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Abraham RS, Basu A, Heimall JR, Dunn E, Yip A, Kapadia M, Kapoor N, Satter LF, Buckley R, O'Reilly R, Cuvelier GDE, Chandra S, Bednarski J, Chaudhury S, Moore TB, Haines H, Dávila Saldaña BJ, Chellapandian D, Rayes A, Chen K, Caywood E, Chandrakasan S, Lugt MTV, Ebens C, Teira P, Shereck E, Miller H, Aquino V, Eissa H, Yu LC, Gillio A, Madden L, Knutsen A, Shah AJ, DeSantes K, Barnum J, Broglie L, Joshi AY, Kleiner G, Dara J, Prockop S, Martinez C, Mousallem T, Oved J, Burroughs L, Marsh R, Torgerson TR, Leiding JW, Pai SY, Kohn DB, Pulsipher MA, Griffith LM, Notarangelo LD, Cowan MJ, Puck J, Dvorak CC, Haddad E. Relevance of lymphocyte proliferation to PHA in severe combined immunodeficiency (SCID) and T cell lymphopenia. Clin Immunol 2024; 261:109942. [PMID: 38367737 PMCID: PMC11018339 DOI: 10.1016/j.clim.2024.109942] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Severe combined immunodeficiency (SCID) is characterized by a severe deficiency in T cell numbers. We analyzed data collected (n = 307) for PHA-based T cell proliferation from the PIDTC SCID protocol 6901, using either a radioactive or flow cytometry method. In comparing the two groups, a smaller number of the patients tested by flow cytometry had <10% of the lower limit of normal proliferation as compared to the radioactive method (p = 0.02). Further, in patients with CD3+ T cell counts between 51 and 300 cells/μL, there was a higher proliferative response with the PHA flow assay compared to the 3H-T assay (p < 0.0001), suggesting that the method of analysis influences the resolution and interpretation of PHA results. Importantly, we observed many SCID patients with profound T cell lymphopenia having normal T cell proliferation when assessed by flow cytometry. We recommend this test be considered only as supportive in the diagnosis of typical SCID.
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Affiliation(s)
- Roshini S Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, OH, USA.
| | - Amrita Basu
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, OH, USA
| | - Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, PA, USA
| | - Elizabeth Dunn
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Alison Yip
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Malika Kapadia
- Division of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard University Medical School, Boston, MA, USA
| | - Neena Kapoor
- Transplantation and Cellular Therapy Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lisa Forbes Satter
- Pediatrics, Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Rebecca Buckley
- Departments of Pediatrics and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Richard O'Reilly
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Geoffrey D E Cuvelier
- Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Sharat Chandra
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey Bednarski
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Sonali Chaudhury
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago-Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Theodore B Moore
- Division of Hematology/Oncology, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
| | - Hilary Haines
- Division of Pediatric Hematology-Oncology and Bone Marrow Transplant, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Blachy J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Hospital-George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Ahmad Rayes
- Division of Pediatric Hematology and Oncology, Intermountain Primary Childrens Hospital, Huntsman Cancer Institute, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Karin Chen
- Department of Pediatrics, University of Washington-Seattle Children's Hospital, Seattle, WA, USA
| | - Emi Caywood
- Nemours Children's Health Delaware, Thomas Jefferson University, Wilmington, DE, USA
| | - Shanmuganathan Chandrakasan
- Bone Marrow Transplantation Program, Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Christen Ebens
- Division of Pediatric Blood and Marrow Transplantation & Cellular Therapy, University of Minnesota, Minneapolis, MN, USA
| | - Pierre Teira
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Evan Shereck
- Division of Pediatric Hematology/Oncology, Oregon Health and Science University, Portland, OR, USA
| | | | - Victor Aquino
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hesham Eissa
- Division of Pediatric Hematology-Oncology-BMT, University of Colorado, Aurora, CO, USA
| | - Lolie C Yu
- Division of Pediatric Hematology-Oncology/HSCT, LSUHSC and Children's Hospital, New Orleans, LA, USA
| | - Alfred Gillio
- Institute for Pediatric Cancer and Blood Disorders, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Lisa Madden
- Pediatric Blood and Marrow Transplantation Program, Texas Transplant Institute, Methodist Children's Hospital, San Antonio, TX, USA
| | - Alan Knutsen
- Department of Pediatrics, Pediatric Allergy and Immunology Division, Saint Louis University, St Louis, MO, USA
| | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine Pediatric Stem Cell Transplantation, Stanford University, Stanford, CA, USA
| | - Kenneth DeSantes
- American Family Children's Hospital, University of Wisconsin, Madison, WI, USA
| | - Jessie Barnum
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Larisa Broglie
- Division of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Avni Y Joshi
- Division of Pediatric and Adult Allergy and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Gary Kleiner
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Holtz Children's Hospital at Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jasmeen Dara
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Susan Prockop
- Division of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard University Medical School, Boston, MA, USA
| | - Caridad Martinez
- Pediatrics, Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Talal Mousallem
- Departments of Pediatrics and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Joseph Oved
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauri Burroughs
- Department of Pediatrics, University of Washington-Seattle Children's Hospital, Seattle, WA, USA
| | - Rebecca Marsh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Pharming Healthcare Inc, Warren, NJ, USA
| | - Troy R Torgerson
- Department of Pediatrics, University of Washington-Seattle Children's Hospital, Seattle, WA, USA
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University Baltimore, MD and Institute for Clinical and Translational Research, Johns Hopkins All Childrens Hospital, St. Petersburg, FL, USA
| | - Sung Yun Pai
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Donald B Kohn
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael A Pulsipher
- Division of Pediatric Hematology and Oncology, Intermountain Primary Childrens Hospital, Huntsman Cancer Institute, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Linda M Griffith
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Morton J Cowan
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Puck
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher C Dvorak
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Elie Haddad
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
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Dignum T, Burroughs L, Mallhi K, Brandling-Bennett HA. Dermatologic complications in pediatric patients after hematopoietic stem cell transplantation for sickle cell disease. Pediatr Dermatol 2024; 41:61-65. [PMID: 37965881 DOI: 10.1111/pde.15471] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/29/2023] [Indexed: 11/16/2023]
Abstract
Dermatologic complications are common following allogeneic hematopoietic stem cell transplantation, but dermatologic complications among pediatric patients undergoing hematopoietic stem cell transplantation for the treatment of sickle cell disease have been poorly characterized. In this case series of 17 patients (<21 years old) with sickle cell disease who underwent hematopoietic stem cell transplantation, 16 (94.1%) experienced one or more dermatologic complications after transplant, with the most common complications including acute or chronic mucocutaneous graft-versus-host disease (GVHD) (34.1% of complications), skin eruptions of unknown origin (15.9% of complications), infections (15.9% of complications), and chemotherapy-related pigmentary changes (11.4% of complications). Patients who developed acute or chronic skin GVHD were significantly older at the time of hematopoietic stem cell transplantation. These findings highlight the need to closely monitor for dermatologic complications in pediatric patients who undergo hematopoietic stem cell transplantation for sickle cell disease and underscore the importance of involving dermatology early on when skin complications occur, although further research with a larger multicenter study could help clarify the risk for dermatologic complications and help identify potential ways to mitigate this risk.
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Affiliation(s)
- Tessa Dignum
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauri Burroughs
- University of Washington School of Medicine, Seattle, Washington, USA
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Kanwaldeep Mallhi
- University of Washington School of Medicine, Seattle, Washington, USA
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Heather A Brandling-Bennett
- University of Washington School of Medicine, Seattle, Washington, USA
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital, Seattle, Washington, USA
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3
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Geerlinks AV, Scull B, Krupski C, Fleischmann R, Pulsipher MA, Eapen M, Connelly JA, Bollard CM, Pai SY, Duncan C, Kean LS, Baker KS, Burroughs L, Andolina JR, Shenoy S, Roehrs P, Hanna R, Talano JA, Schultz KR, Stenger EO, Lin H, Zoref-Lorenz A, McClain KL, Jordan MB, Man TK, Allen CE, Marsh RA. Alemtuzumab and CXCL9 levels predict likelihood of sustained engraftment after reduced intensity conditioning HCT. Blood Adv 2023:495332. [PMID: 37042921 PMCID: PMC10368780 DOI: 10.1182/bloodadvances.2022009478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 04/13/2023] Open
Abstract
Overall survival following reduced intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT) using alemtuzumab, fludarabine, and melphalan is favorable in patients transplanted for inborn errors of immunity (IEI), but RIC is associated with high rates of mixed chimerism (MC) and secondary graft failure (GF). We hypothesized that peri-transplant alemtuzumab levels or specific patterns of inflammation would predict these risks. We assessed samples from BMT CTN 1204 (NCT01998633) to study the impact of alemtuzumab levels and cytokine patterns on MC and impending or established secondary GF (defined as donor chimerism <5% after initial engraftment and/or requirement of cellular intervention). Thirty-three patients with HLH (n=25) and other IEI (n=8) who underwent HCT with T-cell replete grafts were included. Patients with day 0 alemtuzumab levels ≤0.32μg/mL had a markedly lower incidence of MC, 14.3%, versus 90.9% in patients >0.32μg/mL (p=0.008). Impending or established secondary GF was only observed in patients with day 0 alemtuzumab levels >0.32µg/mL (p=0.08). Unexpectedly, patients with impending or established secondary GF had lower CXCL9 levels. The cumulative incidence of impending or established secondary GF in patients with a day +14 CXCL9 level ≤2394pg/mL (day +14 median) was 73.6% versus 0% in patients >2394pg/mL (p=0.002). CXCL9 levels inversely correlated with alemtuzumab levels. These findings support a relationship between alemtuzumab levels, CXCL9 levels, and sustained engraftment. These data suggest a model in which higher levels of alemtuzumab at day 0 deplete donor T-cells, inhibit the graft-versus-marrow reaction (thereby suppressing CXCL9 levels), and adversely impact sustained engraftment in the non-myeloablative HCT setting. Clinical Trial # NCT01998633.
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Affiliation(s)
- Ashley V Geerlinks
- Children's Hospital, London Health Sciences Centre, Western University, London, Canada
| | - Brooks Scull
- Baylor College of Medicine, Houston, Texas, United States
| | - Christa Krupski
- Cincinnati Children's Hospital Medical Center/University of Cincinnati, Cincinnati, Ohio, United States
| | | | - Michael A Pulsipher
- Huntsman Cancer Institute/Intermountain Primary Chlldren's Hospital, Spencer Fox Eccles School of Medicine, University of Utah., Salt Lake City, Utah, United States
| | - Mary Eapen
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - James A Connelly
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Catherine M Bollard
- Children's National Hospital and The George Washington University, United States
| | - Sung-Yun Pai
- National Institutes of Health, Bethesda, Maryland, United States
| | - Christine Duncan
- Dana Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Leslie S Kean
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, United States
| | - K Scott Baker
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Lauri Burroughs
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, Washington, United States
| | - Jeffrey R Andolina
- University of Rochester Medical Center, Rochester, New York, United States
| | - Shalini Shenoy
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Philip Roehrs
- University of Virginia, Charlottesville, Virginia, United States
| | - Rabi Hanna
- Cleveland Clinic, Cleveland, Ohio, United States
| | - Julie-An Talano
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | | | - Elizabeth O Stenger
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, Georgia, United States
| | - Howard Lin
- Texas Children's Hospital, United States
| | | | | | - Michael B Jordan
- CINCINNATI CHILDREN'S HOSP MED CTR, Cincinnati, Ohio, United States
| | - Tsz-Kwong Man
- Baylor College of Medicine, Houston, Texas, United States
| | - Carl E Allen
- Baylor College of Medicine, Houston, Texas, United States
| | - Rebecca A Marsh
- Cincinnati Children's Hospital Medical Center, United States
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4
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Cancio M, Hebert K, Kim S, Aljurf M, Olson T, Anderson E, Burroughs L, Vatsayan A, Myers K, Hashem H, Hanna R, Horn B, Prestidge T, Boelens JJ, Boulad F, Eapen M. Outcomes in Hematopoietic Stem Cell Transplantation for Congenital Amegakaryocytic Thrombocytopenia. Transplant Cell Ther 2022; 28:101.e1-101.e6. [PMID: 34670170 PMCID: PMC8816844 DOI: 10.1016/j.jtct.2021.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/28/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 02/03/2023]
Abstract
Congenital amegakaryocytic thrombocytopenia (CAMT) is a rare, inherited bone marrow failure syndrome. Hematopoietic stem cell transplantation (HSCT) is considered a curative treatment option, but existing descriptions of patient and transplant characteristics and outcomes after related and unrelated donor HSCT are sparse. We describe outcomes after HSCT for congenital amegakaryocytic thrombocytopenia (CAMT; n = 86) from 2000 to 2018. We conducted an analysis of data collected by the Center for International Blood and Marrow Transplant Research on patients with CAMT receiving therapeutic allogeneic HSCT. The predominant donor type was HLA-matched or mismatched unrelated donors (n = 58, 67%). The remaining included HLA-matched sibling (n = 23, 27%) and HLA-mismatched relative (n = 5, 6%). The predominant graft types were bone marrow (n = 53, 62%) and cord blood (n = 25, 29%). The median age at transplantation was 3 years, with 82 of 86 patients being transplanted aged ≤10 years. The 5-year graft failure-free and overall survival were 83% (95% confidence interval [CI], 74-90) and 86% (95% CI, 78-93), respectively. An examination for risk factors confirmed mortality was higher after HLA-mismatched relative and mismatched unrelated donor HSCT compared to HLA-matched sibling and matched unrelated donor HSCT (hazard ratio 3.52, P = .04; 75% versus 93%). The 1-year incidence of graft failure was 19% after HLA-mismatched HSCT (n = 32) compared to 7% after HLA-matched HSCT (n = 54, P = .15). Day-100 grade II-IV acute graft-versus-host disease was 13%, 26%, and 30% after HLA-matched sibling, HLA-matched and mismatched unrelated donor HSCT. The 5-year incidence of chronic graft-versus-host disease was 33% with 24 of 28 patients having received grafts from HLA-matched (n = 13) and mismatched unrelated (n = 11) donors. Although HLA-matched donors are preferred, HLA-mismatched donors also extend survival for CAMT.
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Affiliation(s)
- Maria Cancio
- MSK Kids, Stem Cell Transplantation and Cellular Therapy, Memorial Sloan Kettering Cancer Center, New York, NY,Correspondence: Maria Cancio, MD; Memorial Sloan Kettering Cancer Center, 1275 York Ave. New York, NY 10065,
| | - Kyle Hebert
- Center for International Blood and Marrow Transplant Research, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Soyoung Kim
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Timothy Olson
- Comprehensive Bone Marrow Failure Center, Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Lauri Burroughs
- Department of Pediatrics, University of Washington-Seattle Children’s Hospital, Seattle, WA
| | - Anant Vatsayan
- Division of Blood and Marrow Transplantation, Children’s National Health System, Washington, DC
| | - Kasiani Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center
| | - Hasan Hashem
- Department of Pediatrics, Division of Pediatric Hematology Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Rabi Hanna
- Department of Pediatric Hematology Oncology and BMT, Cleveland Clinic Children’s, Cleveland, OH
| | - Biljana Horn
- Pediatric Hematology/Oncology, University of Florida, Gainesville, FL
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children’s Hospital, Auckland, New Zealand
| | - Jaap-Jan Boelens
- MSK Kids, Stem Cell Transplantation and Cellular Therapy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Farid Boulad
- MSK Kids, Stem Cell Transplantation and Cellular Therapy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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5
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Myers K, Hebert K, Antin J, Boulad F, Burroughs L, Hofmann I, Kamble R, MacMillan ML, Eapen M. Hematopoietic Stem Cell Transplantation for Shwachman-Diamond Syndrome. Biol Blood Marrow Transplant 2020; 26:1446-1451. [PMID: 32428734 DOI: 10.1016/j.bbmt.2020.04.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 11/15/2022]
Abstract
We report the outcomes of hematopoietic stem cell transplantation (HSCT) for 52 patients with Shwachman-Diamond syndrome (SDS) who underwent transplantation between 2000 and 2017. The median age at transplantation was 11 years, and the median duration of follow-up was 60 months. The indication for HSCT was bone marrow failure (BMF; cytopenia or aplastic anemia) in 39 patients and myelodysplasia (MDS)/acute myelogenous leukemia (AML) in 13 patients. The donor type was an HLA-matched sibling for 18 patients, an HLA-matched or mismatched relative for 6 patients, and an HLA-matched or mismatched unrelated donor for 28 patients. Preparative regimens for BMF were myeloablative in 13 patients and reduced intensity in 26. At the time of this report, 29 of the 39 patients with BMF were alive, and the 5-year overall survival was 72% (95% confidence interval, 57% to 86%). Graft failure and graft-versus-host disease were the predominant causes of death. Preparative regimens for patients with MDS/AML were myeloablative in 8 and reduced intensity in 5. At the time of this report, only 2 of 13 patients were alive (15%), with relapse the predominant cause of death. Survival after transplantation for SDS-related BMF is better compared with historical reports, but strategies are needed to overcome graft failure and graft-versus-host disease. For SDS- related MDS or AML, transplantation does not extend survival. Rigorous surveillance and novel treatments for leukemia are urgently needed.
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Affiliation(s)
- Kasiani Myers
- Division of Blood and Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kyle Hebert
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joseph Antin
- Division of Hematology and Oncology, Dana Farber Cancer Institute at Brigham and Women's Hospital, Boston, Massachusetts
| | - Farid Boulad
- Division of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lauri Burroughs
- Data Abstraction Department- Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Inga Hofmann
- Division of Blood and Bone Marrow Transplant, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Rammurti Kamble
- Division of Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Margaret L MacMillan
- Division of Pediatrics-Blood and Marrow Transplant Program, University of Minnesota Blood and Marrow Transplant Program, Minneapolis, Minnesota
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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6
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Harrington WE, Mató S, Burroughs L, Carpenter PA, Gershon A, Schmid DS, Englund JA. Vaccine Oka Varicella Meningitis in Two Adolescents. Pediatrics 2019; 144:peds.2019-1522. [PMID: 31776194 PMCID: PMC6889945 DOI: 10.1542/peds.2019-1522] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/24/2022] Open
Abstract
The live-attenuated varicella vaccine, a routine immunization in the United States since 1995, is both safe and effective. Like wild-type varicella-zoster virus, however, vaccine Oka (vOka) varicella can establish latency and reactivate as herpes zoster, rarely leading to serious disease, particularly among immunocompromised hosts. Previous cases of reactivated vOka resulting in meningitis have been described in young children who received a single dose of varicella vaccine; less is known about vOka reactivation in older children after the 2-dose vaccine series. We present 2 adolescents with reactivated vOka meningitis, 1 immunocompetent and 1 immunocompromised, both of whom received 2 doses of varicella vaccine many years before as children. Pediatricians should be aware of the potential of vOka varicella to reactivate and cause clinically significant central nervous system disease in vaccinated children and adolescents.
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Affiliation(s)
- Whitney E. Harrington
- Seattle Children’s Hospital, Seattle, Washington;,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Sayonara Mató
- Randall Children’s Hospital at Legacy Emanuel, Portland, Oregon
| | - Lauri Burroughs
- Seattle Children’s Hospital, Seattle, Washington;,Department of Pediatrics, University of Washington, Seattle, Washington;,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul A. Carpenter
- Seattle Children’s Hospital, Seattle, Washington;,Department of Pediatrics, University of Washington, Seattle, Washington;,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anne Gershon
- Department of Pediatrics, Vagelos School of Physicians and Surgeons, Columbia University, New York, New York; and
| | - D. Scott Schmid
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet A. Englund
- Seattle Children’s Hospital, Seattle, Washington;,Department of Pediatrics, University of Washington, Seattle, Washington
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7
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Burroughs L, Mitroi J, Bolbecker A, Moussa-Tooks A, Lundin N, O'Donnell B, Hetrick W. Transcranial direct current stimulation of the human cerebellum during associative learning. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.558] [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: 11/30/2022] Open
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8
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Dahlberg A, Leisenring W, Bleakley M, Meshinchi S, Baker KS, Summers C, Hadland B, Delaney C, Mallhi K, Burroughs L, Carpenter P, Woolfrey A. Prognosis of relapse after hematopoietic cell transplant (HCT) for treatment of leukemia or myelodysplastic syndrome (MDS) in children. Bone Marrow Transplant 2019; 54:1337-1345. [PMID: 30670822 DOI: 10.1038/s41409-019-0438-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/24/2022]
Abstract
We studied 232 consecutive children transplanted between 1990 and 2011 with relapse after first hematopoietic cell transplant (HCT). Kaplan-Meier survival and hazard ratios for mortality were calculated for factors known at time of relapse using Cox proportional hazards models. The median (range) age at time of first HCT was 10.9 (0.5-20.9) years, time to relapse was 6.1 (0.2-89.5) months after HCT, and age at relapse was 11.7 (0.7-23.6) years. The 3-year overall survival (OS) after relapse was 13% (95% confidence interval (CI): 9%, 18%).The median (range) follow-up for the 18 surviving patients was 7.2 (3.0-24.4) years after relapse. The remaining 214 died after a median of 3 months (0.02-190.4). OS was not significantly different for patients with ALL as compared to AML. Fifty-one patients proceeded to second transplant of whom nine survive. Factors associated with improved survival included late relapse (>12 months), ALL in first CR at the time of first transplant and chemotherapy-based first conditioning regimens. These results can be used to counsel patients at the time of relapse after first transplant and as a baseline for comparison as to the effectiveness of newer therapies which are greatly needed for treatment of post-transplant relapse.
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Affiliation(s)
- Ann Dahlberg
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA.
| | - Wendy Leisenring
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Marie Bleakley
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - K Scott Baker
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Corinne Summers
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Brandon Hadland
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Colleen Delaney
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Kanwaldeep Mallhi
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Lauri Burroughs
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Paul Carpenter
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Ann Woolfrey
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
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9
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Vora S, Englund J, Petrovic A, Woolfrey A, Mallhi K, Burroughs L. 1553. Infectious Complications Following Hematopoietic Cell Transplantation in Patients With Primary Immunodeficiency Diseases. Open Forum Infect Dis 2018. [PMCID: PMC6252415 DOI: 10.1093/ofid/ofy210.1381] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Hematopoietic cell transplantation (HCT) has significantly improved long-term survival for children with primary immunodeficiency diseases (PID). Little is known about specific risk factors for infections after transplant in PID patients and differences from others undergoing HCT. Factors impacting success of HCT in PID include age at HCT, underlying genetic defect, type of donor and conditioning regimen, and importantly, the presence of pre-existing infection. We describe the epidemiology and risk factors for bacterial, viral and fungal infections in patients undergoing HCT for PID. Methods After IRB approval, medical records of patients undergoing HCT at Seattle Children’s Hospital for PID between 1998 and 2017 were reviewed. Donor and stem cell source, conditioning regimen, development of graft vs. host disease (GVHD), chimerism and mortality were considered, in addition to details of pre-HCT infections. Timing, character and treatment details of each incident infection during 12 months post-HCT were collected. Standardized antimicrobial prophylactic regimens were administered. Primary outcomes included mortality and infection-free survival. Kaplan–Meier curves were used to examine infection-free survival, by diagnosis and by HCT era. Results Sixty-nine patients with PID underwent HCT during the study period. Mean age at HCT was 6.2 years and varied by underlying PID. Altogether, 24 children (34.8%) had severe combined immune deficiency (SCID), 14 (20.3%) had chronic granulomatous disease (CGD), nine (13%) had combined immune deficiency (CID), and six (8.7%) had hyper IgM syndrome. Fifty-six patients received HLA-matched grafts. Umbilical cord blood was utilized in 10% of patients. Acute GVHD grades II–IV developed in 46 (67%) patients. Bacterial infections were the most common infection post-HCT, followed by respiratory and herpes group viral infections. Overall mortality at 1 year was 19%, of which at least 50% was infection related. Conclusion Infection occurs frequently and contributes to morbidity and mortality in patients undergoing HCT for PID. Understanding the timing of infections and contributing risk factors could help develop preemptive and monitoring strategies to improve outcomes in this patient population. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Surabhi Vora
- Seattle Children’s Hospital, Seattle, Washington
| | - Janet Englund
- Department of Pediatrics, University of Washington, Seattle, Washington
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10
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Haddad E, Logan BR, Griffith LM, Buckley RH, Parrott RE, Prockop SE, Small TN, Chaisson J, Dvorak CC, Murnane M, Kapoor N, Abdel-Azim H, Hanson IC, Martinez C, Bleesing JJH, Chandra S, Smith AR, Cavanaugh ME, Jyonouchi S, Sullivan KE, Burroughs L, Skoda-Smith S, Haight AE, Tumlin AG, Quigg TC, Taylor C, Dávila Saldaña BJ, Keller MD, Seroogy CM, Desantes KB, Petrovic A, Leiding JW, Shyr DC, Decaluwe H, Teira P, Gillio AP, Knutsen AP, Moore TB, Kletzel M, Craddock JA, Aquino V, Davis JH, Yu LC, Cuvelier GDE, Bednarski JJ, Goldman FD, Kang EM, Shereck E, Porteus MH, Connelly JA, Fleisher TA, Malech HL, Shearer WT, Szabolcs P, Thakar MS, Vander Lugt MT, Heimall J, Yin Z, Pulsipher MA, Pai SY, Kohn DB, Puck JM, Cowan MJ, O'Reilly RJ, Notarangelo LD. SCID genotype and 6-month posttransplant CD4 count predict survival and immune recovery. Blood 2018; 132:1737-1749. [PMID: 30154114 PMCID: PMC6202916 DOI: 10.1182/blood-2018-03-840702] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [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] [Received: 03/26/2018] [Accepted: 08/20/2018] [Indexed: 12/26/2022] Open
Abstract
The Primary Immune Deficiency Treatment Consortium (PIDTC) performed a retrospective analysis of 662 patients with severe combined immunodeficiency (SCID) who received a hematopoietic cell transplantation (HCT) as first-line treatment between 1982 and 2012 in 33 North American institutions. Overall survival was higher after HCT from matched-sibling donors (MSDs). Among recipients of non-MSD HCT, multivariate analysis showed that the SCID genotype strongly influenced survival and immune reconstitution. Overall survival was similar for patients with RAG, IL2RG, or JAK3 defects and was significantly better compared with patients with ADA or DCLRE1C mutations. Patients with RAG or DCLRE1C mutations had poorer immune reconstitution than other genotypes. Although survival did not correlate with the type of conditioning regimen, recipients of reduced-intensity or myeloablative conditioning had a lower incidence of treatment failure and better T- and B-cell reconstitution, but a higher risk for graft-versus-host disease, compared with those receiving no conditioning or immunosuppression only. Infection-free status and younger age at HCT were associated with improved survival. Typical SCID, leaky SCID, and Omenn syndrome had similar outcomes. Landmark analysis identified CD4+ and CD4+CD45RA+ cell counts at 6 and 12 months post-HCT as biomarkers predictive of overall survival and long-term T-cell reconstitution. Our data emphasize the need for patient-tailored treatment strategies depending upon the underlying SCID genotype. The prognostic significance of CD4+ cell counts as early as 6 months after HCT emphasizes the importance of close follow-up of immune reconstitution to identify patients who may need additional intervention to prevent poor long-term outcome.
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Affiliation(s)
- Elie Haddad
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Linda M Griffith
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | | | | - Susan E Prockop
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Trudy N Small
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Chaisson
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christopher C Dvorak
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Megan Murnane
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Neena Kapoor
- Blood and Marrow Transplant Program, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Hisham Abdel-Azim
- Blood and Marrow Transplant Program, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Caridad Martinez
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jack J H Bleesing
- Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Sharat Chandra
- Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Angela R Smith
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN
| | | | - Soma Jyonouchi
- Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kathleen E Sullivan
- Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lauri Burroughs
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Seattle Children's Hospital, Seattle, WA
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Emory/Children's Healthcare of Atlanta, Atlanta, GA
| | - Audrey G Tumlin
- Aflac Cancer and Blood Disorders Center, Emory/Children's Healthcare of Atlanta, Atlanta, GA
| | - Troy C Quigg
- Texas Transplant Institute, Methodist Children's Hospital, San Antonio, TX
| | - Candace Taylor
- Texas Transplant Institute, Methodist Children's Hospital, San Antonio, TX
| | - Blachy J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Michael D Keller
- Division of Blood and Marrow Transplantation, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Kenneth B Desantes
- American Family Children's Hospital, University of Wisconsin, Madison, WI
| | - Aleksandra Petrovic
- Blood and Marrow Transplant, John Hopkins All Children's Hospital, St. Petersburg, FL
| | - Jennifer W Leiding
- Blood and Marrow Transplant, John Hopkins All Children's Hospital, St. Petersburg, FL
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL
| | - David C Shyr
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | - Hélène Decaluwe
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Pierre Teira
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Alfred P Gillio
- Institute for Pediatric Cancer and Blood Disorders, Hackensack University Medical Center, Hackensack, NJ
| | - Alan P Knutsen
- Pediatric Allergy and Immunology, Saint Louis University, Cardinal Glennon Children's Medical Center, St. Louis, MO
| | - Theodore B Moore
- Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Morris Kletzel
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John A Craddock
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Victor Aquino
- Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey H Davis
- Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Lolie C Yu
- Division of Hematology/Oncology and Hematopoietic Stem Cell Transplantation, The Center for Cancer and Blood Disorders, Children's Hospital/Louisiana State University Medical Center, New Orleans, LA
| | - Geoffrey D E Cuvelier
- Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | | | - Frederick D Goldman
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth M Kang
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Evan Shereck
- Division of Pediatric Hematology/Oncology, Oregon Health and Science University, Portland, OR
| | - Matthew H Porteus
- Pediatric Stem Cell Transplantation, Stanford University, Stanford, CA
| | | | - Thomas A Fleisher
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Harry L Malech
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | | | | - Monica S Thakar
- Pediatric Blood and Marrow Transplant Program, Division of Hematology, Oncology, and Blood Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Mark T Vander Lugt
- Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, MI; and
| | - Jennifer Heimall
- Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ziyan Yin
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Michael A Pulsipher
- Blood and Marrow Transplant Program, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Sung-Yun Pai
- Hematology-Oncology, Boston Children's Hospital, Boston, MA
| | - Donald B Kohn
- Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Jennifer M Puck
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Morton J Cowan
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Richard J O'Reilly
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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11
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Allen CE, Marsh R, Dawson P, Bollard CM, Shenoy S, Roehrs P, Hanna R, Burroughs L, Kean L, Talano JA, Schultz KR, Pai SY, Baker KS, Andolina JR, Stenger EO, Connelly J, Ramirez A, Bryant C, Eapen M, Pulsipher MA. Reduced-intensity conditioning for hematopoietic cell transplant for HLH and primary immune deficiencies. Blood 2018; 132:1438-1451. [PMID: 29997222 PMCID: PMC6161764 DOI: 10.1182/blood-2018-01-828277] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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] [Received: 01/18/2018] [Accepted: 07/01/2018] [Indexed: 12/27/2022] Open
Abstract
Allogeneic hematopoietic cell transplantation (HCT) with myeloablative conditioning for disorders associated with excessive inflammation such as hemophagocytic lymphohistiocytosis (HLH) is associated with early mortality. A multicenter prospective phase 2 trial of reduced-intensity conditioning with melphalan, fludarabine, and intermediate-timing alemtuzumab was conducted for HLA matched or single HLA locus mismatched related or unrelated donor HCT in a largely pediatric cohort. Graft-versus-host disease (GVHD) prophylaxis was cyclosporine with methylprednisolone. The primary end point was 1-year overall survival (OS). Thirty-four patients with HLH and 12 with other primary immune deficiencies were transplanted. With a median follow-up of 20 months, the 1-year OS for transplanted patients was 80.4% (90% confidence interval [CI], 68.6%-88.2%). Five additional deaths by 16 months yielded an 18-month OS probability of 66.7% (90% CI, 52.9%-77.3%). Two patients experienced primary graft failure, and 18 patients either experienced a secondary graft failure or required a second intervention (mostly donor lymphocyte infusion [DLI]). At 1 year, the proportion of patients alive with sustained engraftment without DLI or second HCT was 39.1% (95% CI, 25.2%-54.6%), and that of being alive and engrafted (with or without DLI) was 60.9% (95% CI, 45.4 %-74.9%). The day 100 incidence of grade II to IV acute GVHD was 17.4% (95% CI, 8.1%-29.7%), and 1-year incidence of chronic GVHD was 26.7% (95% CI, 14.6%-40.4%). Although the trial demonstrated low early mortality, the majority of surviving patients required DLI or second HCT. These results demonstrate a need for future approaches that maintain low early mortality with improved sustained engraftment. The trial was registered at Clinical Trials.gov (NCT 01998633).
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Affiliation(s)
- Carl E Allen
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Rebecca Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Health System and Department of Pediatrics, The George Washington University, Washington, DC
| | - Shalini Shenoy
- Division of Pediatric Hematology-Oncology, Washington University School of Medicine, St. Louis, MO
| | - Philip Roehrs
- Levine Children's Hospital, Carolinas HealthCare System, Charlotte, NC
| | - Rabi Hanna
- Department of Pediatric Hematology and Oncology and BMT, Cleveland Clinic, Cleveland, OH
| | - Lauri Burroughs
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Leslie Kean
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA
- Seattle Children's Hospital, Seattle, WA
| | - Julie-An Talano
- Department of Pediatric Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Kirk R Schultz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sung-Yun Pai
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA
- Seattle Children's Hospital, Seattle, WA
| | - Jeffrey R Andolina
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Elizabeth O Stenger
- Aflac Center and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - James Connelly
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | | | | | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; and
| | - Michael A Pulsipher
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA
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12
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Nemecek ER, Hilger RA, Adams A, Shaw BE, Kiefer D, Le-Rademacher J, Levine JE, Yanik G, Leung W, Talano JA, Haut P, Delgado D, Kapoor N, Petrovic A, Adams R, Hanna R, Rangarajan H, Dalal J, Chewning J, Verneris MR, Epstein S, Burroughs L, Perez-Albuerne ED, Pulsipher MA, Delaney C. Treosulfan, Fludarabine, and Low-Dose Total Body Irradiation for Children and Young Adults with Acute Myeloid Leukemia or Myelodysplastic Syndrome Undergoing Allogeneic Hematopoietic Cell Transplantation: Prospective Phase II Trial of the Pediatric Blood and Marrow Transplant Consortium. Biol Blood Marrow Transplant 2018; 24:1651-1656. [PMID: 29753157 DOI: 10.1016/j.bbmt.2018.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/22/2018] [Accepted: 04/25/2018] [Indexed: 12/22/2022]
Abstract
This multicenter study evaluated a treosulfan-based regimen in children and young adults with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplant (HCT). Forty patients with median age 11 years (range, 1 to 19) underwent allogeneic HCT for AML in first (n = 18), second (n = 11), and third or greater remission (n = 3) or MDS (n = 8) using bone marrow (n = 25), peripheral blood stem cells (n = 5), or cord blood (n = 9). The regimen consisted of body surface area (BSA)-based treosulfan 10 g/m2/day (BSA ≤ .5 m2), 12 g/m2/day (BSA > .5 to 1.0 m2), or 14 g/m2/day (BSA > 1.0 m2) on days -6 to -4; fludarabine 30 mg/m2/day on days -6 to -2; and a single fraction of 200 cGy total body irradiation on day -1. Graft-versus-host disease (GVHD) prophylaxis included tacrolimus and methotrexate for marrow and peripheral blood stem cell and cyclosporine/mycophenolate mofetil for cord blood. One-year overall survival, disease-free survival, and nonrelapse mortality were 80%, 73%, and 3%, respectively. One-year relapse was 38% for AML and 13% for MDS. No serious organ toxicities were observed. All 37 assessable patients engrafted. Cumulative incidences of grades II to IV acute GVHD and chronic GVHD were 22% and 40%, respectively. BSA-based treosulfan dosing resulted in predictable area under the curve and maximum concentration, which is required for dosing without measuring individual pharmacokinetic parameters. Observed differences in pharmacokinetics did not impact disease control or regimen toxicity. This BSA-based treosulfan regimen resulted in excellent engraftment and disease-free survival and minimal toxicity and transplant-related mortality (3%) in children and young adults with AML and MDS.
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Affiliation(s)
- Eneida R Nemecek
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
| | - Ralf A Hilger
- West German Cancer Center, University Hospital Essen, University Duisburg Essen, Essen, Germany
| | - Alexia Adams
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre Kiefer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | | | - John E Levine
- Division of Pediatric Hematology/Oncology, Mount Sinai School of Medicine, New York, New York
| | - Gregory Yanik
- Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
| | - Wing Leung
- Division of Pediatric Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Julie-An Talano
- Division of Pediatric Hematology/Oncology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Paul Haut
- Division of Pediatric Hematology/Oncology, Riley Children's Hospital at Indiana University Health, Indianapolis, Indiana
| | - David Delgado
- Division of Pediatric Hematology/Oncology, Riley Children's Hospital at Indiana University Health, Indianapolis, Indiana
| | - Neena Kapoor
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California
| | - Aleksandra Petrovic
- Division of Pediatric Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Roberta Adams
- Division of Pediatric Hematology/Oncology, Mayo Clinic Arizona and Phoenix Children's Hospital, Phoenix, Arizona
| | - Rabi Hanna
- Division of Pediatric Hematology/Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Hemalatha Rangarajan
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jignesh Dalal
- Division of Pediatric Hematology/Oncology, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Joseph Chewning
- Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael R Verneris
- Division of Pediatric Hematology/Oncology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Stacy Epstein
- Levine Children's Hospital, Carolinas Medical Center, Charlotte, North Carolina
| | - Lauri Burroughs
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington
| | - Evelio D Perez-Albuerne
- Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Michael A Pulsipher
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California
| | - Colleen Delaney
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington
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Brogile L, Thakar M, Logan BR, Artz A, Jacobsohn DA, Bunin NJ, Burroughs L, Martinez C, Nelson AS, Woolfrey AE, Pasquini MC, Sorror ML. Evaluation of the Hematopoietic Cell Comorbidity Index (HCT-CI) in Recipients of Allogeneic Transplantation for Non-Malignant. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.590] [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: 10/18/2022]
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14
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Leiding JW, Logan BR, Yin Z, Arbuckle E, Bleesing JJ, Sullivan KE, Heimall J, Burroughs L, Skoda-Smith S, Chandrakasan S, Yu LC, Oshrine BR, Cuvelier GD, Thakar M, Chen K, Shenoy S, Saldana BD, Weinacht KG, Joshi A, Boulad F, Quigg TC, Dvorak CC, Knutsen A, Chong H, Miller HK, de la Morena MT, DeSantes K, Cowan MJ, Notarangelo LD, Kohn DB, Pai SY, Stenger E, Puck J, Kapoor N, Pulsipher MA, Haddad E, Griffith LM, Shearer W, Malech HL, Parikh S, Marsh RA, Kang EM. Resolution of CGD Related Colitis after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Chronic Granulomatous Disease—Early Results From the 6903 Study of the Primary Immune Deficiency Treatment Consortium (PIDTC). Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Morgan S, Krueger D, Burroughs L, Binkley N. Impact of Very Dense Artifacts on Hologic and GE Lunar Densitometers. J Clin Densitom 2018. [DOI: 10.1016/j.jocd.2017.10.039] [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: 10/18/2022]
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Heimall J, Logan BR, Cowan MJ, Notarangelo LD, Puck J, Fleisher T, Griffith LM, Kohn DB, Pulsipher MA, Shearer W, Hanson IC, Kapoor N, O'Reilly RJ, Boyer M, Pai SY, Parikh S, Goldman F, Burroughs L, Marsh RA, Kletzel M, Thakar M, Connelly JA, Cuvellier G, Loechelt B, Shereck E, Knudsen A, Sullivan K, DeSantes K, Gillio AP, Haddad E, Petrovic A, Quigg TC, Smith AR, Stenger E, Dvorak CC, Buckley RH. Poor T Cell Reconstitution at 100 Days after T Cell-Replete Hematopoietic Cell Transplantation (HCT) for SCID Is Associated with Later Risk of Death or Need for 2nd Transplant in the 6901 Prospective Study of the Pidtc. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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Scott A, Glover J, Skoda-Smith S, Torgerson T, Xu M, Burroughs L, Woolfrey A, Fleming M, Shimamura A. Severe combined immunodeficiency (SCID) presenting with neonatal aplastic anemia. Pediatr Blood Cancer 2015; 62:2047-9. [PMID: 26011426 PMCID: PMC4583355 DOI: 10.1002/pbc.25587] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/15/2015] [Indexed: 11/10/2022]
Abstract
Aplastic anemia in the neonate is rare. We report a case of severe combined immunodeficiency (SCID) presenting with neonatal aplastic anemia. This report highlights the importance of considering SCID early in the evaluation of neonatal aplastic anemia prior to the development of infectious complications.
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Affiliation(s)
- Angela Scott
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Pediatric Hematology and Oncology, Seattle Children’s Hospital; Department of Pediatrics, University of Washington
| | - Jason Glover
- Randall Children's Hospital at Legacy Emanuel; Department of Pediatric Hematology and Oncology, Children's Cancer and Blood Disorders Program
| | - Suzanne Skoda-Smith
- Seattle Children’s Research Institute, Seattle Children’s Hospital; Department of Pediatrics, Immunology Division, University of Washington
| | - Troy Torgerson
- Department of Pediatrics, University of Washington; Department of Pediatrics, Seattle Children’s Hospital
| | - Min Xu
- Department of Laboratories, Seattle Children’s Hospital; Department of Laboratory Medicine, University of Washington
| | - Lauri Burroughs
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Pediatric Hematology and Oncology, Seattle Children’s Hospital; Department of Pediatrics, University of Washington
| | - Ann Woolfrey
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Pediatric Hematology and Oncology, Seattle Children’s Hospital; Department of Pediatrics, University of Washington
| | - Mark Fleming
- Department of Pathology, Boston Children’s Hospital; Harvard Medical School
| | - Akiko Shimamura
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Pediatric Hematology and Oncology, Seattle Children’s Hospital; Department of Pediatrics, University of Washington
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Hagin D, Burroughs L, Torgerson TR. Hematopoietic Stem Cell Transplant for Immune Deficiency and Immune Dysregulation Disorders. Immunol Allergy Clin North Am 2015; 35:695-711. [DOI: 10.1016/j.iac.2015.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Heimall J, Logan BR, Cowan MJ, Notarangelo LD, Griffith LM, Puck J, Parikh S, O'Reilly RJ, Pai SY, Hanson IC, Martinez C, Pulsipher MA, Kapoor N, Goldman F, Kletzel M, Filipovich L, Cuvellier G, Thakar M, Burroughs L, Knudsen A, Connelly JA, Quigg TC, Smith AR, Sullivan K, Loechelt BJ, Gillio AP, Haddad E, Kohn DB, Fleisher T, Shearer W, Dvorak CC, Buckley RH. Early Hematopoietic Cell Transplant (HCT) Outcomes of Children with Severe Combined Immunodeficiency Disease (SCID): The First Seventy Four Patients of the Primary Immune Deficiency Treatment Consortium (PIDTC) Prospective Study 6901. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.459] [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: 11/30/2022]
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Pai SY, Logan BR, Griffith LM, Buckley RH, Parrott RE, Dvorak CC, Kapoor N, Hanson IC, Filipovich AH, Jyonouchi S, Sullivan KE, Small TN, Burroughs L, Skoda-Smith S, Haight AE, Grizzle A, Pulsipher MA, Chan KW, Fuleihan RL, Haddad E, Loechelt B, Aquino VM, Gillio A, Davis J, Knutsen A, Smith AR, Moore TB, Schroeder ML, Goldman FD, Connelly JA, Porteus MH, Xiang Q, Shearer WT, Fleisher TA, Kohn DB, Puck JM, Notarangelo LD, Cowan MJ, O'Reilly RJ. Transplantation outcomes for severe combined immunodeficiency, 2000-2009. N Engl J Med 2014; 371:434-46. [PMID: 25075835 PMCID: PMC4183064 DOI: 10.1056/nejmoa1401177] [Citation(s) in RCA: 465] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The Primary Immune Deficiency Treatment Consortium was formed to analyze the results of hematopoietic-cell transplantation in children with severe combined immunodeficiency (SCID) and other primary immunodeficiencies. Factors associated with a good transplantation outcome need to be identified in order to design safer and more effective curative therapy, particularly for children with SCID diagnosed at birth. METHODS We collected data retrospectively from 240 infants with SCID who had received transplants at 25 centers during a 10-year period (2000 through 2009). RESULTS Survival at 5 years, freedom from immunoglobulin substitution, and CD3+ T-cell and IgA recovery were more likely among recipients of grafts from matched sibling donors than among recipients of grafts from alternative donors. However, the survival rate was high regardless of donor type among infants who received transplants at 3.5 months of age or younger (94%) and among older infants without prior infection (90%) or with infection that had resolved (82%). Among actively infected infants without a matched sibling donor, survival was best among recipients of haploidentical T-cell-depleted transplants in the absence of any pretransplantation conditioning. Among survivors, reduced-intensity or myeloablative pretransplantation conditioning was associated with an increased likelihood of a CD3+ T-cell count of more than 1000 per cubic millimeter, freedom from immunoglobulin substitution, and IgA recovery but did not significantly affect CD4+ T-cell recovery or recovery of phytohemagglutinin-induced T-cell proliferation. The genetic subtype of SCID affected the quality of CD3+ T-cell recovery but not survival. CONCLUSIONS Transplants from donors other than matched siblings were associated with excellent survival among infants with SCID identified before the onset of infection. All available graft sources are expected to lead to excellent survival among asymptomatic infants. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
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Affiliation(s)
- Sung-Yun Pai
- The authors' affiliations are listed in the Appendix
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Kim YJ, Boeckh M, Cook L, Stempel H, Jerome K, Boucek R, Burroughs L, Englund J. Cytomegalovirus infection and ganciclovir resistance caused by UL97 mutations in pediatric transplant recipients. Transpl Infect Dis 2012. [DOI: 10.1111/j.1399-3062.2012.00760.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - H. Stempel
- Seattle Children's Hospital; Seattle; Washington; USA
| | | | - R. Boucek
- Seattle Children's Hospital; Seattle; Washington; USA
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Burroughs L, Woolfrey A, Storer B, Deeg H, Flowers M, Martin P, Carpenter P, Doney K, Appelbaum F, Sanders J, Storb R. Improved Survival Following HLA-Matched Related Marrow Transplantation in Pediatric Patients with Severe Aplastic Anemia: (A 39-Year Retrospective Analysis). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.333] [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: 10/18/2022]
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Burroughs L, Torgerson T, Storer B, Leisenring W, Nemecek E, Frangoul H, Walters M, Scharenberg A, Rawlings D, Skoda-Smith S, Ochs H, Storb R, Woolfrey A. Nonmyeloablative Conditioning Followed by Allogeneic Marrow Grafts for Treatment of Primary Immune Deficiency Disorders: Preliminary Results of a Phase II Study. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.088] [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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Burroughs L, Storb R, Leisenring W, Torgerson T, Nemecek E, Frangoul H, Walters M, Scharenberg A, Rawlings D, Skoda-Smith S, Ochs H, Woolfrey A. Postgrafting Immune Suppression Combined With Nonmyeloablative Conditioning For Transplantation Of HLA-Matched Related Or Unrelated Hematopoetic Cell Grafts: Preliminary Results Of A Phase II Study For Treatment Of Primary Immunodeficiency Disorders. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.262] [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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Burroughs L, Woolfrey A, Shimamura A. Shwachman-Diamond syndrome: a review of the clinical presentation, molecular pathogenesis, diagnosis, and treatment. Hematol Oncol Clin North Am 2009; 23:233-48. [PMID: 19327581 DOI: 10.1016/j.hoc.2009.01.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Shwachman-Diamond syndrome is a rare autosomal-recessive, multisystem disease characterized by exocrine pancreatic insufficiency, impaired hematopoiesis, and leukemia predisposition. Other clinical features include skeletal, immunologic, hepatic, and cardiac disorders. This article focuses on the clinical presentation, diagnostic work-up, clinical management, and treatment of patients with Shwachman-Diamond syndrome.
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Affiliation(s)
- Lauri Burroughs
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D1-100, PO Box 19024, Seattle, WA 98109-1024, USA.
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Morgan S, Nunnally N, Burroughs L, Hager M, Norris N. Is a patient-focused poster about dual-energy X-ray absorptiometry (DXA) useful for patient education? J Clin Densitom 2007. [DOI: 10.1016/j.jocd.2007.03.066] [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: 10/23/2022]
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27
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Burroughs L, Mielcarek M, Leisenring W, Sandmaier BM, Maloney DG, Baron F, Martin PJ, Flowers MED, Forman SJ, Chauncey TR, Bruno B, Storb R. Extending postgrafting cyclosporine decreases the risk of severe graft-versus-host disease after nonmyeloablative hematopoietic cell transplantation. Transplantation 2006; 81:818-25. [PMID: 16570002 DOI: 10.1097/01.tp.0000203556.06145.5b] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unknown whether the duration of systemic immunosuppressive treatment after allogeneic nonmyeloablative hematopoietic cell transplantation (HCT) might influence the incidence, severity, timing, and/or corticosteroid-responsiveness of graft-versus-host disease (GVHD). METHODS We retrospectively analyzed outcomes among 185 patients with hematologic malignancies who were given grafts from HLA-matched related donors following conditioning with 2 Gy total body irradiation alone or in combination with fludarabine between December 1998 and March 2003. Postgrafting immunosuppression consisted of mycophenolate mofetil (days 0-27) in combination with 3 different cyclosporine (CSP) regimens: taper from (A) days 35 to 56 (n=107), (B) days 56 to 77 (n=35), and (C) days 56 to 180 (n=43). RESULTS The overall incidences of grades II-IV and III-IV acute GVHD, and extensive chronic GVHD were 52%, 13%, and 56%, respectively. The duration of CSP prophylaxis did not significantly influence the overall rate of acute GVHD (grade II-IV), extensive chronic GVHD, or non-relapse mortality. However, prolonged administration of CSP (group C) was associated with a significantly decreased hazard of grades III-IV acute GVHD (HR 0.2, 95% CI [0.04, 0.9]) and with an increased likelihood of discontinuing all systemic immunosuppression (HR 2.4, 95% CI [1.1, 5.2]) when compared to the shortest course of CSP (group A). CONCLUSION Longer CSP duration decreased the risk of severe GVHD and increased the likelihood of discontinuing all systemic immunosuppression after nonmyeloablative HCT with HLA-matched related grafts.
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Affiliation(s)
- Lauri Burroughs
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., Seattle, WA 98109, USA
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Morgan S, Lopez-Ben, Nunnally N, Burroughs L, Desmond R. How Often Does Nonprogression of Vertebral Area or BMC Translate into a Compression Fracture? J Clin Densitom 2006. [DOI: 10.1016/j.jocd.2006.04.020] [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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Burroughs L, Mielcarek M, Little MT, Bridger G, Macfarland R, Fricker S, Labrecque J, Sandmaier BM, Storb R. Durable engraftment of AMD3100-mobilized autologous and allogeneic peripheral-blood mononuclear cells in a canine transplantation model. Blood 2005; 106:4002-8. [PMID: 16105977 PMCID: PMC1895108 DOI: 10.1182/blood-2005-05-1937] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [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] [Received: 05/13/2005] [Accepted: 07/28/2005] [Indexed: 11/20/2022] Open
Abstract
Peripheral-blood mononuclear cells (PBMCs) mobilized with AMD3100, a CXCR4 antagonist, combined with granulocyte colony-stimulating factor (G-CSF) have reconstituted autologous hematopoiesis in cancer patients following myeloablative conditioning. The engraftment potential of PBMCs mobilized with AMD3100 alone, however, has remained unproven. We therefore studied AMD3100-mobilized PBMCs in a canine model. Four dogs received 920 cGy total body irradiation (TBI) before infusion of autologous AMD3100-mobilized PBMCs (median CD34 cell count, 3.9 x 10(6)/kg). Neutrophil (> 0.5 x 10(9)/L [500/microL]) and platelet (> 20 x 10(9)/L [> 20 000/microL]) recoveries occurred at medians of 9 (range, 7-10) days and 25 (range, 23-38) days, respectively, after TBI, and all dogs had normal marrow function at 1 year after transplantation. To evaluate the long-term engraftment potential of AMD3100-mobilized PBMCs, 5 dogs were given 920 cGy TBI followed by infusion of AMD3100-mobilized PBMCs (median CD34 cell dose, 4.7 x 10(6)/kg) from their dog leukocyte antigen (DLA)-identical littermates. Neutrophil and platelet recoveries occurred at medians of 8 (range, 8-10) days and 26 (range, 26-37) days, respectively, after TBI. With a median follow-up of 53 (range, 33-61) weeks, recipients' marrow function was normal, and blood-donor chimerism levels were 97% to 100%. In summary, both autologous and allogeneic AMD3100-mobilized PBMCs led to prompt and durable engraftment in dogs after 920 cGy TBI.
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Affiliation(s)
- Lauri Burroughs
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D1-100, PO Box 19024, Seattle, WA 98109-1024, USA
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30
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Mielcarek M, Burroughs L, Leisenring W, Diaconescu R, Martin PJ, Sandmaier BM, Maloney DG, Maris MB, Chauncey TR, Shizuru JA, Blume KG, Hegenbart U, Niederwieser D, Forman S, Bruno B, Woolfrey A, Storb R. Prognostic relevance of 'early-onset' graft-versus-host disease following non-myeloablative haematopoietic cell transplantation. Br J Haematol 2005; 129:381-91. [PMID: 15842663 DOI: 10.1111/j.1365-2141.2005.05458.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [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: 11/29/2022]
Abstract
We retrospectively analysed outcomes among 395 patients with haematologic malignancies who underwent non-myeloablative haematopoietic cell transplantation (HCT) from human leucocyte antigen (HLA)-matched related (n = 297) or unrelated donors (n = 98) in order to identify a possible correlation between the time of onset of graft-versus-host disease (GVHD) and survival. The non-myeloablative regimen consisted of 2 Gy total body irradiation with or without fludarabine, followed by postgrafting immunosuppression with mycophenolate mofetil and cyclosporine. The cumulative incidences of grades II-IV acute GVHD and extensive chronic GVHD were 45% and 47%, respectively, with related donors, and 68% and 68%, respectively, with unrelated donors. High-dose corticosteroid treatment for acute or chronic GVHD was started at a median of 79 (range, 8-799) days and 30 (range, 5-333) days after transplantation from related and unrelated donors respectively. With related donors, the cumulative incidence of non-relapse mortality among patients with GVHD was 55% at 4 years when prednisone was started before day 50 (n = 72), compared with 29% when treatment was started after day 50 (n = 115) (P < 0.001). With unrelated donors, time to onset of treatment for GVHD was not associated with survival. Patients with early-onset GVHD after non-myeloablative HCT from HLA-identical related donors might benefit from intensified primary immunosuppressive treatment.
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Affiliation(s)
- Marco Mielcarek
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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Burroughs L, Mielcarek M, Little MT, Bridger G, MacFarland R, Fricker S, Sandmaier B, Torok-Storb B, Storb R. Durable engraftment of AMD3100-mobilized hematopoietic stem cells in a canine autologous and allogeneic model. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.209] [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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Burroughs L, Storb R. Low-intensity allogeneic hematopoietic stem cell transplantation for myeloid malignancies: separating graft-versus-leukemia effects from graft-versus-host disease. Curr Opin Hematol 2005; 12:45-54. [PMID: 15604891 DOI: 10.1097/01.moh.0000148762.05110.56] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW Over the past several years, significant advances in allogeneic hematopoietic cell transplantation (HCT), specifically the development of nonablative and reduced-intensity conditioning regimens, have enabled the extension of transplantation to include older or medically infirm patients with myeloid malignancies. The regimens rely largely on graft-versus-leukemia effects rather than high-dose therapy to eliminate malignant cells. Studies have demonstrated that the regimens allow sustained engraftment with relatively low transplant-related mortality. However, conclusions regarding the ultimate efficacy of these regimens for myeloid malignancies have been limited, given the small numbers of patients who have had transplants so far. This review summarizes recent studies of nonablative or reduced-intensity regimens for patients with myeloid malignancies (acute and chronic myelogenous leukemia, myelodysplastic syndrome, and myeloproliferative disorders). In addition, this review evaluates what is currently known regarding the association of graft-versus-leukemia responses and graft-versus-host disease (GVHD). When possible, graft-versus-leukemia responses are highlighted in the articles discussed. RECENT FINDINGS This review covers six articles and four abstracts that have been published since September 2003 on patients with myeloid malignancies who received HCT following nonmyeloablative or reduced-intensity conditioning. Due to the heterogeneity of the conditioning and GVHD prophylaxis regimens, direct comparisons between studies are difficult. However, these studies have demonstrated encouraging overall survivals (30 to 74%), disease-free/event-free or progression-free survivals (19 to 62%), and nonrelapse mortalities (15 to 55%). In addition, these studies demonstrated evidence for graft-versus-leukemia responses. However, relapse and progressive disease continued to be problems, particularly in patients with large tumor burdens at time of HCT. SUMMARY Over the past 10 years, significant advances have been made in the field of transplantation. Nonmyeloablative and reduced-intensity HCT have promised patients with hematologic and nonhematologic malignancies potential cures. However, disease relapse and nonrelapse mortality, mainly from GVHD and its therapy, continue to be problems. Future studies are needed to increase our understanding of GVHD and graft-versus-leukemia responses, which will greatly improve outcome. In addition, a better understanding of minor histocompatibility antigens may lead to more targeted immunotherapy and enhance the precision and success of transplantation.
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Affiliation(s)
- Lauri Burroughs
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
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Messer JW, Leslie JE, Houghtby GA, Peeler JT, Barnett JE, Appelt A, Boone E, Bryant H, Burroughs L, Coleman K, Cupery M, Cyr R, Dombrowski P, Donahue P, Farmer S, Ginn R, Grant H, Hawkins J, Heady J, Herbst D, Kelley W, Misup M, Morris L, Mullen R, Ondrus N, Payton C, Seiz D, Share R, Stern M, Williams R. Bacillus stearothermophilus Disc Assay for Detection of Inhibitors in Milk: Collaborative Study. J AOAC Int 1982. [DOI: 10.1093/jaoac/65.5.1208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A 2-part (A and B) collaborative study was conducted on a Bacillus stearothermophilus paper disc (12.7 mm) method to detect residual inhibitors in milk. The 18 participating collaborators assayed raw milk samples spiked with a beta-lactam (penicillin G). Of the 18 collaborators, 14 participated in part A and 16 in part B. Part A demonstrated that either Antibiotic Medium No. 4 or PM Indicator Agar is suitable for use in the assay. The lowest concentration detectable, not significantly different from 100% at the α = 0.05 level, was 0.008 unit/mL with either medium. Part B demonstrated that the sensitivity of the method is equal to that of the current AOAC method (16.131- 16.136). The concentration of beta-lactam detected by 50% of the analysts was 0.003-0.005 unit/mL in this study, compared with 0.005 unit/mL reported in an earlier collaborative study on the current AOAC method. No false positive results were reported in part A or part B. All samples found positive by the confirmatory test in part B were correctly identified as a beta-lactam with commercial Penase discs. The lowest concentration detectable by the method, not significantly different from 100% at the α = 0.05 level, was 0.008 unit/mL. The method was adopted official first action.
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Affiliation(s)
- James W Messer
- Food and Drug Administration, Division of Microbiology, 1090 Tusculum Ave, Cincinnati, OH 45226
| | - James E Leslie
- Food and Drug Administration, Division of Microbiology, 1090 Tusculum Ave, Cincinnati, OH 45226
| | - Gary A Houghtby
- Food and Drug Administration, Division of Microbiology, 1090 Tusculum Ave, Cincinnati, OH 45226
| | - James T Peeler
- Food and Drug Administration, Division of Microbiology, 1090 Tusculum Ave, Cincinnati, OH 45226
| | - Jerald E Barnett
- Food and Drug Administration, Division of Microbiology, 1090 Tusculum Ave, Cincinnati, OH 45226
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Heaton KW, Haber GB, Burroughs L, Murphy D. How fiber may prevent obesity: promotion of satiety and prevention of rebound hypoglycemia. Am J Clin Nutr 1978. [DOI: 10.1093/ajcn/31.10.s280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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