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Elhadad S, Chapin J, Copertino D, Van Besien K, Ahamed J, Laurence J. MASP2 levels are elevated in thrombotic microangiopathies: association with microvascular endothelial cell injury and suppression by anti-MASP2 antibody narsoplimab. Clin Exp Immunol 2021; 203:96-104. [PMID: 32681658 PMCID: PMC7405159 DOI: 10.1111/cei.13497] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022] Open
Abstract
Involvement of the alternative complement pathway (AP) in microvascular endothelial cell (MVEC) injury characteristic of a thrombotic microangiopathy (TMA) is well documented. However, the role of the lectin pathway (LP) of complement has not been explored. We examined mannose-binding lectin associated serine protease (MASP2), the effector enzyme of the LP, in thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome and post-allogeneic hematopoietic stem cell transplantation (alloHSCT) TMAs. Plasma MASP2 and terminal complement component sC5b-9 levels were assessed by enzyme-linked immunosorbent assay (ELISA). Human MVEC were exposed to patient plasmas, and the effect of the anti-MASP2 human monoclonal antibody narsoplimab on plasma-induced MVEC activation was assessed by caspase 8 activity. MASP2 levels were highly elevated in all TMA patients versus controls. The relatively lower MASP2 levels in alloHSCT patients with TMAs compared to levels in alloHSCT patients who did not develop a TMA, and a significant decrease in variance of MASP2 levels in the former, may reflect MASP2 consumption at sites of disease activity. Plasmas from 14 of the 22 TMA patients tested (64%) induced significant MVEC caspase 8 activation. This was suppressed by clinically relevant levels of narsoplimab (1·2 μg/ml) for all 14 patients, with a mean 65·7% inhibition (36.8-99.4%; P < 0·0001). In conclusion, the LP of complement is activated in TMAs of diverse etiology. Inhibition of MASP2 reduces TMA plasma-mediated MVEC injury in vitro. LP inhibition therefore may be of therapeutic benefit in these disorders.
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Affiliation(s)
- S. Elhadad
- Department of MedicineDivision of Hematology and Medical OncologyWeill Cornell Medical CollegeNew YorkNYUSA
| | - J. Chapin
- Department of MedicineDivision of Hematology and Medical OncologyWeill Cornell Medical CollegeNew YorkNYUSA
- Present address:
CRISPR TherapeuticsCambridgeMAUSA
| | - D. Copertino
- Department of MedicineDivision of Hematology and Medical OncologyWeill Cornell Medical CollegeNew YorkNYUSA
| | - K. Van Besien
- Department of MedicineDivision of Hematology and Medical OncologyWeill Cornell Medical CollegeNew YorkNYUSA
| | - J. Ahamed
- Oklahoma Medical Research FoundationOklahoma CityOKUSA
| | - J. Laurence
- Department of MedicineDivision of Hematology and Medical OncologyWeill Cornell Medical CollegeNew YorkNYUSA
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2
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Bachanova V, Westin J, Tam C, Borchmann P, Jaeger U, McGuirk J, Holte H, Waller E, Jaglowski S, Bishop M, Andreadis C, Foley S, Fleury I, Teshima T, Mielke S, Salles G, Ho P, Izutsu K, Maziarz R, Van Besien K, Kersten M, Wagner-Johnston N, Kato K, Corradini P, Han X, Agoulnik S, Chu J, Eldjerou L, Pacaud L, Schuster S. CORRELATIVE ANALYSES OF CYTOKINE RELEASE SYNDROME AND NEUROLOGICAL EVENTS IN TISAGENLECLEUCEL-TREATED RELAPSED/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA PATIENTS. Hematol Oncol 2019. [DOI: 10.1002/hon.118_2630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- V. Bachanova
- Division of Hematology; Oncology and Transplantation, University of Minnesota; Minneapolis United States
| | - J. Westin
- Department of Lymphoma & Meyloma; M.D. Anderson Cancer Center; Houston United States
| | - C. Tam
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Australia
| | - P. Borchmann
- Department of Hematology/Oncology; University Hospital of Cologne; Cologne Germany
| | - U. Jaeger
- Department of Hematology/Hemostaseology; Medical University Vienna; Vienna Austria
| | - J. McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics; Kansas Hospital and Medical Center; Kansas City United States
| | - H. Holte
- Lymphoma Section; University of Oslo; Oslo Norway
| | - E. Waller
- Department of Stem Cell Transplantation and Immunology; Emory University School of Medicine; Atlanta United States
| | - S. Jaglowski
- Department of Internal Medicine; The Ohio State University; Columbus United States
| | - M. Bishop
- Section of Hematology/Oncology; University of Chicago; Chicago United States
| | - C. Andreadis
- Department of Hematology and Blood and Marrow Transplat; University of California San Francisco; San Francisco United States
| | - S.R. Foley
- Division of Clinical Pathology; McMaster University; Hamilton Canada
| | - I. Fleury
- Department of Hematology; Hôpital Maisonneuve-Rosemont; Montreal Canada
| | - T. Teshima
- Department of Hematology; Hokkaido University Hospital; Sapporo Japan
| | - S. Mielke
- Department of Internal Medicine; University Hospital Wuerzburg; Wuerzburg Germany
| | - G. Salles
- Hematology Department; Lyon-Sud Hospital Center; Pierre-Benite France
| | - P.J. Ho
- Department of Haematology; Royal Prince Alfred Hospital; Camperdown Australia
| | - K. Izutsu
- Department of Hematology; National Cancer Center Hospital; Tokyo Japan
| | - R. Maziarz
- Department of Hematology and Oncology; Oregon Health and Science University; Portland United States
| | - K. Van Besien
- Department of Medical Oncology; Weill Cornell Medicine; New York United States
| | - M.J. Kersten
- Department of Hematology; Academic Medical Center; Amsterdam Netherlands
| | - N. Wagner-Johnston
- Department of Oncology and Hematologic Malignancies; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Baltimore United States
| | - K. Kato
- Hematology; Oncology & Cardiovascular Medicine, Kyushu University; Fukuoka Prefecture Japan
| | - P. Corradini
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
| | - X. Han
- Biomarkers and Diagnostics Biometrics; Novartis Pharmaceuticals Corporation; East Hanover United States
| | - S. Agoulnik
- Precision Medicine; Novartis Pharmaceuticals Corporation; Cambridge United States
| | - J. Chu
- Novartis Oncology; Novartis Pharmaceuticals Corporation; East Hanover United States
| | - L. Eldjerou
- Global Cell & Gene Medical Affairs; Novartis Pharmaceuticals Corporation; East Hanover United States
| | - L. Pacaud
- Novartis Oncology; Novartis Pharmaceuticals Corporation; East Hanover United States
| | - S. Schuster
- Division of Hematology Oncology; University of Pennsylvania; Philadelphia United States
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3
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Jaeger U, Tam C, Borchmann P, McGuirk J, Holte H, Waller E, Jaglowski S, Andreadis C, Foley S, Fleury I, Westin J, Teshima T, Mielke S, Salles G, Ho P, Izutsu K, Schuster S, Bachanova V, Maziarz R, Van Besien K, Kersten M, Wagner-Johnston N, Kato K, Corradini P, Tiwari R, Forcina A, Pacaud L, Bishop M. INTRAVENOUS IMMUNOGLOBULIN THERAPY USE IN PATIENTS WITH RELAPSED/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA TREATED WITH TISAGENLECLEUCEL IN THE JULIET TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.189_2631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- U. Jaeger
- Hematology and Hemostaseology; and Comprehensive Cancer Center, Medical University of Vienna; Vienna Austria
| | - C. Tam
- Department of Hematology; Peter MacCallum Cancer Centre; Melbourne Australia
| | - P. Borchmann
- Department of Hematology/Oncology; University Hospital of Cologne; Cologne Germany
| | - J. McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics; Kansas Hospital and Medical Center; Kansas City United States
| | - H. Holte
- Lymphoma Section; University of Oslo, Oslo
| | - E. Waller
- Hematology and Medical Oncology; Medicine and Pathology, Emory University School of Medicine; Atlanta United States
| | - S. Jaglowski
- Department of Hematology; Ohio State University, Columbus
| | - C. Andreadis
- Department of Hematology and Blood and Marrow Transplant; University of California San Francisco; San Francisco United States
| | - S.R. Foley
- Division of Clinical Pathology; McMaster University; Hamilton Canada
| | - I. Fleury
- Department of Hematology; Hôpital Maisonneuve-Rosemont; Montreal Canada
| | - J. Westin
- Department of Lymphoma & Meyloma; MD Anderson Cancer Center; Houston United States
| | - T. Teshima
- Department of Hematology; Hokkaido University Hospital; Sapporo Japan
| | - S. Mielke
- Department of Internal Medicine; University Hospital Wuerzburg; Wuerzburg Germany
| | - G. Salles
- Department of Hematology/Oncology; Hospital Center Lyon-Sud; Pierre-Benite France
| | - P.J. Ho
- Department of Haematology; Royal Prince Alfred Hospital; Camperdown Australia
| | - K. Izutsu
- Department of Hematology; National Cancer Center Hospital; Tokyo Japan
| | - S. Schuster
- Division of Hematology Oncology; University of Pennsylvania; Philadelphia United States
| | - V. Bachanova
- Division of Hematology; Oncology and Transplantation, University of Minnesota; Minneapolis United States
| | - R. Maziarz
- Department of Hematology; Oregon Health and Science University; Portland United States
| | - K. Van Besien
- Department of Medical Oncology; Weill Cornell Medicine; New York United States
| | - M.J. Kersten
- Department of Hematology; Academic Medical Center; Amsterdam Netherlands
| | - N. Wagner-Johnston
- Department of Hematology/Oncology; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Baltimore United States
| | - K. Kato
- Department of Haematology; Kyushu University Hospital; Fukuoka Prefecture Japan
| | - P. Corradini
- Department of Oncology and Hemato-oncology; University of Milan; Milan Italy
| | - R. Tiwari
- Global Medical Affaris; Novartis Pharmaceuticals Corporation; Hyderabad India
| | - A. Forcina
- Novartis Oncology; Novartis Pharma AG; Basel Switzerland
| | - L. Pacaud
- Novartis Oncology; Novartis Pharmaceuticals Corporation; East Hanover United States
| | - M. Bishop
- Section of Hematology/Oncology; University of Chicago; Chicago United States
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Ruan J, Leonard J, Coleman M, Rutherford S, Van Besien K, Rodriguez A, Benderoff L, Mehta-Shah N, Moskowitz A, Sokol L, Cerchietti L, Inghirami G, Martin P. MULTI-CENTER PHASE II STUDY OF ORAL AZACITIDINE (CC-486) PLUS CHOP AS INITIAL TREATMENT FOR PERIPHERAL T-CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.8_2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J. Ruan
- Medicine/Hematology-Oncology; Weill Cornell Medical College; New York United States
| | - J.P. Leonard
- Medicine/Hematology-Oncology; Weill Cornell Medical College; New York United States
| | - M. Coleman
- Medicine/Hematology-Oncology; Weill Cornell Medical College; New York United States
| | - S. Rutherford
- Medicine/Hematology-Oncology; Weill Cornell Medical College; New York United States
| | - K. Van Besien
- Medicine/Hematology-Oncology; Weill Cornell Medical College; New York United States
| | - A. Rodriguez
- Medicine/Hematology-Oncology; Weill Cornell Medical College; New York United States
| | - L. Benderoff
- Medicine/Hematology-Oncology; Weill Cornell Medical College; New York United States
| | - N. Mehta-Shah
- Department of Medicine; Washington University in St. Louis; St Louis United States
| | - A. Moskowitz
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York United States
| | - L. Sokol
- Department of Medicine; Moffitt Cancer Center; Tampa United States
| | - L. Cerchietti
- Medicine/Hematology-Oncology; Weill Cornell Medical College; New York United States
| | - G. Inghirami
- Department of Pathology; Weill Cornell Medical College; New York United States
| | - P. Martin
- Medicine/Hematology-Oncology; Weill Cornell Medical College; New York United States
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Forsberg P, Guarneri D, Rossi A, Pearse R, Perry A, Pekle K, Greenberg J, Shore T, Gergis U, Mayer S, Van Besien K, Jayabalan D, Coleman M, Ely S, Niesvizky R, Mark T. A phase I study of the addition of high-dose lenalidomide to melphalan conditioning for autologous stem-cell transplant in relapsed or refractory multiple myeloma. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.596] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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6
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Schroeder L, del Cerro P, Thomas R, Malloy R, Artz A, Van Besien K. A Center Specific Guide Successfully Informs Patients About Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.492] [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: 10/14/2022]
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7
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Muffly L, Swanson K, Boulukos M, Kocherginsky M, del Cerro P, Godley L, Kline J, Larson R, Odenike O, Pape L, Schroeder L, Stock W, Van Besien K, Artz A. Listen to Thy Patient: Poor Quality of Life (QoL) Reported by Older Adults Prior to Allogeneic Stem Cell Transplantation (allo-HCT) Is Independently Associated with Worse Transplant Outcomes. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.072] [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: 10/14/2022]
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8
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Van Besien K, Liu H, Rich ES, Godley LA, Odenike O, Joseph L, Kline JP, Nguyen VH, Cunningham JM, Larson RA, Stock W, Wickrema A, Artz AS. Reduced intensity conditioning with combined haploidentical and cord blood transplantation results in rapid engrafment and durable remissions. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6525] [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: 11/20/2022] Open
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9
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Locke FL, Artz AS, Godley LA, Odenike O, Larson RA, Van Besien K, Stock W. A prospective feasibility study of clofarabine (CLO) cytoreduction prior to allogeneic stem cell transplant (HCT) conditioning for refractory leukemia and MDS. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6537] [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: 11/20/2022] Open
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10
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Van Besien K, Kline JP, Hardj M, Godley LA, Larson RA, Nguyen VH, Odenike O, Stock W, Horowitz S, Artz AS. Pharmacokinetics and assessment of renal toxicity of a clofarabine (Clo), melphalan (Mel), and alemtuzumab (Alm) conditioning regimen. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6541] [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: 11/20/2022] Open
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11
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Smith SM, Van Besien K, Conner K, Gajewski T, Kuna T, Karrison T, Wade Iii JL, Zwiebel J, Vokes EE. A phase I study of G3139 in combination with RICE chemotherapy in relapsed non-Hodgkin’s lymphoma (NHL). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17529 Background: Aggressive lymphomas are chemosensitive, but frequently relapse. Bcl-2 protein overexpression promotes tumor cell survival via anti-apoptosis, and is clinically correlated with shortened remission duration and decreased survival. The antisense oligonucleotide oblimersen sodium (G3139) downregulates bcl-2, has activity in NHL, and may be synergistic with chemotherapy. Methods: Pts had histologically confirmed aggressive NHL that relapsed after one prior anthracycline-based regimen. G3139 was given as a continuous infusion on Days 1–8 (168 hours) every 14 days, with stem cell collection following cycle 3. Standard RICE chemotherapy was given on Days 4–6, allowing 72 hrs pre- and 48 hrs post-chemo G3139. Dose-limiting toxicity (DLT) was defined as grade 3 or greater non-hematologic toxicity, grade 4 thrombocytopenia, duration of neutropenia <500/mL greater than 7 days despite growth factors, grade 3 hemolytic anemia, or prolonged severe anemia. Pharmacodynamic endpoints included measurement of bcl-2 protein in peripheral blood (FACS analysis) and tumor (IHC), and bcl-2 RT-PCR in blood and tumor. Results: 8 pts were enrolled. At dose level 1 (G3139 3 mg/kg/day), both enrolled pts had grade 4 thrombocytopenia. The next 6 patients were treated with G3139 2.5 mg/kg/day (Dose Level -1) without any DLT’s. There were no grade 3 or 4 non-hematologic toxicities. 7 evaluable pts had successful stem cell collections: median CD34+ 4.2 × 106/kg (range, 1.3–8.72 × 106/kg). Responses: 4 CR/CRu, 2 PR, 1 SD, 1 too early. There was no detectable decrease in bcl-2 protein in the blood using flow cytometry or RT-PCR. Conclusion: The maximum tolerated dose of G3139 given over 8 days in combination with RICE chemotherapy is 2.5 mg/kg/day. It is unlikely that this dose sufficiently suppresses bcl-2 levels. The protocol will thus be amended to shorten the G3139 infusion to 5 days with renewed efforts to escalate the dose. No significant financial relationships to disclose.
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Affiliation(s)
- S. M. Smith
- The University of Chicago Phase II Consortium; University of Chicago, Chicago, IL; National Cancer Institute, Washington, DC
| | - K. Van Besien
- The University of Chicago Phase II Consortium; University of Chicago, Chicago, IL; National Cancer Institute, Washington, DC
| | - K. Conner
- The University of Chicago Phase II Consortium; University of Chicago, Chicago, IL; National Cancer Institute, Washington, DC
| | - T. Gajewski
- The University of Chicago Phase II Consortium; University of Chicago, Chicago, IL; National Cancer Institute, Washington, DC
| | - T. Kuna
- The University of Chicago Phase II Consortium; University of Chicago, Chicago, IL; National Cancer Institute, Washington, DC
| | - T. Karrison
- The University of Chicago Phase II Consortium; University of Chicago, Chicago, IL; National Cancer Institute, Washington, DC
| | - J. L. Wade Iii
- The University of Chicago Phase II Consortium; University of Chicago, Chicago, IL; National Cancer Institute, Washington, DC
| | - J. Zwiebel
- The University of Chicago Phase II Consortium; University of Chicago, Chicago, IL; National Cancer Institute, Washington, DC
| | - E. E. Vokes
- The University of Chicago Phase II Consortium; University of Chicago, Chicago, IL; National Cancer Institute, Washington, DC
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12
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Michaelis LC, Sher D, Myers M, Siddiqui M, Collins-Jones D, Ulaszek J, Huo D, Wickrema A, Van Besien K, Stock W. Prognostic significance of WT-1 levels in patients with myelodysplastic syndrome and leukemia after reduced-intensity allogeneic transplantation. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6524 Background: Expression of WT-1, a zinc-finger transcription factor, is elevated at diagnosis in many kinds of leukemia. The prognostic significance of the WT-1 transcript level before and after stem cell transplant is controversial. We performed real-time quantitative PCR (RQ-PCR) on samples from pts with leukemia and MDS undergoing allo stem-cell transplant (SCT) to determine if WT-1 expression correlates with survival (OS) and/or disease-free survival (DFS). Methods: Pts were conditioned with fludarabine, melphalan and alemtuzumab. cDNA was synthesized for RQ-PCR, which was performed on bone marrow (BM) and peripheral blood (PB) samples drawn prior to transplant admission and at day 28 (D28) post transplantation. All samples were analyzed using LightCycler technology and reported as a normalized ratio of WT-1 copy number to ABL copy number. Results: Data on 48 patients who underwent allo SCT are reported here. During a median follow up of 17 months, 24 patients died and the OS rate at one year was 52%. The DFS rate at one year was 34%. There was a statistically significant association between pretransplant WT-1 levels measured in PB and OS, with increase in risk of death by 36% for every 10 fold increase in WT-1 levels (p=0.048). Pretransplant WT-1 levels in both PB and BM also predicted DFS: the risk of relapse or death was increased by 44% (PB) and 71% (BM) for every 10 fold increase in WT-1 levels (p=0.012; p=0.048). However, after controlling for disease status at transplantation using a Cox model, pretransplant WT-1 levels were no longer a significant predictor because these levels were highly correlated with disease status at transplantation. We did not find any significant correlation between WT-1 levels 28 days post-transplantation and outcome. Conclusions: Our preliminary results differ from several published studies demonstrating prognostic significance of WT-1 RQ-PCR after allo SCT. Although elevated WT-1 levels prior to transplantation correlate with higher risk of post-transplant relapse and death from any cause, these preliminary data fail to establish an independent prognostic role for WT-1 RQ-PCR in the setting of reduced intensity allo SCT. Analysis of additional post-transplant time points is proceeding. No significant financial relationships to disclose.
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Affiliation(s)
| | - D. Sher
- University of Chicago, Chicago, IL
| | - M. Myers
- University of Chicago, Chicago, IL
| | | | | | | | - D. Huo
- University of Chicago, Chicago, IL
| | | | | | - W. Stock
- University of Chicago, Chicago, IL
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13
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Michaelis L, Lin S, Joseph L, Artz A, Kline J, Pollea D, Stock W, Rich E, Jones D, Casey B, Del Cerro P, Van Besien K. The relationship of day 30 and day 100 donor chimerism to clinical outcomes following reduced-intensity allogeneic transplantation for hematologic malignancies. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.105] [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: 11/17/2022]
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14
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Artz AS, Van Besien K, Zimmerman T, Gajewski TF, Rini BI, Hu HS, Stadler WM, Vogelzang NJ. Long-term follow-up of nonmyeloablative allogeneic stem cell transplantation for renal cell carcinoma: The University of Chicago Experience. Bone Marrow Transplant 2005; 35:253-60. [PMID: 15543195 DOI: 10.1038/sj.bmt.1704760] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Nonmyeloablative allogeneic stem cell transplantation (NST) has considerable activity in patients with metastatic renal cell carcinoma (RCC), although there are limited long-term follow-up data. Between February 1999 and May 2003, 18 patients with metastatic RCC underwent 19 matched-sibling NSTs after conditioning with fludarabine and cyclophosphamide with tacrolimus and mycophenolate mofetil as post-transplant immunosuppression. Among the four objective responses, all were partial and have relapsed with a median response duration of 609 days (range, 107-926). All responders are alive at a median of 41 months. Median overall survival for the entire cohort was 14 months. There were four early treatment-related deaths and one late treatment-related death. Eight patients died from progressive disease and five (28%) from treatment-related mortality. Stratifying transplant outcome as early death, intermediate (no response, no early death), or response, the combination of pre-treatment anemia and decreased performance status, was associated with adverse outcome (P = 0.015) and reduced survival (HR 5.4, 95% confidence interval of 1.4 to 21, P = 0.007). Responders demonstrated prolonged survival compared to nonresponders (P = 0.002). NST leads to durable responses in a minority of metastatic RCC patients. Appropriate patient selection is paramount. Anemia and decreased performance status may enable risk stratification.
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Affiliation(s)
- A S Artz
- University of Chicago Hospitals, Chicago, IL 60637-1470, USA.
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15
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Abstract
Follicular non-Hodgkin's lymphomas usually present in advanced stage and although frequently are chemotherapy-sensitive remain incurable using conventional approaches. Treatment options are evolving rapidly and now include targeted therapies such as monoclonal antibodies. Recent studies, including the EBMTR-sponsored 'CUP Trial' (conventional Chemotherapy, Unpurged autograft, Purged autograft), demonstrate that for patients under age 60 years with recurrent chemotherapy-sensitive disease, autologous stem cell transplantation (ASCT) provides a survival benefit over conventional therapy. Allogeneic stem cell transplantation (alloSCT) has become a more effective option. Although incorporation of TBI into the preparative regimen may increase treatment-related mortality (TRM), relapses appear to be reduced compared to a chemotherapy-alone regimen. Reduced-intensity alloSCT procedures are now being performed at an increasing rate, in part due to a lower risk for TRM. Until more data are available, however, reduced-intensity alloSCT should be considered only in cases where myeloablative conditioning is contra-indicated. There are no clear means for choosing ASCT vs alloSCT, a decision influenced by the amount of residual tumor, disease-responsiveness, degree of marrow involvement and extent of prior chemotherapy. ASCT or alloSCT in first remission remains an investigational procedure. Future considerations include incorporation of novel preparative regimens, in vitro purging techniques, antilymphoma vaccines, post transplant immunotherapy and ex vivo-manipulated donor lymphocyte infusions.
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Affiliation(s)
- W W Tse
- Department of Medicine, Comprehensive Cancer Center of Case Western Reserve University, Cleveland, OH 44106, USA
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16
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Levitan DA, Harlin H, Smith SM, Van Besien K, Larson RA, Gajewski TF, Zimmerman TM. The University of Chicago experience with a reduced intensity allogeneic peripheral blood stem cell transplant preparative regimen using fludarabine, cyclophosphamide, and antithymocyte globulin (ATG) in pts with a hematologic malignancy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Van Besien K, Devine S, Wickrema A, Jessop E, Amin K, Yassine M, Maynard V, Stock W, Peace D, Ravandi F, Chen YH, Hoffman R, Sossman J. Regimen-related toxicity after fludarabine-melphalan conditioning: a prospective study of 31 patients with hematologic malignancies. Bone Marrow Transplant 2003; 32:471-6. [PMID: 12942092 DOI: 10.1038/sj.bmt.1704166] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A total of 31 consecutive patients with hematologic malignancies who were considered poor candidates for TBI underwent allogeneic stem cell transplantation after conditioning with fludarabine and melphalan. A total of 25 matched sibling recipients received fludarabine 25 mg/m(2) x 5 days and melphalan 70 mg/m(2) x 2 days. For unrelated and haploidentical donor recipients, fludarabine was increased to 30 mg/m(2) and ATG 30 mg/kg x 4 days was added. Graft-versus-host disease prophylaxis consisted of tacrolimus and mini methotrexate. All patients engrafted. Regimen-related toxicity was considerable and included mainly renal, hepatic and mucosal toxicity. There were seven regimen-related-deaths including two VOD, two pulmonary, one renal, one cardiac and one mucosal toxicity. One case of fatal pulmonary toxicity death could be attributed to pre-existing pulmonary damage. Progression-free survival at 12 months was 44% (90% CI: 30-58%) for recipients of HLA-identical sibling transplants and 33% (90% CI: 21-45%) for all patients. In conclusion, the fludarabine-melphalan regimen leads to consistent engraftment. The regimen-related toxicity is considerable and cannot be explained solely by patient selection. Cardiac toxicity is emerging as a unique toxicity of this regimen. Despite toxicity, fludarabine-melphalan has considerable activity and leads to durable remission in a proportion of patients.
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Affiliation(s)
- K Van Besien
- University of Illinois at Chicago, Chicago, IL 60637, USA
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18
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Abstract
To determine the safety of single daily dose (SDD) gentamicin in recipients of stem cell transplantation (SCT), we evaluated all adult patients at MD Anderson Cancer Center who received SDD gentamicin for treatment of febrile neutropenia. Thirty-three patients received gentamicin 5 mg/kg i.v. every 24 h. Mean duration of therapy was 7 days (range 3-32 days). All patients received vancomycin and 17 received cisplatinum. All patients had normal renal function prior to therapy. Serum gentamicin levels were monitored only when renal function deteriorated. The incidence of nephrotoxicity and clinically significant ototoxicity was 3% and 12%, respectively. All four patients who developed ototoxicity had normal renal function before and during therapy. The mean duration of gentamicin therapy was significantly longer in patients who developed ototoxicity, 20 days vs 9 days (P = 0.001). Patients treated with SDD gentamicin for >10 days were more likely to develop ototoxicity (P = 0.045). Single daily dosing of gentamicin was associated with clinically significant ototoxicity in 12% of our patients. A larger randomized EORTC trial evaluating SDD vs MDD amikacin failed to detect a difference in ototoxicity. However, the median duration of therapy was only 8 days. The increased incidence of ototoxicity in our study may be due to prolonged therapy, type of aminoglycoside used, concomitant ototoxic agents, small sample size, or a combination of the above.
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Affiliation(s)
- D Warkentin
- CSU Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Center, University of British Columbia, Vancouver, Canada
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19
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Margolin KA, Van Besien K, Wright C, Niland J, Champlin R, Fung HC, Kashyap A, Molina A, Nademanee AP, O'Donnell MR, Parker P, Smith E, Spielberger R, Somlo G, Snyder D, Stein A, Woo D, Thomas M, Sniecinski I, Forman SJ. Interleukin-2-activated autologous bone marrow and peripheral blood stem cells in the treatment of acute leukemia and lymphoma. Biol Blood Marrow Transplant 1999; 5:36-45. [PMID: 10232739 DOI: 10.1053/bbmt.1999.v5.pm10232739] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this pilot trial of interleukin (IL)-2-treated autologous bone marrow (BM) and peripheral stem cell (PSC)-supported high-dose chemoradiotherapy, we report 36 patients with poor-prognosis leukemia and lymphoma who received BM and/or granulocyte colony-stimulating factor (G-CSF)-mobilized autologous PSCs that had been exposed to IL-2 for 24 hours ex vivo. Patients then received IL-2 by low-dose continuous intravenous (i.v.) infusion until hematologic reconstitution and then by intermediate-dose continuous i.v. infusion for six 2-week maintenance cycles given at 1-month intervals. The median Day to neutrophils over 500/microL was 22 with BM and 10 with PSCs (p = 0.01). The median Day to platelets >20,000/microL was 50 for BM and 25 for PSCs, and to platelets >50,000/microL was 138 for BM and 34 for PSCs (p not significant). After the first three patients received IL-2 at 2 mIU x m(-2) x day(-1) and had slow reconstitution, four patients were treated without IL-2 until the maintenance phase following reconstitution. The remaining 29 patients received the initial "post-infusion" IL-2 at 1 mIU x m(-2) x day(-1). Toxicities associated with the infusion of IL-2-activated cells consisted of chills and fever in about one-half of the patients and transient hypotension in 12%. Low-dose IL-2 by continuous i.v. infusion in the early posttransplant period was associated with exacerbation of fever, diarrhea, and altered mental status in a minority of patients. The major dose-limiting toxicities of maintenance IL-2 were fever, fatigue, gastrointestinal symptoms, skin rash, and dyspnea. Among 24 lymphoma patients, nine are in continuous complete remission (CCR) from 18-48 months, and 15 have died (12 due to relapse and three of therapy-related toxicities). Of 12 acute leukemia patients, two with acute lymphoblastic leukemia (ALL) are in CCR at 38 and 43 months, and one patient who was in cytogenetic but not molecular remission of Philadelphia chromosome-positive ALL died of progressive leukemia at Day 108. Three of nine with myeloid leukemia are in CCR at 21, 46, and 53 months; one is in hematologic and cytogenetic remission of acute promyelocytic leukemia at 55 months with multiple new cytogenetic abnormalities; one is alive at 54 months with pancytopenia after incomplete hematologic recovery followed by multiple new cytogenetic abnormalities (myelodysplasia); and one had an unrelated donor transplant after relapsing 4 months following protocol therapy. One myeloid leukemia patient remains without evidence of relapse, but is transfusion-dependent at 15 months following transplant.
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Affiliation(s)
- K A Margolin
- Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
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20
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Piamsomboon S, Kudelka AP, Termrungruanglert W, Van Besien K, Edwards CL, Lifshitz S, Schomer DF, Champlin R, Mante RP, Kavanagh JJ, Verschraegen CF. Remission of refractory gestational trophoblastic disease in the brain with ifosfamide, carboplatin, and etoposide (ICE): first report and review of literature. EUR J GYNAECOL ONCOL 1998; 18:453-6. [PMID: 9443008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Gestational trophoblastic disease (GTD) metastatic to the brain has a very poor prognosis with a survival rate of less than 25%, especially for patients in whom brain metastases develop while on or after chemotherapy. Cure can be achieved by chemotherapy alone. The regimen of etoposide, methotrexate, actinomycin-D, vincristine, and cyclophosphamide has shown encouraging results and is considered to be standard first-line treatment for high risk patients. For patients in whom this regimen fails, a salvage chemotherapy regimen is used. The combination of ifosfamide, carboplatin, and etoposide (ICE) has synergistic activity in preclinical studies. This regimen has shown activity in metastatic breast cancer and non-small-cell lung cancer as well as platinum-resistant germ-cell tumors and metastatic GTD. This is the first report of a patient with a highly refractory GTD in whom brain metastasis developed while on chemotherapy, and whose brain metastasis went into remission with a low dose ICE regimen. Accordingly, ICE may be considered for patients with chemotherapy refractory GTD metastatic to the brain.
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Affiliation(s)
- S Piamsomboon
- Siriraj Hospital, Mahidol University, Bangkok, Thailand
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21
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Rondón G, Giralt S, Pereira M, Van Besien K, Mehra R, Champlin R, Andreeff M. Analysis of chimerism following allogeneic bone marrow transplantation by fluorescent-in-situ hybridization. Leuk Lymphoma 1997; 25:463-7. [PMID: 9250816 DOI: 10.3109/10428199709039033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Twelve patients (9 males and 3 females) with chronic myelogenous leukemia, underwent CD8+ T cell depleted allogeneic bone marrow transplantation with a sex-mismatched donor. To assess chimerism we performed fluorescent in-situ hybridization for the X and Y chromosome at different time points after BMT. Patient median age was 33 years (range, 27-48); median time to transplant was 28 months (range, 5-87). All patients received thiotepa 10 mg/kg; cyclophosphamide 120 mg/kg and 12.0 Gy of fractionated total body irradiation. CD8+ cells were depleted from the normal donor marrow with anti-CD8 murine monoclonal antibodies and immunomagnetic beads. Bone marrow aspirates were studied at <60, 60-140, 140-300, and >300 days post BMT. Hybridization was done on mononuclear cells and a median of 518 cells were counted per slide with a fluorescent microscope. The median percentage of donor cells was 99.04%, 98.21%, 98.15%, and 99.52% at <60, 60-140, 140-300, and >300 days after BMT. Mixed chimerism was a rare occurrence after CD8 depleted allogeneic BMT and occured only at low levels. Inhibition of repopulation by host hematopoietic cells may be associated with the graft-versus-leukemia effect against CML.
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Affiliation(s)
- G Rondón
- Department of Hematology, University of Texas, M.D. Anderson Cancer Center, Houston, USA
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22
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Giralt S, Weber D, Colome M, Dimopoulos M, Mehra R, Van Besien K, Gajewski J, Andersson B, Khouri I, Przepiorka D, von Wolff B, Delasalle K, Korbling M, Seong D, Alexanian R, Champlin R. Phase I trial of cyclosporine-induced autologous graft-versus-host disease in patients with multiple myeloma undergoing high-dose chemotherapy with autologous stem-cell rescue. J Clin Oncol 1997; 15:667-73. [PMID: 9053492 DOI: 10.1200/jco.1997.15.2.667] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine the feasibility and toxicity of inducing autologous graft-versus-host disease (GVHD) with cyclosporine in patients with multiple myeloma undergoing autologous stem-cell transplantation. PATIENTS AND METHODS Fourteen multiple myeloma patients with a median age of 50 years (range, 41 to 63) were enrolled. The median time from diagnosis to transplant was 651 days (range, 229 to 3,353). Ten patients had primary refractory disease, two were in first remission, and two were responsive to salvage therapy. The preparative regimen consisted of thiotepa, busulfan, and cyclophosphamide. Cyclosporine was administered daily for 28 days after the stem-cell infusion, and the dose was adjusted to maintain whole-blood cyclosporine levels between 50 and 150 ng/dL in the first seven patients (low-level group) and between 150 and 300 ng/dL in the other seven patients (high-level group). RESULTS All patients achieved neutrophil engraftment a median of 11 days after transplant. Four patients developed > or = grade 2 hepatic toxicity, six developed > or = grade 2 nephrotoxicity, and four developed reversible cardiac toxicity. Only one treatment-related death occurred. Cyclosporine was withheld in seven patients for a median of 6 days because of renal and/or liver dysfunction. One patient developed clinical skin GVHD, which responded to corticosteroid therapy. Six patients developed histologic evidence of GVHD without clinical signs of GVHD (subclinical GVHD). The incidence of clinical and subclinical GVHD was similar in both cyclosporine groups. Three of 11 patients assessable for response achieved remissions. Three patients experienced disease progression 80, 160, and 354 days after transplant. Ten patients are alive without progression between 56 and 444 days after transplant. CONCLUSION Induction of autologous GVHD by posttransplant cyclosporine is feasible and well tolerated in patients with multiple myeloma.
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Affiliation(s)
- S Giralt
- Department of Hematology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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23
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Giralt S, Hester J, Huh Y, Hirsch-Ginsberg C, Rondón G, Seong D, Lee M, Gajewski J, Van Besien K, Khouri I, Mehra R, Przepiorka D, Körbling M, Talpaz M, Kantarjian H, Fischer H, Deisseroth A, Champlin R. CD8-depleted donor lymphocyte infusion as treatment for relapsed chronic myelogenous leukemia after allogeneic bone marrow transplantation. Blood 1995; 86:4337-43. [PMID: 7492795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Donor lymphocyte infusions can reinduce complete remission in the majority of patients with chronic myelogenous leukemia (CML) who relapse into chronic phase after allogeneic bone marrow transplantation (BMT). Such infusions are associated with a high incidence of graft-versus-host disease (GVHD) and marrow aplasia. BMT using selective depletion of CD8+ lymphocytes from donor cells reduces the incidence of GVHD without an increase in leukemia relapse. We hypothesized that infusion of CD8-depleted donor peripheral blood lymphocytes could also reinduce complete remissions with a lesser potential to produce symptomatic GVHD in patients with CML who relapsed after allogeneic BMT. Ten patients with Ph(+) CML who relapsed a median of 353 days after BMT (range, 82 to 1,096 days) received donor lymphocyte infusions depleted of CD8+ cells. Nine patients received a single infusion and 1 received two infusions. Four patients were treated while in chronic phase with clonal evolution, 2 during accelerated phase, 3 during blast crisis, and 1 in a cytogenetic relapse. A mean of 0.9 +/- 0.3 x 10(8) mononuclear cells/kg were infused, containing 0.6 +/- 0.4 x 10(6) CD3+CD8+ cells/kg. Six patients achieved hematologic and cytogenetic remission at 4, 8, 11, 15, 39, and 54 weeks after lymphocyte infusion. Two patients developed > or = grade II acute GVHD, and 1 patient developed mild chronic GVHD. We conclude that donor lymphocyte infusions depleted of CD8+ cells can induce remissions with a low rate of severe acute GVHD in patients with CML who relapse after allogeneic BMT, supporting the hypothesis that CD8+ lymphocytes are important effectors of GVHD, but may not be essential for the graft-versus-leukemia effect against this disease. Further controlled studies are required to confirm these preliminary observations.
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Affiliation(s)
- S Giralt
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77031, USA
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24
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Giralt S, O'Brien S, Talpaz M, Van Besien K, Chan KW, Rondón G, Andersson B, Mehra R, Khouri I, Estey E. Interferon-alpha and interleukin-2 as treatment for leukemia relapse after allogeneic bone marrow transplantation. Cytokines Mol Ther 1995; 1:115-22. [PMID: 9384668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We treated 12 patients with leukemia relapse after allogenic bone marrow transplantation with a combination of interferon-alpha (IFN-alpha) ((2.5-5.0) x 10(6) u/m2 subcutaneously three times a week) and interleukin-2 (IL-2) ((1.8-3.6) x 10(6) IU/m2 subcutaneously five times a week) to determine the toxicity and efficacy of combination cytokine therapy in this setting. The median age of the patients was 39 years (range: 16-50). There were nine females and three males. The median time to relapse from BMT was 98 days (range: 0-963). At the time of relapse, six patients had AML, four patients had CML (two in blast crisis and two in chronic phase with clonal evolution), and one patient had lymphoblastic lymphoma. Combination cytokine therapy was started a median of 108 days post BMT (range: 37-2404). Nine patients treated at the higher dose level required a 50% dose reduction because of toxicity or GVHD (three CNS, two GVHD, one high fever, one diarrhoea with hypotension, and one pericarditis). At a lower dose level, 2 of 10 patients had their treatment discontinued because of toxicity or GVHD. Six patients developed clinical findings consistent with acute GVHD while on combination cytokine therapy. Two patients responded to combination cytokine therapy: one with CML and one with AML. Combination cytokine therapy is feasible in the setting of relapse post allogeneic BMT. The combination of IL-2 1.8 x 10(6) IU/m2 five times a week with IFN-2 2.5 x 10(6) U/m2 three times a week seems to be tolerable, and merits further study in this setting.
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Affiliation(s)
- S Giralt
- Department of Hematology, University of Texas MD Anderson Cancer Center, Houston 77030, USA
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25
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Giralt SA, LeMaistre CF, Vriesendorp HM, Andersson BS, Dimopoulos M, Gajewski J, Van Besien K, Mehra R, Przepiorka D, Khouri I. Etoposide, cyclophosphamide, total-body irradiation, and allogeneic bone marrow transplantation for hematologic malignancies. J Clin Oncol 1994; 12:1923-30. [PMID: 8083714 DOI: 10.1200/jco.1994.12.9.1923] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To determine the efficacy and toxicity of etoposide, cyclophosphamide, and fractionated total-body irradiation (TBI) as the conditioning regimen for allogeneic bone marrow transplantation (BMT) in patients with hematologic malignancies. PATIENTS AND METHODS Seventy-nine patients underwent BMT from a human leukocyte antigen (HLA)-identical sibling using cyclosporine/methotrexate for graft-versus-host disease (GVHD) prophylaxis. Thirty-four patients had early leukemia (acute leukemia or lymphoblastic lymphoma in first remission, chronic myelogenous leukemia [CML], or refractory anemia [RA]), and 45 patients had more advanced disease. Patients received etoposide 1,500 mg/m2 on day -8, followed by cyclophosphamide 60 mg/kg/d on days -7 and -6, and 10.2 Gy of TBI administered in six fractions of 1.7 Gy given twice daily for 3 days from day -3 to -1. Donor bone marrow was harvested and infused on day 0. RESULTS Patients with early leukemia had a disease-free survival rate of 53% +/- 9% and an overall survival rate of 57% +/- 10% at 3 years. Patients with advanced disease had a disease-free survival rate of 15% +/- 5% and overall survival rate of 17% +/- 5%. The actuarial relapse rate for the early-leukemia group is 33% +/- 9% versus 69% +/- 9% for patients with more advanced disease. Severe toxicity was most frequently manifested as pulmonary hemorrhage followed by multiorgan failure and death. The 100-day mortality rate for the early-leukemia group was 10% versus 50% for patients with more advanced disease. CONCLUSION The combination of cyclophosphamide, etoposide, and TBI is a relatively safe and effective preparative regimen for patients with early hematologic malignancies. Controlled trials are needed to evaluate critically this combination versus other standard preparative regimens. Greater toxicity was observed in patients with advanced disease, and this program does not appear to offer any advantage over other regimens.
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Affiliation(s)
- S A Giralt
- Department of Hematology, University of Texas, M.D. Anderson Cancer Center, Houston 77030
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26
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Abstract
We report an unusual case of a patient with a myelodysplastic syndrome associated with life threatening relapsing polychondritis. The improvement in symptoms attributable to the relapsing polychondritis during treatment of the hematologic disorder suggests that relapsing polychondritis is a paraneoplastic syndrome associated with myelodysplastic syndromes.
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Affiliation(s)
- K Van Besien
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis
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27
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Abstract
One hundred thirty-three patients (34.5% Child's C class) with at least one severe variceal hemorrhage and treated with repeated endoscopic sclerotherapy had a follow-up of 1-6 years (mean 20 months). The risk of rebleeding decreased significantly from 2 months after onset of sclerotherapy. Sixty-four patients (or 48%) rebled, within 2 months in 45 (70%). The incidence of rebleeding correlated with Child's category and with the size of the varices. The 2-month mortality rate was 28.6%; two-thirds died of severe rebleeding. Thirteen patients underwent emergency surgery for bleeding uncontrolled by sclerotherapy; nine of them died. Of the 120 treated only by sclerotherapy 93% ultimately died, 90% from variceal rebleeding. Mortality related to the liver disease was thus determined by rebleeding mainly within 2 months and by hepatic failure but not by etiology of the disease or number of previous hemorrhages. The more pronounced mortality in Child C versus B or A patients is thus due to early rebleeding and to more pronounced liver insufficiency in the early and later period. Varices could not be eradicated within 1 year by sclerotherapy in 9 patients; 68 of the 72 patients alive had total eradication, but recurrence of varices was observed in 19 (or 28%) within 1 year, independent of the etiology and severity of liver disease and varices. Only four patients rebled within 1 year, with no mortality. After 1-4 years, another five recurrences were noted, with two nonfatal bleeding episodes. This study argues for continuation of sclerotherapy until total eradication of varices as well as for regular follow-up to avoid recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Van Hootegem
- Department of Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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