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Guo M, Chao NJ, Li JY, Rizzieri DA, Sun QY, Mohrbacher A, Krakow EF, Sun WJ, Shen XL, Zhan XR, Wu DP, Liu L, Wang J, Zhou M, Yang LH, Bao YY, Dong Z, Cai B, Hu KX, Yu CL, Qiao JH, Zuo HL, Huang YJ, Sung AD, Qiao JX, Liu ZQ, Liu TQ, Yao B, Zhao HX, Qian SX, Liu WW, Forés R, Duarte RF, Ai HS. HLA-Mismatched Microtransplant in Older Patients Newly Diagnosed With Acute Myeloid Leukemia: Results From the Microtransplantation Interest Group. JAMA Oncol 2019; 4:54-62. [PMID: 28910431 DOI: 10.1001/jamaoncol.2017.2656] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance The outcome of older patients with acute myeloid leukemia (AML) remains unsatisfactory. Recent studies have shown that HLA-mismatched microtransplant could improve outcomes in such patients. Objective To evaluate outcomes in different age groups among older patients with newly diagnosed AML who receive HLA-mismatched microtransplant. Design, Setting, and Participants This multicenter clinical study included 185 patients with de novo AML at 12 centers in China, the United States, and Spain in the Microtransplantation Interest Group. Patients were divided into the following 4 age groups: 60 to 64 years, 65 to 69 years, 70 to 74 years, and 75 to 85 years. The study period was May 1, 2006, to July 31, 2015. Exposures Induction chemotherapy and postremission therapy with cytarabine hydrochloride with or without anthracycline, followed by highly HLA-mismatched related or fully mismatched unrelated donor cell infusion. No graft-vs-host disease prophylaxis was used. Main Outcomes and Measures The primary end point of the study was to evaluate the complete remission rates, leukemia-free survival, and overall survival in different age groups. Additional end points of the study included hematopoietic recovery, graft-vs-host disease, relapse rate, nonrelapse mortality, and other treatment-related toxicities. Results Among 185 patients, the median age was 67 years (range, 60-85 years), and 75 (40.5%) were female. The denominators in adjusted percentages in overall survival, leukemia-free survival, relapse, and nonrelapse mortality are not the sample proportions of observations. The overall complete remission rate was not significantly different among the 4 age groups (75.4% [52 of 69], 70.2% [33 of 47], 79.1% [34 of 43], and 73.1% [19 of 26). The 1-year overall survival rates were 87.7%, 85.8%, and 77.8% in the first 3 age groups, which were much higher than the rate in the fourth age group (51.7%) (P = .004, P = .008, and P = .04, respectively). The 2-year overall survival rates were 63.7% and 66.8% in the first 2 age groups, which were higher than the rates in the last 2 age groups (34.2% and 14.8%) (P = .02, P = .03, P < .001, and P < .001, respectively). The 1-year cumulative incidences of nonrelapse mortality were 10.2%, 0%, 3.4%, and 26.0% in the 4 age groups and 8.1% in all patients. The median times to neutrophil and platelet recovery were 12 days and 14 days after induction chemotherapy, respectively. Five patients had full or mixed donor engraftment, and 30.8% (8 of 26) of patients demonstrated donor microchimerism. Two patients (1.1%) developed severe acute graft-vs-host disease. Conclusions and Relevance Microtransplant achieved a high complete remission rate in AML patients aged 60 to 85 years and higher 1-year overall survival in those aged 60 to 74 years.
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Affiliation(s)
- Mei Guo
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Duke Cancer Institute, Durham, North Carolina
| | - Jian-Yong Li
- Department of Hematology, Jiangsu Province People's Hospital, Nanjing, China
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Duke Cancer Institute, Durham, North Carolina
| | - Qi-Yun Sun
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Ann Mohrbacher
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles
| | - Elizabeth F Krakow
- Division of Medical Oncology, University of Washington, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle
| | - Wan-Jun Sun
- Department of Hematology, The Second Artillery General Hospital, Beijing, China
| | - Xu-Liang Shen
- Department of Hematology, He Ping Central Hospital of the Changzhi Medical College, Changzhi, China
| | - Xin-Rong Zhan
- Department of Hematology, Central Hospital of Xinxiang City, Xinxiang, China
| | - De-Pei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Liu
- Department of Hematology, The Fourth Military Medical University, Xi'an, China
| | - Juan Wang
- Department of Hematology, Central Hospital of Cangzhou City, Cangzhou, China
| | - Min Zhou
- Department of Hematology, The Second People's Hospital of Changzhou City, Changzhou, China
| | - Lin-Hua Yang
- Department of Hematology, The Second Affiliated Hospital of Shanxi University, Taiyuan, China
| | - Yang-Yi Bao
- Department of Hematology, Central Hospital of Hefei City, Hefei, China
| | - Zheng Dong
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Bo Cai
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Kai-Xun Hu
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Chang-Lin Yu
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Jian-Hui Qiao
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Hong-Li Zuo
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Ya-Jing Huang
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Duke Cancer Institute, Durham, North Carolina
| | - Jun-Xiao Qiao
- Department of Hematology, The Second Artillery General Hospital, Beijing, China
| | - Zhi-Qing Liu
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Tie-Qiang Liu
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Bo Yao
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Hong-Xia Zhao
- Department of Hematology, The Second Artillery General Hospital, Beijing, China
| | - Si-Xuan Qian
- Department of Hematology, Jiangsu Province People's Hospital, Nanjing, China
| | - Wei-Wei Liu
- Statistics Department, The Academy of Military Medical Sciences, Beijing, China
| | - Rafael Forés
- Department of Hematology, Hospital Universitario Puerta de Hierro, Majadahonda, Comunidad de Madrid, Spain
| | - Rafael F Duarte
- Department of Hematology, Hospital Universitario Puerta de Hierro, Majadahonda, Comunidad de Madrid, Spain
| | - Hui-Sheng Ai
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
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Yu CL, Qiao ZH, Wang JM, Liang YM, Wu DP, Chen BA, Shi BF, Sun WJ, Qiao JX, Guo M, Qiao JH, Sun QY, Hu KX, Huang YJ, Zuo HL, Huang XJ, Ai HS. The long-term outcome of reduced-intensity allogeneic stem cell transplantation from a matched related or unrelated donor, or haploidentical family donor in patients with leukemia: a retrospective analysis of data from the China RIC Cooperative Group. Ann Hematol 2016; 96:279-288. [PMID: 27864604 DOI: 10.1007/s00277-016-2864-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/09/2016] [Accepted: 10/20/2016] [Indexed: 11/26/2022]
Abstract
This study compared 6-year follow-up data from patients undergoing reduced-intensity conditioning (RIC) transplantation with an HLA-matched related donor (MRD), an HLA-matched unrelated donor (MUD), or an HLA-haploidentical donor (HID) for leukemia. Four hundred and twenty-seven patients from the China RIC Cooperative Group were enrolled, including 301 in the MRD, 79 in the HID, and 47 in the MUD groups. The conditioning regimen involved fludarabine combined with anti-lymphocyte globulin and cyclophosphamide. Graft-versus-host disease (GVHD) prophylaxis was administered using cyclosporin A (CsA) and mycophenolate mofetil (MMF). Four hundred and nineteen patients achieved stable donor chimerism. The incidence of stage II-IV acute GVHD in the HID group was 44.3 %, significantly higher than that in the MRD (23.6 %) and MUD (19.1 %) groups. The 1-year transplantation-related mortality (TRM) rates were 44.3, 17.6, and 21.3, respectively. Event-free survival (EFS) at 6 years in the HID group was 36.7 %, significantly lower than that of the MRD and MUD groups (59.1 and 66.0 %, P < 0.001 and P = 0.001, respectively). For advanced leukemia, the relapse rate of the HID group was 18.5 %, lower than that of the MRD group (37.5 %, P = 0.05), but the EFS at 6 years was 31.7 and 30.4 % (P > 0.05), respectively. RIC transplantation with MRD and MUD had similar outcome in leukemia which is better than that with HID. RIC transplantation with HID had lower relapsed with higher TRM and GVHD rate, particularly in advanced leukemias. RIC transplantation with MRD and MUD had similar outcomes in leukemia and they were better than those with HID. RIC transplantation with HID had a lower relapse rate but higher TRM and GVHD rates, particularly in cases of advanced leukemia.
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Affiliation(s)
- Chang-Lin Yu
- Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China
| | - Zhen-Hua Qiao
- Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian-Min Wang
- Chang Hai Hospital of Shanghai Second Military Medical University, Shanghai, China
| | - Ying-Min Liang
- Tang-Du Hospital of Fourth Military Medical University, Xi'an, China
| | - De-Pei Wu
- Affiliated Hospital of Suzhou University, Suzhou, China
| | - Bao-An Chen
- Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | | | - Wan-Jun Sun
- Second Artillery General Hospital, Beijing, China
| | | | - Mei Guo
- Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China
| | - Jian-Hui Qiao
- Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China
| | - Qi-Yun Sun
- Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China
| | - Kai-Xun Hu
- Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China
| | - Ya-Jing Huang
- Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China
| | - Hong-Li Zuo
- Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China
| | - Xiao-Jun Huang
- Department of Hematology and Transplantation, People's Hospital Under Beijing University, Beijing, 100044, China.
| | - Hui-Sheng Ai
- Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China.
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Hu KX, Sun QY, Guo M, Qiao JX, Yu CL, Qiao JH, Dong Z, Sun WJ, Zuo HL, Huang YJ, Cai B, Ai HS. A Study of Human Leukocyte Antigen Mismatched Cellular Therapy (Stem Cell Microtransplantation) in High-Risk Myelodysplastic Syndrome or Transformed Acute Myelogenous Leukemia. Stem Cells Transl Med 2016; 5:524-9. [PMID: 26838271 DOI: 10.5966/sctm.2015-0196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 08/11/2015] [Accepted: 11/02/2015] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED The treatment outcomes of myelodysplastic syndrome (MDS) and transformed acute myelogenous leukemia (tAML) remain very unsatisfactory. We designed a combination of human leukocyte antigen (HLA)-mismatched hematopoietic stem cell microtransplantation (MST) with chemotherapy for patients with MDS and tAML and evaluated its effects and toxicity. Patients were between 13 and 79 years old. Patients with MDS (n=21) were given HLA-mismatched MST combined with decitabine and cytarabine; patients with tAML (n=22) were given HLA-mismatched MST combined with decitabine and cytarabine, and also mitoxantrone. Patients in complete remission (CR) also received MST plus decitabine and medium-dose cytarabine chemotherapy without graft-versus-host disease (GVHD) prophylaxis. The overall response rate of the patients with MDS was significantly higher than that of those with tAML (81% vs. 50%; p=.03). The CR rates were 52.4% and 36.4% in the two groups, respectively. There was no difference in the cytogenetic CR rate between the MDS and tAML groups (85.7% vs. 70%, respectively; p=.7). The 24-month overall survival of the patients with MDS was significantly higher than that of the patients with tAML (84.7% and 34.1%, respectively; p=.003). The median recovery times of neutrophils and platelets were, respectively, 14 and 17 days in the patients with MDS, and 16 and 19 days in those with tAML. The treatment-related mortality rates were 4.8% and 18.2%, respectively, in the MDS and tAML groups (p=.34). No GVHD was observed in any patient. Microtransplantation combined with decitabine and chemotherapy may provide a novel, effective, and safe treatment for high-risk MDS and tAML. SIGNIFICANCE Microtransplantation (MST) refers to regular chemotherapy combined with granulocyte colony-stimulating factor-mobilized peripheral blood stem cell infusion of human leukocyte antigen-mismatched donor cells without using immunosuppressive agents. It aims to support hematopoietic recovery and perform graft-versus-leukemia (GVL) effects but differs from traditional allogeneic stem cell transplantation because the rate of donor cell chimerism is low and there is and no graft-versus-host disease (GVHD) risk. Thus, a trial was designed to evaluate the safety and efficacy of MST in patients with myelodysplastic syndrome and those with transformed acute myelogenous leukemia. Higher complete remission and cytogenetic complete response rates were observed, and the treatment improved disease progress-free survival, sped hematopoietic recovery, and avoided GVHD.
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Affiliation(s)
- Kai-Xun Hu
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Qi-Yun Sun
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Mei Guo
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Jun-Xiao Qiao
- Department of Hematology, Second Artillery General Hospital, Beijing, People's Republic of China
| | - Chang-Lin Yu
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Jian-Hui Qiao
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Zheng Dong
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Wan-Jun Sun
- Department of Hematology, Second Artillery General Hospital, Beijing, People's Republic of China
| | - Hong-Li Zuo
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Ya-Jing Huang
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Bo Cai
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - Hui-Sheng Ai
- Department of Hematology and Transplantation, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People's Republic of China
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Qiu BY, Qiao JX, Yong J. Meta-analysis of Selective Serotonin Reuptake Inhibitors (SSRIs) Compared to Tricyclic Antidepressants (TCAs) in the Efficacy and Safety of Anti-depression Therapy in Parkinson's Disease(PD) Patients. Iran J Pharm Res 2014; 13:1213-9. [PMID: 25587309 PMCID: PMC4232786] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To assess the efficacy and safety of selective serotonin reuptake inhibitors(SSRIs) and tricyclic antidepressants(TCAs) in treatment of Parkinsonian depression. A computer-based search was conducted in the databases of PUBMED, MEDLINE, EMBASE and CochraneControlled Trails Register up to December 2011. The random controlled clinic trials about SSRIs and TCAs in treatment of Parkinsonian depression were collected. Statistical analysis was completed using Review Manager, version 5.0. Five clinic controlled trials were identified for this meta-analysis. There was no significant statistical difference in the response rate of treatment [RR 0.95, 95%CI (0.78, 1.16)] and Hamilton depression score [RR -2.54, 95%CI (-5.35, 0.26)] between two groups. In term of complications, no statistical difference was observed in the insomnia rate between two groups [RR 0.82, 95%CI (0.24, 2.84)]. Moreover, the incidence rate of xerostomia [RR 0.21, 95%CI (0.07, 0.65)] and constipation [RR 0.12, 95%CI(0.02, 0.63)] was lower in SSRIs group rather than those in TCAs group. In general, SSRIs and TCAs have comparable efficacy and equal acceptability in treatment of Parkinson's disease-induced depression. However, SSRIs are superior to TCAs in the terms of xerostomia and constipation.
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Guo M, Hu KX, Liu GX, Yu CL, Qiao JH, Sun QY, Qiao JX, Dong Z, Sun WJ, Sun XD, Zuo HL, Man QH, Liu ZQ, Liu TQ, Zhao HX, Huang YJ, Wei L, Liu B, Wang J, Shen XL, Ai HS. HLA-mismatched stem-cell microtransplantation as postremission therapy for acute myeloid leukemia: long-term follow-up. J Clin Oncol 2012; 30:4084-90. [PMID: 23045576 DOI: 10.1200/jco.2012.42.0281] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Despite best current therapies, approximately half of patients with acute myeloid leukemia in first complete remission (AML-CR1) with no HLA-identical donors experience relapse. Whether HLA-mismatched stem-cell microtransplantation as a novel postremission therapy in these patients will improve survival and avoid graft-versus-host disease (GVHD) is still unknown. PATIENTS AND METHODS One hundred one patients with AML-CR1 (9 to 65 years old) from four treatment centers received programmed infusions of G-CSF-mobilized HLA-mismatched donor peripheral-blood stem cells after each of three cycles of high-dose cytarabine conditioning without GVHD prophylaxis. Donor chimerism and microchimerism and WT1+CD8+ T cells were analyzed. RESULTS The 6-year leukemia-free survival (LFS) and overall survival (OS) rates were 84.4% and 89.5%, respectively, in the low-risk group, which were similar to the rates in the intermediate-risk group (59.2% and 65.2%, respectively; P=.272 and P=.308). The 6-year LFS and OS were 76.4% and 82.1%, respectively, in patients who received a high dose of donor CD3+ T cells (≥1.1×10(8)/kg) in each infusion, which were significantly higher than the LFS and OS in patients who received a lower dose (<1.1×10(8)/kg) of donor CD3+ T cells (49.5% and 55.3%, respectively; P=.091 and P=.041). No GVHD was observed in any of the patients. Donor microchimerism (2 to 1,020 days) was detected in 20 of the 23 female patients who were available for Y chromosome analysis. A significant increase in WT1+CD8+ T cells (from 0.2% to 4.56%) was observed in 33 of 39 patients with positive HLA-A*02:01 antigen by a pentamer analysis. CONCLUSION Microtransplantation as a postremission therapy may improve outcomes and avoid GVHD in patients with AML-CR1.
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Affiliation(s)
- Mei Guo
- Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, Dongdajie 8, Beijing 100071, China
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