cappel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Olga Zimmermann
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Lisa-Marie Pfeffermann
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Verena Katzki
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe-University Frankfurt/Main, German Red Cross Blood Donor Service Baden-Württemberg-Hessen, Frankfurt/Main, Germany
| | - Richard Schäfer
- Institute for Transfusion Medicine and Immunohematology, Goethe-University Frankfurt/Main, German Red Cross Blood Donor Service Baden-Württemberg-Hessen, Frankfurt/Main, Germany
| | - Eva Rettinger
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Michael Merker
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Sebastian Bremm
- Data Analytics & Visualization, Frankfurt University of Applied Sciences, Frankfurt/Main, Germany
| | - Kirsten Schaefer
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Jan Soerensen
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Peter Bader
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Sabine Huenecke
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
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4
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Bonig H, Kuçi Z, Kuçi S, Bakhtiar S, Basu O, Bug G, Dennis M, Greil J, Barta A, Kállay KM, Lang P, Lucchini G, Pol R, Schulz A, Sykora KW, Teichert von Luettichau I, Herter-Sprie G, Ashab Uddin M, Jenkin P, Alsultan A, Buechner J, Stein J, Kelemen A, Jarisch A, Soerensen J, Salzmann-Manrique E, Hutter M, Schäfer R, Seifried E, Paneesha S, Novitzky-Basso I, Gefen A, Nevo N, Beutel G, Schlegel PG, Klingebiel T, Bader P. Children and Adults with Refractory Acute Graft-versus-Host Disease Respond to Treatment with the Mesenchymal Stromal Cell Preparation "MSC-FFM"-Outcome Report of 92 Patients. Cells 2019; 8:cells8121577. [PMID: 31817480 PMCID: PMC6952775 DOI: 10.3390/cells8121577] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/24/2019] [Accepted: 11/30/2019] [Indexed: 01/22/2023] Open
Abstract
(1) Background: Refractory acute graft-versus-host disease (R-aGvHD) remains a leading cause of death after allogeneic stem cell transplantation. Survival rates of 15% after four years are currently achieved; deaths are only in part due to aGvHD itself, but mostly due to adverse effects of R-aGvHD treatment with immunosuppressive agents as these predispose patients to opportunistic infections and loss of graft-versus-leukemia surveillance resulting in relapse. Mesenchymal stromal cells (MSC) from different tissues and those generated by various protocols have been proposed as a remedy for R-aGvHD but the enthusiasm raised by initial reports has not been ubiquitously reproduced. (2) Methods: We previously reported on a unique MSC product, which was generated from pooled bone marrow mononuclear cells of multiple third-party donors. The products showed dose-to-dose equipotency and greater immunosuppressive capacity than individually expanded MSCs from the same donors. This product, MSC-FFM, has entered clinical routine in Germany where it is licensed with a national hospital exemption authorization. We previously reported satisfying initial clinical outcomes, which we are now updating. The data were collected in our post-approval pharmacovigilance program, i.e., this is not a clinical study and the data is high-level and non-monitored. (3) Results: Follow-up for 92 recipients of MSC-FFM was reported, 88 with GvHD ≥°III, one-third only steroid-refractory and two-thirds therapy resistant (refractory to steroids plus ≥2 additional lines of treatment). A median of three doses of MSC-FFM was administered without apparent toxicity. Overall response rates were 82% and 81% at the first and last evaluation, respectively. At six months, the estimated overall survival was 64%, while the cumulative incidence of death from underlying disease was 3%. (4) Conclusions: MSC-FFM promises to be a safe and efficient treatment for severe R-aGvHD.
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Affiliation(s)
- Halvard Bonig
- Goethe University Medical Center, Institute of Transfusion Medicine and Immunohematology, and German Red Cross Blood Center Frankfurt, Frankfurt am Main, Frankfurt 60528, Germany; (R.S.); (E.S.)
- Correspondence: or ; Tel.: +49696782177
| | - Zyrafete Kuçi
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Frankfurt 60590, Germany; (Z.K.); (S.K.); (S.B.); (A.J.); (J.S.); (E.S.-M.); (M.H.); (T.K.); (P.B.)
| | - Selim Kuçi
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Frankfurt 60590, Germany; (Z.K.); (S.K.); (S.B.); (A.J.); (J.S.); (E.S.-M.); (M.H.); (T.K.); (P.B.)
| | - Shahrzad Bakhtiar
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Frankfurt 60590, Germany; (Z.K.); (S.K.); (S.B.); (A.J.); (J.S.); (E.S.-M.); (M.H.); (T.K.); (P.B.)
| | - Oliver Basu
- University Children’s Hospital Essen, Essen 45122, Germany;
| | - Gesine Bug
- Department of Medicine 2, Hematology and Oncology, University Hospital, Goethe University Frankfurt, Frankfurt am Main 60590, Germany;
| | - Mike Dennis
- Christie Hospital, Department of Haematology, Manchester M20 4BX, UK;
| | - Johann Greil
- University Children’s Hospital Heidelberg, Heidelberg 69120, Germany;
| | - Aniko Barta
- Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Department for Haematology and SCT, Budapest H1097, Hungary;
| | - Krisztián M. Kállay
- Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Pediatric Hematology and Stem Cell Transplantation Department, Budapest H1097, Hungary;
| | - Peter Lang
- University Children’s Hospital Tübingen, Tübingen 72076, Germany;
| | - Giovanna Lucchini
- Great Ormond Street Hospital, Department of Hematology/Oncology, London WC1N 3JH, UK;
| | - Raj Pol
- Department of Haematology, University of Sheffield, Sheffield S10 2TN, UK;
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm 89070, Germany;
| | - Karl-Walter Sykora
- Children’s Hospital, Medizinische Hochschule Hannover, Hannover 30625, Germany;
| | - Irene Teichert von Luettichau
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Technische Universität München, München 80804, Germany;
| | - Grit Herter-Sprie
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Center for Molecular Medicine Cologne, University of Cologne, Cologne 50937, Germany;
| | - Mohammad Ashab Uddin
- Department for Stem Cells & Immunotherapies, NHSBT, Birmingham B15 2SG, UK; (M.A.U.); (P.J.)
| | - Phil Jenkin
- Department for Stem Cells & Immunotherapies, NHSBT, Birmingham B15 2SG, UK; (M.A.U.); (P.J.)
| | - Abdulrahman Alsultan
- Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children’s Hospital, Riyadh 14611, Saudi Arabia;
| | - Jochen Buechner
- Oslo University Hospital, Department of Pediatric Hematology and Oncology, Oslo 0424, Norway;
| | - Jerry Stein
- Schneider Children’s Medical Center of Israel, Department for Hemato-Oncology, Petach Tikva 4920235, Israel;
| | - Agnes Kelemen
- B-A-Z County Hospital, Pediatric Haematology and Stem Cell Transplantation Unit, Miskolc 3526, Hungary;
| | - Andrea Jarisch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Frankfurt 60590, Germany; (Z.K.); (S.K.); (S.B.); (A.J.); (J.S.); (E.S.-M.); (M.H.); (T.K.); (P.B.)
| | - Jan Soerensen
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Frankfurt 60590, Germany; (Z.K.); (S.K.); (S.B.); (A.J.); (J.S.); (E.S.-M.); (M.H.); (T.K.); (P.B.)
| | - Emilia Salzmann-Manrique
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Frankfurt 60590, Germany; (Z.K.); (S.K.); (S.B.); (A.J.); (J.S.); (E.S.-M.); (M.H.); (T.K.); (P.B.)
| | - Martin Hutter
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Frankfurt 60590, Germany; (Z.K.); (S.K.); (S.B.); (A.J.); (J.S.); (E.S.-M.); (M.H.); (T.K.); (P.B.)
| | - Richard Schäfer
- Goethe University Medical Center, Institute of Transfusion Medicine and Immunohematology, and German Red Cross Blood Center Frankfurt, Frankfurt am Main, Frankfurt 60528, Germany; (R.S.); (E.S.)
| | - Erhard Seifried
- Goethe University Medical Center, Institute of Transfusion Medicine and Immunohematology, and German Red Cross Blood Center Frankfurt, Frankfurt am Main, Frankfurt 60528, Germany; (R.S.); (E.S.)
| | - Shankara Paneesha
- Department of Haematology & Stem Cell Transplantation, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK;
| | | | - Aharon Gefen
- Rambam Medical Center, Ruth Rappaport Children’s Hospital, Pediatric Hematology Oncology Division, The Reiner-Shudi Pediatric Bone Marrow Transplantation Unit, Haifa 3109601, Israel; (A.G.); (N.N.)
| | - Neta Nevo
- Rambam Medical Center, Ruth Rappaport Children’s Hospital, Pediatric Hematology Oncology Division, The Reiner-Shudi Pediatric Bone Marrow Transplantation Unit, Haifa 3109601, Israel; (A.G.); (N.N.)
| | - Gernot Beutel
- Hannover Medical School (MHH), Hannover, Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover 30625, Germany;
| | | | - Thomas Klingebiel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Frankfurt 60590, Germany; (Z.K.); (S.K.); (S.B.); (A.J.); (J.S.); (E.S.-M.); (M.H.); (T.K.); (P.B.)
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Frankfurt am Main, Frankfurt 60590, Germany; (Z.K.); (S.K.); (S.B.); (A.J.); (J.S.); (E.S.-M.); (M.H.); (T.K.); (P.B.)
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5
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Heinze A, Grebe B, Bremm M, Huenecke S, Munir TA, Graafen L, Frueh JT, Merker M, Rettinger E, Soerensen J, Klingebiel T, Bader P, Ullrich E, Cappel C. The Synergistic Use of IL-15 and IL-21 for the Generation of NK Cells From CD3/CD19-Depleted Grafts Improves Their ex vivo Expansion and Cytotoxic Potential Against Neuroblastoma: Perspective for Optimized Immunotherapy Post Haploidentical Stem Cell Transplantation. Front Immunol 2019; 10:2816. [PMID: 31849984 PMCID: PMC6901699 DOI: 10.3389/fimmu.2019.02816] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 08/14/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022] Open
Abstract
Neuroblastoma (NB) is the most common solid extracranial tumor in childhood. Despite therapeutic progress, prognosis in high-risk NB is poor and innovative therapies are urgently needed. Therefore, we addressed the potential cytotoxic capacity of interleukin (IL)-activated natural killer (NK) cells compared to cytokine-induced killer (CIK) cells for the treatment of NB. NK cells were isolated from peripheral blood mononuclear cells (PBMCs) by indirect CD56-enrichment or CD3/CD19-depletion and expanded with different cytokine combinations, such as IL-2, IL-15, and/or IL-21 under feeder-cell free conditions. CIK cells were generated from PBMCs by ex vivo stimulation with interferon-γ, IL-2, OKT-3, and IL-15. Comparative analysis of expansion rate, purity, phenotype and cytotoxicity was performed. CD56-enriched NK cells showed a median expansion rate of 4.3-fold with up to 99% NK cell content. The cell product after CD3/CD19-depletion consisted of a median 43.5% NK cells that expanded significantly faster reaching also 99% of NK cell purity. After 10–12 days of expansion, both NK cell preparations showed a significantly higher median cytotoxic capacity against NB cells relative to CIK cells. Remarkably, these NK cells were also capable of efficiently killing NB spheroidal 3D culture in long-term cytotoxicity assays. Further optimization using a novel NK cell culture medium and a prolonged culturing procedure after CD3/CD19-depletion for up to 15 days enhanced the expansion rate up to 24.4-fold by maintaining the cytotoxic potential. Addition of an IL-21 boost prior to harvesting significantly increased the cytotoxicity. The final cell product consisted for the major part of CD16−, NCR-expressing, poly-functional NK cells with regard to cytokine production, CD107a degranulation and antitumor capacity. In summary, our study revealed that NK cells have a significantly higher cytotoxic potential to combat NB than CIK cell products, especially following the synergistic use of IL-15 and IL-21 for NK cell activation. Therefore, the use of IL-15+IL-21 expanded NK cells generated from CD3/CD19-depleted apheresis products seems to be highly promising as an immunotherapy in combination with haploidentical stem cell transplantation (SCT) for high-risk NB patients.
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Affiliation(s)
- Annekathrin Heinze
- Experimental Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Beatrice Grebe
- Experimental Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Melanie Bremm
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Sabine Huenecke
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Tasleem Ah Munir
- Experimental Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Lea Graafen
- Experimental Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Jochen T Frueh
- Experimental Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Michael Merker
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Jan Soerensen
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Thomas Klingebiel
- Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Evelyn Ullrich
- Experimental Immunology, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, Frankfurt am Main, Germany
| | - Claudia Cappel
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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6
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Merker M, Salzmann-Manrique E, Katzki V, Huenecke S, Bremm M, Bakhtiar S, Willasch A, Jarisch A, Soerensen J, Schulz A, Meisel R, Bug G, Bonig H, Klingebiel T, Bader P, Rettinger E. Clearance of Hematologic Malignancies by Allogeneic Cytokine-Induced Killer Cell or Donor Lymphocyte Infusions. Biol Blood Marrow Transplant 2019; 25:1281-1292. [PMID: 30878607 DOI: 10.1016/j.bbmt.2019.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/06/2019] [Indexed: 11/18/2022]
Abstract
Well-established donor lymphocyte infusion (DLI) and novel cytokine-induced killer (CIK) cell therapy for the treatment of relapsing hematologic malignancies after allogeneic hematopoietic stem cell transplantation (HSCT) were compared with respect to feasibility, safety, and efficacy. Altogether, a total of 221 infusions were given to 91 patients (DLI, n = 55; CIK, n = 36). T cell recovery was significantly improved after CIK cell therapy (P < .0001). Although patients with CIK cell treatment showed a significantly worse prognosis at the time of HSCT (risk score, 1.7 versus 2.1; P < .0001), DLI and CIK cell therapy induced complete remission (CR) in 29% and 53% patients, respectively, whereas relapse occurred in 71% and 47%. In both groups, all patients with overt hematologic relapse at the time of immunotherapy (DLI, n = 11; CIK, n = 8) succumbed to their disease, while 36% and 68% patients with DLI or CIK cell therapy applied due to molecular relapse or active disease at the time of transplantation achieved CR. The 6-month overall survival rate in the latter patients was 57% and 77%, respectively, with a median follow-up of 27.9 months (range, .9 to 149.2 months). The 6-month cumulative incidence of relapse was 55% and 22% in patients who received DLI and CIK cell therapy, respectively (P = .012). Acute graft-versus-host disease developed in 35% of the patients who received DLI and in 25% of those who received CIK. No transfusion-related deaths occurred. These data, while underscoring the therapeutic value of conventional DLI, suggest the improved safety and to a certain extent efficacy of CIK cell therapy for patients at high risk for post-transplantation relapse of various hematologic malignancies.
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Affiliation(s)
- Michael Merker
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Verena Katzki
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sabine Huenecke
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Melanie Bremm
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Shahrzad Bakhtiar
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andre Willasch
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andrea Jarisch
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan Soerensen
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ansgar Schulz
- Pediatric Oncology, Department of Pediatric and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Roland Meisel
- Clinic of Pediatric Oncology, Hematology and Immunology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Gesine Bug
- Hematology/Oncology, Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Halvard Bonig
- German Red Cross Blood Donor Service Baden-Württemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Department of Cellular Therapeutics/Cell Processing, Goethe University Frankfurt, Frankfurt am Main, Germany; Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington
| | - Thomas Klingebiel
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Peter Bader
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Eva Rettinger
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany.
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7
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Doberschuetz N, Soerensen J, Bonig H, Willasch A, Rettinger E, Pfirrmann V, Salzmann-Manrique E, Schäfer R, Klingebiel T, Bader P, Jarisch A. Mobilized peripheral blood stem cell apheresis via Hickman catheter in pediatric patients. Transfusion 2019; 59:1061-1068. [PMID: 30610749 DOI: 10.1111/trf.15113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Autologous stem cell transplantation remains an integral treatment tool for certain childhood malignancies. In children, a central venous catheter is typically necessary to provide adequate flow rates for preparative apheresis. In this study, the feasibility and efficiency of collecting CD34+ cells via an indwelling Hickman catheter, preimplanted for chemotherapy, instead of placing an additional temporary central venous catheter was evaluated. STUDY DESIGN AND METHODS Forty-eight pediatric leukaphereses for autologous hematopoietic stem cell transplantation using Spectra Optia MNC, Version 3.0 were reviewed. We compared preimplanted Hickman catheters with a temporary Shaldon catheter, inserted for apheresis. Apheresis was considered successful if a dose of 2 × 106 CD34+ peripheral blood stem cells/kg BW was achieved. RESULTS In 43 (89.6%) of the 48 patients, a Hickman catheter was used for leukapheresis. Only 5 patients (10.4%) received a temporary Shaldon catheter. In both groups, apheresis was performed without apparent adverse reactions. The dose of collected CD34+ peripheral blood stem cells was 12.7 × 106 (range, 2.3-70.7 × 106 ) cells/kg BW in the Hickman group and 16.2 × 106 (range, 3.8-48.4 × 106 ) cells/kg BW in the Shaldon group, showing no statistically significant difference (p = 0.58). In both groups, the primary endpoint of a minimal CD34+ cell concentration of 2 × 106 cells/kg BW was achieved at a maximum of two leukapheresis sessions. Apheresis efficacy was further confirmed by the collection efficiency of 40.2% in the Hickman group and 27.8% in the Shaldon group (p = 0.32). CONCLUSION These data indicate the reliable feasibility and efficacy of mobilized apheresis via an indwelling Hickman catheter. In light of this, the routine insertion of a dialysis catheter for the purpose of leukapheresis should be critically reconsidered.
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Affiliation(s)
- Nora Doberschuetz
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jan Soerensen
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany.,Department for Cellular Therapeutics, German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt am Main, Germany
| | - Andre Willasch
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eva Rettinger
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Verena Pfirrmann
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Richard Schäfer
- Department for Cellular Therapeutics, German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt am Main, Germany
| | - Thomas Klingebiel
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Peter Bader
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Jarisch
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
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8
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Jarisch A, Salzmann-Manrique E, Cario H, Grosse R, Soerensen J, Fischer R, Schulz A, Hammerstingl R, Wunderlich A, Bader P. Serum ferritin is not a reliable predictor to determine iron overload in thalassemia major patients post-hematopoietic stem cell transplantation. Eur J Haematol 2018; 101:791-797. [PMID: 30187571 DOI: 10.1111/ejh.13169] [Citation(s) in RCA: 6] [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: 06/15/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Iron overload (IO) in transfusion-dependent anemia persists after hematopoietic stem cell transplantation (HSCT) and can cause long-term organ damage. In many studies, the diagnosis of IO before and after HSCT is based on serum ferritin (SF) levels rather than on assessment of liver iron concentration (LIC) by MRI or SQUID. METHOD In a retrospective multicenter study, we analyzed the concordance for indication of iron depletion therapy and correlation between LIC and SF of 36 thalassemia patients after HSCT. LIC was determined either by MRI-R2 (FerriScan®) or SQUID. RESULTS The concordance between LIC and SF varies over time after transplant (P = 0.011). The correlation between SF and LIC was strong in the first year (Spearman's rho 0.75; P < 0.001). In agreement, the concordance between SF and LIC concerning indication for treatment was close to 1 with an overall error rate ca. of 10%. In particular in the first year after HSCT, SF underestimates the degree of iron overload. However, in the longitudinal analysis since the second year post-HSCT onward no association was found between LIC and SF (P = 0.217). Furthermore, in the second year after HSCT, the overall error rate was 35%, whereas in the 3rd, 4th, and >4th year, it was 58%, 60%, and 25%, respectively. CONCLUSIONS Our data suggest serum ferritin is not a reliable predictor to determine iron overload in thalassemia patients after HSCT.
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Affiliation(s)
- Andrea Jarisch
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Holger Cario
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
| | - Regine Grosse
- Department of Pediatric Hematology and Oncology and Department of Adult Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Soerensen
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Roland Fischer
- Department of Pediatric Hematology and Oncology and Department of Adult Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Ansgar Schulz
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm, Germany
| | - Renate Hammerstingl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Arthur Wunderlich
- Department of Diagnostic and Interventional Radiology, University Medical Center, Ulm, Germany
| | - Peter Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
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9
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Bakhtiar S, Salzmann-Manrique E, Hutter M, Krenn T, Duerken M, Faber J, Reinhard H, Kreyenberg H, Huenecke S, Cappel C, Bremm M, Pfirrmann V, Merker M, Barnbrock A, Schöning S, Willasch AM, Rettinger E, Soerensen J, Klingebiel TE, Jarisch A, Bader P. AlloHSCT in paediatric ALL and AML in complete remission: improvement over time impacted by accreditation? Bone Marrow Transplant 2018; 54:737-745. [PMID: 30258130 DOI: 10.1038/s41409-018-0341-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 01/10/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHSCT) has become a well-established treatment option for many patients suffering from malignant and non-malignant diseases. In the past decade, high-resolution HLA-typing, remission surveillance, pre-emptive immune intervention, and standardisation in supportive care measures have substantially improved transplant outcomes. This retrospective study evaluated transplant procedures in 162 paediatric patients with acute lymphoblastic leukaemia (n = 124) or acute myeloid leukaemia (n = 38) who received their first alloHSCT in our institution over an 11-year period. We observed a significant reduction in risk of non-relapse mortality (NRM) over time (HR = 0.34, 95% CI 0.12-0.98; P = 0.05), the 4-year NRM estimate decreased from 20% in 2005-2008 to 7% in 2012-2016 (P = 0.02) and an increase in survival after relapse. There was no significant difference in patients who received a graft from a sibling, haplo, or an unrelated donor with regard to their overall survival (P = 0.45), event-free survival (P = 0.61), and non-relapse mortality (P = 0.19). Our data suggest that a specific transplant infrastructure with a highly experienced team in an accredited transplant centre likely contributes to better transplant outcomes for acute leukaemia patients in complete remission regardless of donor type.
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Affiliation(s)
- Shahrzad Bakhtiar
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Emilia Salzmann-Manrique
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Martin Hutter
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Thomas Krenn
- Paediatric Haematology and Oncology, University of Saarland, Homburg/Saar, Germany
| | - Matthias Duerken
- Department of Paediatric Oncology, University of Mannheim, Mannheim, Germany
| | - Joerg Faber
- Department of Paediatric Haematology and Oncology, Children's Hospital of Johannes Gutenberg University, Mainz, Germany
| | - Harald Reinhard
- Asklepios Kinderklinik Sankt Augustin Arnold-Janssen-Straße 29, 53757, St. Augustin, Germany
| | - Hermann Kreyenberg
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Sabine Huenecke
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Claudia Cappel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Melanie Bremm
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Verena Pfirrmann
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Michael Merker
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Anke Barnbrock
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Stefan Schöning
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Andre Manfred Willasch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Jan Soerensen
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Thomas Erich Klingebiel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Andrea Jarisch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
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10
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Theilen TM, Soerensen J, Bochennek K, Becker M, Schwabe D, Rolle U, Klingebiel T, Lehrnbecher T. Crizotinib in ALK + inflammatory myofibroblastic tumors-Current experience and future perspectives. Pediatr Blood Cancer 2018; 65. [PMID: 29286567 DOI: 10.1002/pbc.26920] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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] [Received: 06/14/2017] [Revised: 10/28/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
Inflammatory myofibroblastic tumor (IMT) and its subtype epithelioid inflammatory myofibroblastic sarcoma (EIMS) are rare soft-tissue tumors. As about 50% of IMT and 100% of EIMS contain activating rearrangements of the anaplastic lymphoma kinase (ALK) gene, targeted kinase inhibition of ALK by compounds such as crizotinib is a potential treatment option. We performed a literature review and analyzed a total of 30 patients with IMT/EIMS treated with crizotinib. A total of 12 patients achieved complete or partial remission. As preliminary data are promising, a prospective study evaluating crizotinib treatment in patients with unresectable/multifocal ALK+ IMT/EIMS is warranted.
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Affiliation(s)
- Till-Martin Theilen
- Department of Pediatric Surgery and Pediatric Urology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Jan Soerensen
- Division of Pediatric Stem Cell Transplantation and Immunology, Hospital for Children and Adolescents*, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Konrad Bochennek
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Martina Becker
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Dirk Schwabe
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Thomas Klingebiel
- Division of Pediatric Stem Cell Transplantation and Immunology, Hospital for Children and Adolescents*, Johann Wolfgang Goethe University, Frankfurt, Germany.,Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
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11
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Bader P, Kuçi Z, Bakhtiar S, Basu O, Bug G, Dennis M, Greil J, Barta A, Kállay KM, Lang P, Lucchini G, Pol R, Schulz A, Sykora KW, von Luettichau I, Herter-Sprie G, Uddin MA, Jenkin P, Alsultan A, Buechner J, Stein J, Kelemen A, Jarisch A, Soerensen J, Salzmann-Manrique E, Hutter M, Schäfer R, Seifried E, Klingebiel T, Bonig H, Kuçi S. Effective treatment of steroid and therapy-refractory acute graft-versus-host disease with a novel mesenchymal stromal cell product (MSC-FFM). Bone Marrow Transplant 2018; 53:852-862. [PMID: 29379171 PMCID: PMC6039391 DOI: 10.1038/s41409-018-0102-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [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: 12/19/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 12/27/2022]
Abstract
The inability to generate mesenchymal stromal cells (MSCs) of consistent potency likely is responsible for inconsistent clinical outcomes of patients with aGvHD receiving MSC products. We developed a novel MSC manufacturing protocol characterized by high in vitro potency and near-identity of individual doses, referred to as “MSC-Frankfurt am Main (MSC-FFM)”. Herein, we report outcomes of the 69 patients who have received MSC-FFM. These were 51 children and 18 adults with refractory aGvHD grade II (4%), III (36%) or IV (59%). Patients were refractory either to frontline therapy (steroids) (29%) or to steroids and 1–5 additional lines of immunosuppressants (71%) were given infusions in four weekly intervals. The day 28 overall response rate was 83%; at the last follow-up, 61% and 25% of patients were in complete or partial remission. The median follow-up was 8.1 months. Six-month estimate for cumulative incidence of non-relapse mortality was 27% (range, 16–38); leukemia relapse mortality was 2% (range, 0–5). This was associated with a superior six-month overall survival (OS) probability rate of 71% (range, 61–83), compared to the outcome of patients not treated with MSC-FFM. This novel product was effective in children and adults, suggesting that MSC-FFM represents a promising therapy for steroid refractory aGvHD.
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Affiliation(s)
- Peter Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Zyrafete Kuçi
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Shahrzad Bakhtiar
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Oliver Basu
- University Children's Hospital, Essen, Germany
| | - Gesine Bug
- Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Michael Dennis
- Department of Haematology, Christie Hospital, Manchester, United Kingdom
| | - Johann Greil
- University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Aniko Barta
- Department for Haematology and SCT, St. István and St. László Hospital, Budapest, Hungary
| | - Krisztián M Kállay
- Department for Haematology and SCT, St. István and St. László Hospital, Budapest, Hungary
| | - Peter Lang
- University Children's Hospital Tübingen, Tübingen, Germany
| | - Giovanna Lucchini
- Department of Hematology/Oncology, Great Ormond Street Hospital, London, United Kingdom
| | - Raj Pol
- Department of Haematology, University of Sheffield, Sheffield, United Kingdom
| | | | | | - Irene von Luettichau
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Kinderklinik München Schwabing, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Grit Herter-Sprie
- Department I for Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Mohammad Ashab Uddin
- Department for Stem Cells & Immunotherapies, NHSBT, Birmingham, Great Britain, UK
| | - Phil Jenkin
- Department for Stem Cells & Immunotherapies, NHSBT, Birmingham, Great Britain, UK
| | - Abdulrahman Alsultan
- Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia
| | - Jochen Buechner
- Oslo University Hospital Rikshospitalet, Department of Pediatric Medicine, Section for Pediatric Hematology/Oncology, Oslo, Norway
| | - Jerry Stein
- Department for Hemato-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Agnes Kelemen
- B-A-Z County Hospital, Pediatric Haematology and Stem Cell Transplantation Unit, Miskolc, Hungary
| | - Andrea Jarisch
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jan Soerensen
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Martin Hutter
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Richard Schäfer
- German Red Cross Blood Center Frankfurt and Institute of Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt am Main, Germany
| | - Erhard Seifried
- German Red Cross Blood Center Frankfurt and Institute of Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt am Main, Germany
| | - Thomas Klingebiel
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Halvard Bonig
- German Red Cross Blood Center Frankfurt and Institute of Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt am Main, Germany
| | - Selim Kuçi
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
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12
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Merker M, Meister MT, Rettinger E, Jarisch A, Soerensen J, Willasch A, Huenecke S, Cappel C, Bremm M, Salzmann-Manrique E, Krenn T, Rossig C, Kremens B, Koscielniak E, Klingebiel T, Bader P. Haploidentical allogeneic hematopoietic stem cell transplantation in patients with high-risk soft tissue sarcomas: results of a single-center prospective trial. Bone Marrow Transplant 2018; 53:891-894. [PMID: 29367709 DOI: 10.1038/s41409-018-0088-6] [Citation(s) in RCA: 6] [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: 07/20/2017] [Revised: 12/06/2017] [Accepted: 12/21/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Michael Merker
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Michael Torsten Meister
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Andrea Jarisch
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Jan Soerensen
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Andre Willasch
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Sabine Huenecke
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Claudia Cappel
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Melanie Bremm
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Emilia Salzmann-Manrique
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Thomas Krenn
- Department of Pediatric Oncology and Hematology, Saarland University Hospital, Homburg/Saar, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | - Bernhard Kremens
- Department of Pediatric Hematology and Oncology, Children's Hospital, University of Duisburg, Essen, Germany
| | - Ewa Koscielniak
- Department of Pediatric Hematology and Oncology, Olgahospital Children's Hospital, Stuttgart, Germany
| | - Thomas Klingebiel
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.
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13
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Bader P, Kuci Z, Bakhtiar S, Basu O, Bug G, Dennis M, Greil J, Kallay KM, Lang P, Luccini G, Pol R, Schulz A, Sykora KW, von Luettichau I, Jarisch A, Soerensen J, Salzmann E, Seifried E, Klingebiel T, Boenig HB, Kuci S. Excellent response, low TRM and good survival in patients with therapy-refractory aGvHD after treatment with potency-defined doses of MSCs generated from a serum-free MSC-BANK of pooled BM-MNCS from multiple healthy donors. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Huenecke S, Cappel C, Esser R, Pfirrmann V, Salzmann-Manrique E, Betz S, Keitl E, Banisharif-Dehkordi J, Bakhtiar S, Königs C, Jarisch A, Soerensen J, Ullrich E, Klingebiel T, Bader P, Bremm M. Development of Three Different NK Cell Subpopulations during Immune Reconstitution after Pediatric Allogeneic Hematopoietic Stem Cell Transplantation: Prognostic Markers in GvHD and Viral Infections. Front Immunol 2017; 8:109. [PMID: 28239380 PMCID: PMC5300968 DOI: 10.3389/fimmu.2017.00109] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 11/01/2016] [Accepted: 01/23/2017] [Indexed: 02/03/2023] Open
Abstract
Natural killer (NK) cells play an important role following allogeneic hematopoietic stem cell transplantation (HSCT) exerting graft-versus-leukemia/tumor effect and mediating pathogen-specific immunity. Although NK cells are the first donor-derived lymphocytes reconstituting post-HSCT, their distribution of CD56++CD16- (CD56bright), CD56++CD16+ (CD56intermediate=int), and CD56+CD16++ (CD56dim) NK cells is explicitly divergent from healthy adults, but to some extent comparable to the NK cell development in early childhood. The proportion of CD56bright/CD56int/CD56dim changed from 15/8/78% in early childhood to 6/4/90% in adults, respectively. Within this study, we first compared the NK cell reconstitution post-HSCT to reference values of NK cell subpopulations of healthy children. Afterward, we investigated the reconstitution of NK cell subpopulations post-HSCT in correlation to acute graft versus host disease (aGvHD) and chronic graft versus host disease (cGvHD) as well as to viral infections. Interestingly, after a HSCT follow-up phase of 12 months, the distribution of NK cell subpopulations largely matched the 50th percentile of the reference range for healthy individuals. Patients suffering from aGvHD and cGvHD showed a delayed reconstitution of NK cells. Remarkably, within the first 2 months post-HSCT, patients suffering from aGvHD had significantly lower levels of CD56bright NK cells compared to patients without viral infection or without graft versus host disease (GvHD). Therefore, the amount of CD56bright NK cells might serve as an early prognostic factor for GvHD development. Furthermore, a prolonged and elevated peak in CD56int NK cells seemed to be characteristic for the chronification of GvHD. In context of viral infection, a slightly lower CD56 and CD16 receptor expression followed by a considerable reduction in the absolute CD56dim NK cell numbers combined with reoccurrence of CD56int NK cells was observed. Our results suggest that a precise analysis of the reconstitution of NK cell subpopulations post-HSCT might indicate the occurrence of undesired events post-HSCT such as severe aGvHD.
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Affiliation(s)
- Sabine Huenecke
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Claudia Cappel
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Ruth Esser
- GMP Development Unit, Hannover Medical School, Institute of Cellular Therapeutics , Hannover , Germany
| | - Verena Pfirrmann
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | | | - Sibille Betz
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Eileen Keitl
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | | | - Shahrzad Bakhtiar
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Christoph Königs
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Andrea Jarisch
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Jan Soerensen
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Evelyn Ullrich
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt, Germany; LOEWE Center for Cell and Gene Therapy, Goethe University, Frankfurt, Germany
| | - Thomas Klingebiel
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Peter Bader
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Melanie Bremm
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
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15
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Bakhtiar S, Gámez-Díaz L, Jarisch A, Soerensen J, Grimbacher B, Belohradsky B, Keller KM, Rietschel C, Klingebiel T, Koletzko S, Albert MH, Bader P. Treatment of Infantile Inflammatory Bowel Disease and Autoimmunity by Allogeneic Stem Cell Transplantation in LPS-Responsive Beige-Like Anchor Deficiency. Front Immunol 2017; 8:52. [PMID: 28197149 PMCID: PMC5281554 DOI: 10.3389/fimmu.2017.00052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/22/2016] [Accepted: 01/12/2017] [Indexed: 01/21/2023] Open
Abstract
Inflammatory bowel disease (IBD) in young children can be a clinical manifestation of various primary immunodeficiency syndromes. Poor clinical outcome is associated with poor quality of life and high morbidity from the complications of prolonged immunosuppressive treatment and malabsorption. In 2012, mutations in the lipopolysaccharide-responsive beige-like anchor (LRBA) gene were identified as the cause of an autoimmunity and immunodeficiency syndrome. Since then, several LRBA-deficient patients have been reported with a broad spectrum of clinical manifestations without reliable predictive prognostic markers. Allogeneic hematopoietic stem cell transplantation (alloHSCT) has been performed in a few severely affected patients with complete or partial response. Herein, we present a detailed course of the disease and the transplantation procedure used in a LRBA-deficient patient suffering primarily from infantile IBD with immune enteropathy since the age of 6 weeks, and progressive autoimmunity with major complications following long-term immunosuppressive treatment. At 12 years of age, alloHSCT using bone marrow of a fully matched sibling donor—a healthy heterozygous LRBA mutant carrier—was performed after conditioning with a reduced-intensity regimen. During the 6-year follow-up, we observed a complete remission of enteropathy, autoimmunity, and skin vitiligo, with complete donor chimerism. The genetic diagnosis of LRBA deficiency was made post-alloHSCT by detection of two compound heterozygous mutations, using targeted sequencing of DNA samples extracted from peripheral blood before the transplantation.
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Affiliation(s)
- Shahrzad Bakhtiar
- Division for Pediatric Stem-Cell Transplantation and Immunology, University Hospital Frankfurt , Frankfurt/Main , Germany
| | - Laura Gámez-Díaz
- Center for Chronic Immunodeficiency, University Hospital , Freiburg , Germany
| | - Andrea Jarisch
- Division for Pediatric Stem-Cell Transplantation and Immunology, University Hospital Frankfurt , Frankfurt/Main , Germany
| | - Jan Soerensen
- Division for Pediatric Stem-Cell Transplantation and Immunology, University Hospital Frankfurt , Frankfurt/Main , Germany
| | - Bodo Grimbacher
- Center for Chronic Immunodeficiency, University Hospital , Freiburg , Germany
| | - Bernd Belohradsky
- Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University , Munich , Germany
| | | | | | - Thomas Klingebiel
- Division for Pediatric Stem-Cell Transplantation and Immunology, University Hospital Frankfurt , Frankfurt/Main , Germany
| | - Sibylle Koletzko
- Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University , Munich , Germany
| | - Michael H Albert
- Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University , Munich , Germany
| | - Peter Bader
- Division for Pediatric Stem-Cell Transplantation and Immunology, University Hospital Frankfurt , Frankfurt/Main , Germany
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16
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Lucchini G, Willasch AM, Daniel J, Soerensen J, Jarisch A, Bakhtiar S, Rettinger E, Brandt J, Klingebiel T, Bader P. Epidemiology, risk factors, and prognosis of capillary leak syndrome in pediatric recipients of stem cell transplants: a retrospective single-center cohort study. Pediatr Transplant 2016; 20:1132-1136. [PMID: 27734564 DOI: 10.1111/petr.12831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Accepted: 09/14/2016] [Indexed: 12/15/2022]
Abstract
CLS involves sudden loss of intravascular fluids into the interstitial spaces. CLS was described as a possible complication after SCT. Few studies report the incidence of CLS in pediatric populations. We aimed to assess CLS incidence, its risk factors, and impact on the survival. The clinical charts of patients <18 years of age transplanted at our institution between 2002 and 2012 were reviewed. CLS was defined by weight gain >3% in 24 hours and positive intake balance despite furosemide administration. In total, 234 patients underwent 275 allogeneic SCT procedures in the analyzed time frame. Fifteen patients developed CLS (5.4%). The probability of developing CLS was significantly increased in patients suffering from sepsis (14.3% vs 0.6%, P<.001). Patients with CLS exhibited an increased risk of acute GvHD in the first 30 days after SCT (10.8% vs 1.8%, P=.002). Ten of the patients with CLS required intensive care. CLS strongly impacts OS at day +100 after SCT and is a predictive factor of TRM at the same date (42.9% vs 5%, P<.0001). The biological relation among sepsis, GvHD, and CLS development in terms of cytokine release and endothelial damage warrants further studies.
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Affiliation(s)
- Giovanna Lucchini
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.,Stem Cell Transplantation Unit, Pediatric Department, Great Ormond Street Hospital, London, United Kingdom
| | - Andre Manfred Willasch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Julia Daniel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Jan Soerensen
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Andrea Jarisch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Shahrzad Bakhtiar
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Joerg Brandt
- Intensive Care Unit, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
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17
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Soerensen J, Suurmond J, Lanting K, Krasnik A. Capacity building in Danish Medical Education: towards culturally competent medical teachers. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw164.044] [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: 11/13/2022] Open
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18
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Bremm M, Huenecke S, Zimmermann O, Pfirrmann V, Quaiser A, Bonig H, Soerensen J, Klingebiel T, Rettinger E, Bader P, Cappel C. In-vitro influence of mycophenolate mofetil (MMF) and Ciclosporin A (CsA) on cytokine induced killer (CIK) cell immunotherapy. J Transl Med 2016; 14:264. [PMID: 27620209 PMCID: PMC5020454 DOI: 10.1186/s12967-016-1024-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/30/2016] [Accepted: 08/30/2016] [Indexed: 01/10/2023] Open
Abstract
Background Cytokine-induced-killer (CIK) cells are a promising immunotherapeutic approach for impending relapse following hematopoietic stem cell transplantation (HSCT). However, there is a high risk for treatment failure associated with severe graft versus host disease (GvHD) necessitating pharmaceutical intervention post-transplant. Whether immunosuppression with mycophenolate mofetil (MMF) or Ciclosporin A (CsA) influences the cytotoxic effect of CIK cell immunotherapy is still an open issue. Methods CIK cells were generated from PBMC as previously described followed by co-incubation with mycophenolic acid (MPA) or CsA. Proliferation, cytotoxicity and receptor expression were investigated following short- (24 h), intermediate- (3 days) and long-term (7 days) MPA incubation with the intention to simulate the in vivo situation when CIK cells were given to a patient with relevant MPA/CsA plasma levels. Results Short-term MPA treatment led to unchanged proliferation capacity and barely had any effect on viability and cytotoxic capability in vitro. The composition of CIK cells with respect to T-, NK-like T- and NK cells remained stable. Intermediate MPA treatment lacked effects on NKG2D, FasL and TRAIL receptor expression, while an influence on proliferation and viability was detectable. Furthermore, long-term treatment significantly impaired proliferation, restricted viability and drastically reduced migration-relevant receptors accompanied by an alteration in the CD4/CD8 ratio. CD3+CD56+ cells upregulated receptors relevant for CIK cell killing and migration, whereas T cells showed the most interference through significant reductions in receptor expression. Interestingly, CsA treatment had no significant influence on CIK cell viability and the cytotoxic potential against K562. Conclusions Our data indicate that if immunosuppressant therapy is indispensable, efficacy of CIK cells is maintained at least short-term, although more frequent dosing might be necessary. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-1024-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melanie Bremm
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.
| | - Sabine Huenecke
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Olga Zimmermann
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Verena Pfirrmann
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Andrea Quaiser
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Halvard Bonig
- Division for Translational Development of Cellular Therapeutics, Institute for Transfusion Medicine and Immunohematology, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.,German Red Cross Blood Donor Service Baden-Württemberg-Hessen, Frankfurt/Main, Germany
| | - Jan Soerensen
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Eva Rettinger
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Peter Bader
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Claudia Cappel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
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19
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Huenecke S, Bremm M, Cappel C, Esser R, Quaiser A, Bonig H, Jarisch A, Soerensen J, Klingebiel T, Bader P, Koehl U. Optimization of individualized graft composition: CD3/CD19 depletion combined with CD34 selection for haploidentical transplantation. Transfusion 2016; 56:2336-45. [DOI: 10.1111/trf.13694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/04/2016] [Accepted: 05/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Sabine Huenecke
- Clinic for Pediatric and Adolescent MedicineUniversity HospitalFrankfurt Germany
| | - Melanie Bremm
- Clinic for Pediatric and Adolescent MedicineUniversity HospitalFrankfurt Germany
| | - Claudia Cappel
- Clinic for Pediatric and Adolescent MedicineUniversity HospitalFrankfurt Germany
| | - Ruth Esser
- GMP Development UnitInstitute of Cellular Therapeutics, IFB‐TX, Hannover Medical SchoolHannover Germany
| | - Andrea Quaiser
- Clinic for Pediatric and Adolescent MedicineUniversity HospitalFrankfurt Germany
| | - Halvard Bonig
- Division for Cell ProcessingInstitute for Transfusion Medicine and Immunohematology, Goethe‐University Frankfurt/Main
- German Red Cross Blood Donor Service, Baden‐Württemberg‐HessenFrankfurt/Main, Germany
| | - Andrea Jarisch
- Clinic for Pediatric and Adolescent MedicineUniversity HospitalFrankfurt Germany
| | - Jan Soerensen
- Clinic for Pediatric and Adolescent MedicineUniversity HospitalFrankfurt Germany
| | - Thomas Klingebiel
- Clinic for Pediatric and Adolescent MedicineUniversity HospitalFrankfurt Germany
| | - Peter Bader
- Clinic for Pediatric and Adolescent MedicineUniversity HospitalFrankfurt Germany
| | - Ulrike Koehl
- Clinic for Pediatric and Adolescent MedicineUniversity HospitalFrankfurt Germany
- GMP Development UnitInstitute of Cellular Therapeutics, IFB‐TX, Hannover Medical SchoolHannover Germany
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20
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Kuçi Z, Bönig H, Kreyenberg H, Bunos M, Jauch A, Janssen JWG, Škifić M, Michel K, Eising B, Lucchini G, Bakhtiar S, Greil J, Lang P, Basu O, von Luettichau I, Schulz A, Sykora KW, Jarisch A, Soerensen J, Salzmann-Manrique E, Seifried E, Klingebiel T, Bader P, Kuçi S. Mesenchymal stromal cells from pooled mononuclear cells of multiple bone marrow donors as rescue therapy in pediatric severe steroid-refractory graft-versus-host disease: a multicenter survey. Haematologica 2016; 101:985-94. [PMID: 27175026 DOI: 10.3324/haematol.2015.140368] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/04/2016] [Indexed: 12/25/2022] Open
Abstract
To circumvent donor-to-donor heterogeneity which may lead to inconsistent results after treatment of acute graft-versus-host disease with mesenchymal stromal cells generated from single donors we developed a novel approach by generating these cells from pooled bone marrow mononuclear cells of 8 healthy "3(rd)-party" donors. Generated cells were frozen in 209 vials and designated as mesenchymal stromal cell bank. These vials served as a source for generation of clinical grade mesenchymal stromal cell end-products, which exhibited typical mesenchymal stromal cell phenotype, trilineage differentiation potential and at later passages expressed replicative senescence-related markers (p21 and p16). Genetic analysis demonstrated their genomic stability (normal karyotype and a diploid pattern). Importantly, clinical end-products exerted a significantly higher allosuppressive potential than the mean allosuppressive potential of mesenchymal stromal cells generated from the same donors individually. Administration of 81 mesenchymal stromal cell end-products to 26 patients with severe steroid-resistant acute graft-versus-host disease in 7 stem cell transplant centers who were refractory to many lines of treatment, induced a 77% overall response at the primary end point (day 28). Remarkably, although the cohort of patients was highly challenging (96% grade III/IV and only 4% grade II graft-versus-host disease), after treatment with mesenchymal stromal cell end-products the overall survival rate at two years follow up was 71±11% for the entire patient cohort, compared to 51.4±9.0% in graft-versus-host disease clinical studies, in which mesenchymal stromal cells were derived from single donors. Mesenchymal stromal cell end-products may, therefore, provide a novel therapeutic tool for the effective treatment of severe acute graft-versus-host disease.
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Affiliation(s)
- Zyrafete Kuçi
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Halvard Bönig
- Institute of Transfusion Medicine and German Red Cross Blood Center Frankfurt, Frankfurt am Main, Germany
| | - Hermann Kreyenberg
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Milica Bunos
- Institute of Transfusion Medicine and German Red Cross Blood Center Frankfurt, Frankfurt am Main, Germany
| | - Anna Jauch
- Institute of Human Genetics, University of Heidelberg, Germany
| | | | - Marijana Škifić
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany University Hospital Centre Zagreb, Clinical Department of Transfusion and Transplantation Biology, Division of Cellular Therapy, Zagreb, Croatia
| | - Kristina Michel
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Ben Eising
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Giovanna Lucchini
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany Great Ormond Street Hospital, Department of Hematology/Oncology, London, United Kingdom
| | - Shahrzad Bakhtiar
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Johann Greil
- University Children's Hospital Heidelberg, Germany
| | - Peter Lang
- University Children's Hospital Tübingen, Germany
| | - Oliver Basu
- University Children's Hospital Essen, Germany
| | | | | | | | - Andrea Jarisch
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Jan Soerensen
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Erhard Seifried
- Institute of Transfusion Medicine and German Red Cross Blood Center Frankfurt, Frankfurt am Main, Germany
| | - Thomas Klingebiel
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Peter Bader
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
| | - Selim Kuçi
- University Hospital Frankfurt, Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, Frankfurt am Main, Germany
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21
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Bader P, Huenecke S, Bönig H, Merker M, Jarisch A, Soerensen J, Willasch A, Bug G, Schulz A, Klingebiel TE, Rettinger E. Preemptive Treatment of Minimal Residual Disease (MRD) with IL-15-Activated Cytokine-Induced Killer Cells for the Prevention of Relapse in Leukemia Patients after Allogeneic Stem Cell Transplantation – Results of a Pilot Study. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.324] [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: 11/25/2022]
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22
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Rettinger E, Huenecke S, Bonig H, Merker M, Jarisch A, Soerensen J, Willasch A, Bug G, Schulz A, Klingebiel T, Bader P. Interleukin-15-activated cytokine-induced killer cells may sustain remission in leukemia patients after allogeneic stem cell transplantation: feasibility, safety and first insights on efficacy. Haematologica 2016; 101:e153-6. [PMID: 26768688 DOI: 10.3324/haematol.2015.138016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Eva Rettinger
- JW Goethe University Frankfurt, Hospital for Children and Adolescents, Department of Stem Cell Transplantation and Immunology, Germany
| | - Sabine Huenecke
- JW Goethe University Frankfurt, Hospital for Children and Adolescents, Department of Stem Cell Transplantation and Immunology, Germany
| | - Halvard Bonig
- JW Goethe University Frankfurt, Institute for Transfusion Medicine and Immunohematology, and German Red Cross Blood Donor Service Baden-Württemberg-Hessen, Department of Cellular Therapeutics / Cell Processing (GMP), Frankfurt/Main, Germany University of Washington, Department of Medicine/Hematology, Seattle, WA, USA
| | - Michael Merker
- JW Goethe University Frankfurt, Hospital for Children and Adolescents, Department of Stem Cell Transplantation and Immunology, Germany
| | - Andrea Jarisch
- JW Goethe University Frankfurt, Hospital for Children and Adolescents, Department of Stem Cell Transplantation and Immunology, Germany
| | - Jan Soerensen
- JW Goethe University Frankfurt, Hospital for Children and Adolescents, Department of Stem Cell Transplantation and Immunology, Germany
| | - Andre Willasch
- JW Goethe University Frankfurt, Hospital for Children and Adolescents, Department of Stem Cell Transplantation and Immunology, Germany
| | - Gesine Bug
- JW Goethe University Frankfurt, Department of Medicine II, Hematology, Oncology, Rheumatology and Infectious Diseases, Germany
| | - Ansgar Schulz
- University Medical Center Ulm, Department of Pediatrics, Germany
| | - Thomas Klingebiel
- JW Goethe University Frankfurt, Hospital for Children and Adolescents, Department of Stem Cell Transplantation and Immunology, Germany
| | - Peter Bader
- JW Goethe University Frankfurt, Hospital for Children and Adolescents, Department of Stem Cell Transplantation and Immunology, Germany
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Kuci Z, Bönig H, Kreyenberg H, Bunos M, Jauch A, Janssen J, Skific M, Michel K, Eising B, Lucchini G, Jarisch A, Soerensen J, Seifried E, Klingebiel T, Bader P, Kuci S. Establishment of a GMP-compliant mesenchymal stromal cell bank from pooled bone marrow mononuclear cells of eight “third-party” healthy donors: clinical evidence of safety and efficacy. Cytotherapy 2015. [DOI: 10.1016/j.jcyt.2015.03.325] [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: 11/25/2022]
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Bouyoucef SE, Uusitalo V, Kamperidis V, De Graaf M, Maaniitty T, Stenstrom I, Broersen A, Scholte A, Saraste A, Bax J, Knuuti J, Furuhashi T, Moroi M, Awaya T, Masai H, Minakawa M, Kunimasa T, Fukuda H, Sugi K, Berezin A, Kremzer A, Clerc O, Kaufmann B, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Kaufmann P, Buechel R, Ferreira M, Cunha M, Albuquerque A, Ramos D, Costa G, Lima J, Pego M, Peix A, Cisneros L, Cabrera L, Padron K, Rodriguez L, Heres F, Carrillo R, Mena E, Fernandez Y, Huizing E, Van Dijk J, Van Dalen J, Timmer J, Ottervanger J, Slump C, Jager P, Venuraju S, Jeevarethinam A, Yerramasu A, Atwal S, Mehta V, Lahiri A, Arjonilla Lopez A, Calero Rueda MJ, Gallardo G, Fernandez-Cuadrado J, Hernandez Aceituno D, Sanchez Hernandez J, Yoshida H, Mizukami A, Matsumura A, Smettei O, Abazid R, Sayed S, Mlynarska A, Mlynarski R, Golba K, Sosnowski M, Winther S, Svensson M, Jorgensen H, Bouchelouche K, Gormsen L, Holm N, Botker H, Ivarsen P, Bottcher M, Cortes CM, Aramayo G E, Daicz M, Casuscelli J, Alaguibe E, Neira Sepulveda A, Cerda M, Ganum G, Embon M, Vigne J, Enilorac B, Lebasnier A, Valancogne L, Peyronnet D, Manrique A, Agostini D, Menendez D, Rajpal S, Kocherla C, Acharya M, Reddy P, Sazonova I, Ilushenkova Y, Batalov R, Rogovskaya Y, Lishmanov Y, Popov S, Varlamova N, Prado Diaz S, Jimenez Rubio C, Gemma D, Refoyo Salicio E, Valbuena Lopez S, Moreno Yanguela M, Torres M, Fernandez-Velilla M, Lopez-Sendon J, Guzman Martinez G, Puente A, Rosales S, Martinez C, Cabada M, Melendez G, Ferreira R, Gonzaga A, Santos J, Vijayan S, Smith S, Smith M, Muthusamy R, Takeishi Y, Oikawa M, Goral JL, Napoli J, Montana O, Damico A, Quiroz M, Damico A, Forcada P, Schmidberg J, Zucchiatti N, Olivieri D, Jeevarethinam A, Venuraju S, Dumo A, Ruano S, Rakhit R, Davar J, Nair D, Cohen M, Darko D, Lahiri A, Yokota S, Ottervanger J, Maas A, Mouden M, Timmer J, Knollema S, Jager P, Sanja Mazic S, Lazovic B, Marina Djelic M, Jelena Suzic Lazic J, Tijana Acimovic T, Milica Deleva M, Vesnina Z, Zafrir N, Bental T, Mats I, Solodky A, Gutstein A, Hasid Y, Belzer D, Kornowski R, Ben Said R, Ben Mansour N, Ibn Haj Amor H, Chourabi C, Hagui A, Fehri W, Hawala H, Shugushev Z, Patrikeev A, Maximkin D, Chepurnoy A, Kallianpur V, Mambetov A, Dokshokov G, Teresinska A, Wozniak O, Maciag A, Wnuk J, Dabrowski A, Czerwiec A, Jezierski J, Biernacka K, Robinson J, Prosser J, Cheung G, Allan S, Mcmaster G, Reid S, Tarbuck A, Martin W, Queiroz R, Falcao A, Giorgi M, Imada R, Nogueira S, Chalela W, Kalil Filho R, Meneghetti W, Matveev V, Bubyenov A, Podzolkov V, Shugushev Z, Maximkin D, Chepurnoy A, Baranovich V, Faibushevich A, Kolzhecova Y, Volkova O, Kallianpur V, Peix A, Cabrera L, Padron K, Rodriguez L, Fernandez J, Lopez G, Mena E, Fernandez Y, Dondi M, Paez D, Butcher C, Reyes E, Al-Housni M, Green R, Santiago H, Ghiotto F, Hinton-Taylor S, Pottle A, Mason M, Underwood S, Casans Tormo I, Diaz-Exposito R, Plancha-Burguera E, Elsaban K, Alsakhri H, Yoshinaga K, Ochi N, Tomiyama Y, Katoh C, Inoue M, Nishida M, Suzuki E, Manabe O, Ito Y, Tamaki N, Tahilyani A, Jafary F, Ho Hee Hwa H, Ozdemir S, Kirilmaz B, Barutcu A, Tan Y, Celik F, Sakgoz S, Cabada Gamboa M, Puente Barragan A, Morales Vitorino N, Medina Servin M, Hindorf C, Akil S, Hedeer F, Jogi J, Engblom H, Martire V, Pis Diez E, Martire M, Portillo D, Hoff C, Balche A, Majgaard J, Tolbod L, Harms H, Bouchelouche K, Soerensen J, Froekiaer J, Gormsen L, Nudi F, Neri G, Procaccini E, Pinto A, Vetere M, Biondi-Zoccai G, Falcao A, Chalela W, Giorgi M, Imada R, Soares J, Do Val R, Oliveira M, Kalil Filho R, Meneghetti J, Tekabe Y, Anthony T, Li Q, Schmidt A, Johnson L, Groenman M, Tarkia M, Kakela M, Halonen P, Kiviniemi T, Pietila M, Yla-Herttuala S, Knuuti J, Roivainen A, Saraste A, Nekolla S, Swirzek S, Higuchi T, Reder S, Schachoff S, Bschorner M, Laitinen I, Robinson S, Yousefi B, Schwaiger M, Kero T, Lindsjo L, Antoni G, Westermark P, Carlson K, Wikstrom G, Sorensen J, Lubberink M, Rouzet F, Cognet T, Guedj K, Morvan M, El Shoukr F, Louedec L, Choqueux C, Nicoletti A, Le Guludec D, Jimenez-Heffernan A, Munoz-Beamud F, Sanchez De Mora E, Borrachero C, Salgado C, Ramos-Font C, Lopez-Martin J, Hidalgo M, Lopez-Aguilar R, Soriano E, Okizaki A, Nakayama M, Ishitoya S, Sato J, Takahashi K, Burchert I, Caobelli F, Wollenweber T, Nierada M, Fulsche J, Dieckmann C, Bengel F, Shuaib S, Mahlum D, Port S, Gemma D, Refoyo E, Cuesta E, Guzman G, Lopez T, Valbuena S, Fernandez-Velilla M, Del Prado S, Moreno M, Lopez-Sendon J, Harbinson M, Donnelly L, Einstein AJ, Johnson LL, Deluca AJ, Kontak AC, Groves DW, Stant J, Pozniakoff T, Cheng B, Rabbani LE, Bokhari S, Caobelli F, Schuetze C, Nierada M, Fulsche J, Dieckmann C, Bengel F, Aguade-Bruix S, Pizzi M, Romero-Farina G, Terricabras M, Villasboas D, Castell-Conesa J, Candell-Riera J, Brunner S, Gross L, Todica A, Lehner S, Di Palo A, Niccoli Asabella A, Magarelli C, Notaristefano A, Ferrari C, Rubini G, Sellem A, Melki S, Elajmi W, Hammami H, Ziadi M, Montero J, Ameriso J, Villavicencio R, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Barinaga Martin C, Martin Fernandez J, Alonso Rodriguez D, Iglesias Garriz I, Gemma D, Refoyo E, Cuesta E, Guzman G, Valbuena S, Rosillo S, Del Prado S, Torres M, Moreno M, Lopez-Sendon J, Taleb S, Cherkaoui Salhi G, Regbaoui Y, Ait Idir M, Guensi A, Puente A, Rosales S, Martinez C, Cabada M, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Martin Lopez CE, Castano Ruiz M, Martin Fernandez J, Iglesias Garriz I. Poster Session 2: Monday 4 May 2015, 08:00-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brehm C, Huenecke S, Esser R, Kloess S, Quaiser A, Betz S, Zimmermann O, Soerensen J, Passweg JR, Klingebiel T, Schwabe D, Bader P, Koehl U. Interleukin-2-stimulated natural killer cells are less susceptible to mycophenolate mofetil than non-activated NK cells: possible consequences for immunotherapy. Cancer Immunol Immunother 2014; 63:821-33. [PMID: 24806448 PMCID: PMC11028798 DOI: 10.1007/s00262-014-1556-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 04/22/2014] [Indexed: 01/05/2023]
Abstract
In a clinical phase I/II trial, pediatric patients with high-risk malignancies were treated with ex vivo IL-2-stimulated donor natural killer (NK) cells after transplantation with haploidentical stem cells. To evaluate the potential negative effects of the immunosuppressive drug mycophenolate mofetil (MMF) used for immunotherapy, the functionality and signaling of ex vivo NK cells was investigated. Our results show that during NK cell expansion, long-term (9 days) incubation with mycophenolic acid (MPA), the active metabolite of MMF, in therapeutically relevant concentrations led to the severe inhibition of NK cell proliferation. This correlated with a significantly reduced cytokine/chemokine secretion and the inhibited acquisition of surface receptors regarding cytotoxicity (e.g., NKp30, NKp44, NKp46, NKG2D), adhesion/migration (e.g., ICAM-1/CD54, LFA-1/CD11a, CD62L, CXCR3) and activation (e.g., CD25). Moreover, MPA prevented phosphorylation of the central signaling molecules STAT-3/-4/-5, AKT and ERK1/2. In contrast, short-term (24 h) MPA incubation of IL-2-stimulated NK cells had no or only marginal effects on the activated NK cell phenotype, including receptor expression, cytokine/chemokine secretion and intracellular signaling. Further, short-term MPA incubation only moderately affected the highly cytotoxic activity of previously IL-2-stimulated NK cells. In conclusion, while long-term MPA incubation significantly compromised ex vivo NK cell functionality, previously IL-2-activated NK cells seemed to be rather resistant to short-term MPA treatment. This finding supports the use of IL-2-activated NK cells as immunotherapy, especially for patients treated with MMF after haploidentical stem cell transplantation.
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Affiliation(s)
- Claudia Brehm
- Clinic for Pediatric and Adolescent Medicine, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany,
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Speckmann C, Lehmberg K, Albert MH, Damgaard RB, Fritsch M, Gyrd-Hansen M, Rensing-Ehl A, Vraetz T, Grimbacher B, Salzer U, Fuchs I, Ufheil H, Belohradsky BH, Hassan A, Cale CM, Elawad M, Strahm B, Schibli S, Lauten M, Kohl M, Meerpohl JJ, Rodeck B, Kolb R, Eberl W, Soerensen J, von Bernuth H, Lorenz M, Schwarz K, Zur Stadt U, Ehl S. X-linked inhibitor of apoptosis (XIAP) deficiency: the spectrum of presenting manifestations beyond hemophagocytic lymphohistiocytosis. Clin Immunol 2013; 149:133-41. [PMID: 23973892 DOI: 10.1016/j.clim.2013.07.004] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [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: 01/09/2013] [Revised: 07/14/2013] [Accepted: 07/23/2013] [Indexed: 02/08/2023]
Abstract
X-linked inhibitor of apoptosis (XIAP) deficiency caused by mutations in BIRC4 was initially described in patients with X-linked lymphoproliferative syndrome (XLP) who had no mutations in SH2D1A. In the initial reports, EBV-associated hemophagocytic lymphohistiocytosis (HLH) was the predominant clinical phenotype. Among 25 symptomatic patients diagnosed with XIAP deficiency, we identified 17 patients who initially presented with manifestations other than HLH. These included Crohn-like bowel disease (n=6), severe infectious mononucleosis (n=4), isolated splenomegaly (n=3), uveitis (n=1), periodic fever (n=1), fistulating skin abscesses (n=1) and severe Giardia enteritis (n=1). Subsequent manifestations included celiac-like disease, antibody deficiency, splenomegaly and partial HLH. Screening by flow cytometry identified 14 of 17 patients in our cohort. However, neither genotype nor protein expression nor results from cell death studies were clearly associated with the clinical phenotype. Only mutation analysis can reliably identify affected patients. XIAP deficiency must be considered in a wide range of clinical presentations.
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Affiliation(s)
- C Speckmann
- Centre of Chronic Immunodeficiency, University Medical Center Freiburg, Germany; Center for Pediatrics and Aldolescent Medicine, University Medical Center Freiburg, Germany.
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Koehl U, Brehm C, Huenecke S, Zimmermann SY, Kloess S, Bremm M, Ullrich E, Soerensen J, Quaiser A, Erben S, Wunram C, Gardlowski T, Auth E, Tonn T, Seidl C, Meyer-Monard S, Stern M, Passweg J, Klingebiel T, Bader P, Schwabe D, Esser R. Clinical grade purification and expansion of NK cell products for an optimized manufacturing protocol. Front Oncol 2013; 3:118. [PMID: 23730623 PMCID: PMC3656406 DOI: 10.3389/fonc.2013.00118] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/26/2013] [Indexed: 12/05/2022] Open
Abstract
Allogeneic natural killer (NK) cells are used for adoptive immunotherapy after stem cell transplantation. In order to overcome technical limitations in NK cell purification and activation, the following study investigates the impact of different variables on NK cell recovery, cytotoxicity, and T-cell depletion during good manufacturing practice (GMP)-grade NK cell selection. Forty NK cell products were derived from 54 unstimulated donor leukaphereses using immunomagnetic CD3 T-cell depletion, followed by a CD56 cell enrichment step. For T-cell depletion, either the depletion 2.1 program in single or double procedure (D2.11depl, n = 18; D2.12depl, n = 13) or the faster depletion 3.1 (D3.1, n = 9) was used on the CliniMACS instrument. Seventeen purified NK cell products were activated in vitro by IL-2 for 12 days. The whole process resulted in a median number of 7.59 × 108 CD56+CD3− cells with both purity and viability of 94%, respectively. The T-cell depletion was significantly better using D2.11depl/2depl compared to D3.1 (log 4.6/log 4.9 vs. log 3.7; p < 0.01) and double procedure in two stages led always to residual T cells below 0.1%. In contrast D3.1 was superior to D2.11depl/2depl with regard to recovery of CD56+CD3− NK cells (68% vs. 41%/38%). Concomitant monocytes and especially IL-2 activation led to increased NK cell activity against malignant target cells compared to unstimulated NK cells, which correlated with both up-regulation of natural cytotoxicity receptors and intracellular signaling. Overall, wide variations in the NK cell expansion rate and the distribution of NK cell subpopulations were found. In conclusion, our results indicate that GMP-grade purification of NK cells might be improved by a sequential processing of T-cell depletion program D2.1 and D3.1. In addition NK cell expansion protocols need to be further optimized.
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Affiliation(s)
- Ulrike Koehl
- Institute of Cellular Therapeutics, Integrated Research and Treatment Center Transplantation, Hannover Medical School Hannover, Germany
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Rettinger E, Bonig H, Wehner S, Lucchini G, Willasch A, Jarisch A, Soerensen J, Esser R, Rossig C, Klingebiel T, Bader P. Feasibility of IL-15-activated cytokine-induced killer cell infusions after haploidentical stem cell transplantation. Bone Marrow Transplant 2013; 48:1141-3. [DOI: 10.1038/bmt.2013.19] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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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Bader P, Willasch A, Soerensen J, Jarisch A, Rettinger E, Lucchini G, Klingebiel TE. Incidence and Mortality of Adenovirus Infection After Pediatric Allogeneic SCT – A Comparison Between Bone Marrow and CD3/19 Depleted PBSC. Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.312] [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: 11/15/2022]
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Bochennek K, Esser R, Lehrnbecher T, Glienke W, Wehner S, Erben S, Soerensen J, Schwabe D, Bader P, Klingebiel T, Koehl U. Impact of Minimal Residual Disease Detection Prior to Autologous Stem Cell Transplantation for Post-transplant Outcome in High Risk Neuroblastoma. Klin Padiatr 2012; 224:139-42. [DOI: 10.1055/s-0031-1301334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- K. Bochennek
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
| | - R. Esser
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
| | - T. Lehrnbecher
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
| | - W. Glienke
- Innere Medizin, Universitätsklinik Frankfurt, Germany
| | - S. Wehner
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
| | - S. Erben
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
| | - J. Soerensen
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
| | - D. Schwabe
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
| | - P. Bader
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
| | - T. Klingebiel
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
| | - U. Koehl
- Pädiatrische Hämatologie und Onkologie, Universitätsklinik Frankfurt, Germany
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Larsen C, Soerensen J, Grantcharov T, Dalsgaard T, Schouenborg L, Ottosen C, Schroeder T, Ottesen B. O507 Impact of virtual reality training in laparoscopic gynaecology. Int J Gynaecol Obstet 2011. [DOI: 10.1016/s0020-7292(09)60880-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lehrnbecher T, Salzmann-Manrique E, Soerensen J, Beutel K, Janka G, Gadner H, Minkov M. Variant alleles of cytokine genes influence risk and clinical course of Langerhans cell histiocytosis. Br J Haematol 2011; 156:138-41. [DOI: 10.1111/j.1365-2141.2011.08816.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kloess S, Huenecke S, Piechulek D, Esser R, Koch J, Brehm C, Soerensen J, Gardlowski T, Brinkmann A, Bader P, Passweg J, Klingebiel T, Schwabe D, Koehl U. IL-2-activated haploidentical NK cells restore NKG2D-mediated NK-cell cytotoxicity in neuroblastoma patients by scavenging of plasma MICA. Eur J Immunol 2010; 40:3255-67. [PMID: 21061445 DOI: 10.1002/eji.201040568] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 07/23/2010] [Accepted: 08/30/2010] [Indexed: 01/08/2023]
Abstract
NK group 2D (NKG2D)-expressing NK cells exhibit cytolytic activity against various tumors after recognition of the cellular ligand MHC class I chain-related gene A (MICA). However, release of soluble MICA (sMICA) compromises NKG2D-dependent NK-cell cytotoxicity leading to tumor escape from immunosurveillance. Although some molecular details of the NKG2D-MICA interaction have been elucidated, its impact for donor NK (dNK) cell-based therapy of solid tumors has not been studied. Within an ongoing phase I/II trial, we used allogeneic IL-2 activated dNK cells after haploidentical stem cell transplantation for immunotherapy of patients with high-risk stage IV neuroblastoma. NKG2D levels on activated dNK cells increased strongly when compared with freshly isolated dNK cells and correlated with enhanced NK-cell cytotoxicity. Most importantly, elevated sMICA levels in patients plasma correlated significantly with impaired dNK-cell-mediated cytotoxicity. This effect could be reversed by high-dose infusion of activated dNK cells, which display high levels of surface NKG2D. Our data suggest that the provided excess of NKG2D leads to clearance of sMICA and preserves cytotoxicity of dNK cells via non-occupied NKG2D. In conclusion, our results identify this tumor immune escape mechanism as a target to improve immunotherapy of neuroblastoma and presumably other tumors.
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Affiliation(s)
- Stephan Kloess
- Pediatric Hematology and Oncology Laboratory for Stem Cell Transplantation and Immunotherapy, Hospital of Johann Wolfgang Goethe-University, Frankfurt, Germany.
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Schlichtiger J, Pekcec A, Bartmann H, Winter P, Fuest C, Soerensen J, Potschka H. Celecoxib treatment restores pharmacosensitivity in a rat model of pharmacoresistant epilepsy. Br J Pharmacol 2010; 160:1062-71. [PMID: 20590600 DOI: 10.1111/j.1476-5381.2010.00765.x] [Citation(s) in RCA: 64] [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: 01/16/2023] Open
Abstract
BACKGROUND AND PURPOSE A functional link between seizure-induced P-glycoprotein overexpression at the blood-brain barrier and therapeutic failure has been suggested by several studies using rodent epilepsy models and human epileptic tissue. Recently, we reported that interference with the mechanisms that up-regulate P-glycoprotein in response to seizure activity might provide a novel approach to control its expression in the epileptic brain. Based on these data, we hypothesized that blocking the appropriate signalling cascade by cyclooxygenase-2 inhibition should improve brain penetration of antiepileptic drugs and help to overcome drug resistance. EXPERIMENTAL APPROACH Effects of the selective cyclooxygenase-2 inhibitor celecoxib on the response to the P-glycoprotein substrate, phenobarbital, was evaluated in a chronic model of drug-resistant temporal lobe epilepsy in rats. Drug-resistant rats selected from this model exhibit a marked overexpression of P-glycoprotein in the hippocampus and other limbic brain regions. KEY RESULTS Responders and non-responders were selected from a group of rats with spontaneous recurrent seizures after prolonged treatment with phenobarbital at maximum tolerated doses. The efficacy of phenobarbital was re-evaluated following a 6 day treatment with celecoxib and the frequency of spontaneous recurrent seizures was significantly reduced in both groups of rats, phenobarbital responders or non-responders selected from the previous drug trial. CONCLUSIONS AND IMPLICATIONS Pretreatment with the cyclooxygenase-2 inhibitor restored the anticonvulsant activity of phenobarbital in rats that failed to exhibit a relevant response before celecoxib treatment. Our data provide further support for a novel therapeutic approach to overcome transporter-mediated drug resistance in epilepsies.
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Affiliation(s)
- J Schlichtiger
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany
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Pannicke U, Hönig M, Schulze I, Rohr J, Heinz GA, Braun S, Janz I, Rump EM, Seidel MG, Matthes-Martin S, Soerensen J, Greil J, Stachel DK, Belohradsky BH, Albert MH, Schulz A, Ehl S, Friedrich W, Schwarz K. The most frequentDCLRE1C(ARTEMIS) mutations are based on homologous recombination events. Hum Mutat 2010; 31:197-207. [DOI: 10.1002/humu.21168] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Wehner S, Soerensen J, Schwabe D, Tramsen L, Quaritsch R, Esser R, Klingebiel T, Koehl U. 10-Parameter flow cytometry as a new tool to improve diagnosis and MRD follow-up of acute leukemias. Klin Padiatr 2009; 221:393-5. [PMID: 19890796 DOI: 10.1055/s-0029-1239535] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Wehner
- Universitätskinderklinik Frankfurt.
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Sanchez-Torres J, Soerensen J, Paz-Ares L, Schytte T, Latz J, Musib L, Yuan Z, Dickgreber N. 9073 Pemetrexed (PEM) safety and pharmacokinetics (PK) in patients (pts) with third-space fluid (TSF): final results of a phase II study. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71786-0] [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: 10/20/2022] Open
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Willasch A, Eing S, Weber G, Kuçi S, Schneider G, Soerensen J, Jarisch A, Rettinger E, Koehl U, Klingebiel T, Kreyenberg H, Bader P. Enrichment of cell subpopulations applying automated MACS technique: purity, recovery and applicability for PCR-based chimerism analysis. Bone Marrow Transplant 2009; 45:181-9. [DOI: 10.1038/bmt.2009.89] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Koehl U, Dirkwinkel E, Koenig M, Erben S, Soerensen J, Bader P, Doerr HW, Preiser W, Weissinger E, Klingebiel T, Martin H, Lehrnbecher T. Reconstitution of cytomegalovirus specific T cells after pediatric allogeneic stem cell transplantation: results from a pilot study using a multi-allele CMV tetramer group. Klin Padiatr 2008; 220:348-52. [PMID: 18949669 DOI: 10.1055/s-0028-1086029] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recovery of cytomegalovirus (CMV)-specific T cell mediated immunity after allogeneic hematopoietic stem cell transplantation (SCT) is critical for protection against CMV disease. Tetramer-based technologies have been shown to be a sensitive tool in the enumeration of specific T cells, but have the disadvantage of HLA-restriction of the peptides. PATIENTS AND METHODS In this pilot study, we tested the feasibility of a panel of 6 CMV-specific tetrameric HLA/CMV-peptide complexes to enumerate CMV-specific CD8 +T cells (CTLs). The reconstitution of CMV-specific CTLs was assessed in 16 children in the first year after allogeneic SCT (median age, 8 years). RESULTS The presented assay covered more than 85% of our patients transplanted in the last 3 years. During CMV-reactivation, all 4 of the 16 analyzed patients with a high virus-load showed less than 10 CMV-specific CTLs/microl; out of these, three had not any detectable CMV-CTLs. On the other hand, five of the children with less than 10 CMV-specific CTLs/microl did not develop CMV reactivation. When enumeration of T cells was performed by means of different tetrameric HLA/CMV-peptide complexes simultaneously, the numbers of CMV-specific CTLs cells widely differed according to the HLA-type. CONCLUSIONS Our pilot study suggests that enumeration of CMV-specific T cells by means of a panel of 6 tetramers might be a useful tool in the risk assessment for CMV reactivation in the majority of patients undergoing allogeneic SCT, but future trials have to evaluate whether this method is appropriate in tailoring antiviral therapy in the individual patient.
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Affiliation(s)
- U Koehl
- Pediatric Hematology and Oncology, University Children's Hospital, Frankfurt/Main, Germany.
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Bader P, Soerensen J, Koehl U, Kreyenberg H, Jarisch A, Weber G, Sach G, Willasch A, Kuci S, Tonn T, Esser R, Klingebiel T. 66: Excellent Engraftment and Rapid Immune Recovery in Haploidentical Stem Cell Transplantation Using CD3/CD19 Depleted Peripheral Stem Cell Grafts After Reduced Intensity Conditioning. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.074] [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: 11/28/2022]
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41
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Koehl U, Bochennek K, Esser R, Brinkmann A, Quaritsch R, Becker M, Soerensen J, Bader P, Schwabe D, Klingebiel T, Fischer J, Zimmermann SY. ISHAGE-based single-platform flowcytometric analysis for measurement of absolute viable T cells in fresh or cryopreserved products: CD34/CD133 selected or CD3/CD19 depleted stem cells, DLI and purified CD56+CD3− NK cells. Int J Hematol 2007; 87:98-105. [DOI: 10.1007/s12185-007-0018-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 08/27/2007] [Accepted: 09/27/2007] [Indexed: 01/25/2023]
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Husted Madsen A, Haugaard K, Soerensen J, Bokmand S, Friis E, Holtveg H, Peter Garne J, Horby J, Christiansen P. Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group. Breast 2007; 17:138-47. [PMID: 17928226 DOI: 10.1016/j.breast.2007.08.006] [Citation(s) in RCA: 78] [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] [Received: 05/02/2007] [Revised: 07/09/2007] [Accepted: 08/06/2007] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Sentinel lymph node biopsy was implemented in the treatment of early breast cancer with the aim of reducing shoulder and arm morbidity. Relatively few prospective studies have been published where the morbidity was assessed by clinical examination. Very few studies have examined the impact on shoulder mobility of node positive patients having a secondary axillary dissection because of the findings of metastases postoperatively. AIM We aimed to investigate the objective and subjective arm morbidity in node negative and node positive patients. METHODS AND MATERIALS In a prospective study, 395 patients with tumors less than 4 cm, were included. Patients were recruited from seven Danish breast cancer clinics. Both subjective and objective arm and shoulder morbidity were measured before, 6 and 18 months after the operation. RESULTS Comparing node negative patients having a sentinel lymph node biopsy with node negative patients having a lymph node dissection of levels I and II of the axilla, we found significant increase in arm volume among the patients who had an axillary dissection. Only minor, but significant, differences in shoulder mobility were observed comparing the two groups of node negative patients. Highly significant difference was found comparing sensibility. Comparing the morbidity in node positive patients who had a one-step axillary dissection with patients having a two-step procedure (sentinel lymph node biopsy followed by delayed axillary dissection) revealed no difference in objective or subjective arm morbidity. CONCLUSION Node negative patients operated with sentinel lymph node biopsy have less arm morbidity compared with node negative patients operated with axillary lymph node dissection. Node positive patients who had a secondary axillary lymph node dissection after sentinel lymph node biopsy had no difference in either objective or subjective morbidity compared with node positive patients having a one-step axillary dissection.
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Affiliation(s)
- Anders Husted Madsen
- Department of Surgery, Aarhus University Hospital, JageHansensgade 2, 8000 Aarhus C, Denmark.
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Waldemar G, Waldorff FB, Buss DV, Eckermann A, Keiding N, Rishoej S, Soerensen J, Soerensen LV, Vogel A. P4–186: The Danish Alzheimer Intervention Study (DAISY): Rationale, design, and baseline characteristics. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gunhild Waldemar
- Memory Disorders Research Group, Dept. of NeurologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Frans B. Waldorff
- Memory Disorders Research Group, Dept. of NeurologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
- Research Unit and Dept. of General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Dorthe V. Buss
- Memory Disorders Research Group, Dept. of NeurologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Ane Eckermann
- Memory Disorders Research Group, Dept. of NeurologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Niels Keiding
- Dept. of BiostatisticsInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | - Susanne Rishoej
- Memory Disorders Research Group, Dept. of NeurologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Jan Soerensen
- CAST - Centre for Applied Health Services Research and Technology AssessmentUniversity of Southern DenmarkOdenseDenmark
| | - Lisbeth V. Soerensen
- Memory Disorders Research Group, Dept. of NeurologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Asmus Vogel
- Memory Disorders Research Group, Dept. of NeurologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
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Bader P, Koehl U, Soerensen J, Lang P, Kreyenberg H, Sach G, Becker M, Willasch A, Esser R, Handgretinger R, Klingebiel T. Haploidentical stem cell transplantation in children: Improved engraftment and immune recovery after depletion of T and B cells instead of positive selection of stem cells? Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Buxmann H, Soerensen J, Koehl U, Schwabe D, Klingebiel T, Reinert RR, Schaefer V. Meningitis Due to Multiple-Resistant
Penicillin- and Cefotaxime-Intermediate Streptococcus pneumoniae in a German
Child after Bone Marrow Transplantation. Infection 2003; 31:425-7. [PMID: 14735387 DOI: 10.1007/s15010-003-3134-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2002] [Accepted: 04/08/2003] [Indexed: 11/29/2022]
Abstract
The incidence of infection with penicillin-non-susceptible Streptococcus pneumoniae is increasing rapidly worldwide. Spain and France are highly affected, whereas the level of penicillin resistance in Germany, Italy, The Netherlands and Scandinavia is low. We report a lethal episode of meningitis due to penicillin- and cefotaxime-intermediate S. pneumoniae in a 7-year-old, allogene bone marrow transplanted German boy, 5 weeks after a holiday in Spain. Three days prior to the infection the patient showed good performance status. He was in complete remission without signs of graft-versus-host disease (GVHD). He died on day 341 post bone marrow transplant (BMT), 2 days after the onset of meningitis. Penicillin-non-susceptible S. pneumoniae should be regarded as a potential infectious agent even in countries with a low prevalence of resistance.
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Affiliation(s)
- H Buxmann
- Dept. of Neonatology, Johann Wolfgang Goethe University, Children's Hospital, Frankfurt am Main, Germany
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Zimmermann SY, Klingebiel T, Koehl U, Soerensen J, Schwabe D. Tecelac as antithymocyte globulin in conditioning for childhood allogeneic stem cell transplantation. Bone Marrow Transplant 2002; 29:957-62. [PMID: 12098062 PMCID: PMC7091629 DOI: 10.1038/sj.bmt.1703561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2001] [Accepted: 02/12/2002] [Indexed: 12/02/2022]
Abstract
Antithymocyte globulin (ATG) preparations in allogeneic stem cell transplantation are used in various conditioning regimens both to prevent graft rejection and reduce the incidence and severity of graft-versus-host disease. Tecelac (RATG) is a highly purified ATG preparation with high specific activity. The high specific antibody content implies the need for lower doses, with reduced side-effects in comparison to other ATGs. Here, we report on the first 10 patients worldwide who received RATG as part of conditioning. Patients were heterogeneous with regard to diagnoses and graft characteristics. RATG was given in cases of matched unrelated donors, mismatched family donors, reduced conditioning, or high risk for graft failure. Mostly mild allergic reactions toward RATG were seen. All of the patients engrafted in due time. Two died within 2 months of transplant of pulmonary complications not related to RATG. Two developed GVHD grade I, no chronic GVHD was seen to date. Viremia occurred in two, with no viral disease developed. Of the eight patients surviving, one suffered relapse of acute leukemia, one shows impending graft failure. The others are well. Using RATG in conditioning is feasible.
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Affiliation(s)
- S Y Zimmermann
- Department of Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany
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Soerensen J. Die Mund-und Halsoperationen. Laryngoscope 1949. [DOI: 10.1288/00005537-193012000-00014] [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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