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Nikiforow S, Whangbo JS, Reshef R, Tsai DE, Bunin NJ, Abu-Arja RF, Mahadeo KM, Weng WK, Van Besien K, Loeb D, Nasta SD, Nemecek ER, Zhao W, Sun Y, Galderisi FC, Wahlstrom J, Mehta A, Gamelin LI, Dinavahi R, Prockop SE. Tabelecleucel for EBV+ PTLD following allogeneic HCT or SOT in a multicenter expanded access protocol. Blood Adv 2024:bloodadvances.2023011626. [PMID: 38625984 DOI: 10.1182/bloodadvances.2023011626] [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] [Received: 10/24/2023] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 04/18/2024] Open
Abstract
Patients with Epstein-Barr virus (EBV)-positive post-transplant lymphoproliferative disease (EBV+ PTLD) in whom initial treatment fails have few options and historically low median overall survival (OS) of 0.7 months following allogeneic hematopoietic cell transplant (HCT) and 4.1 months following solid organ transplant (SOT). Tabelecleucel is an off-the-shelf, allogeneic EBV-specific cytotoxic T-lymphocyte immunotherapy for EBV+ PTLD. Previous single-center experience showed responses in patients with EBV+ PTLD following HCT or SOT. We now report outcomes from a multicenter expanded access protocol (NCT02822495) in HCT (n = 14) and SOT (n = 12) recipients treated with tabelecleucel for EBV+ PTLD that was relapsed/refractory to rituximab ± chemotherapy. The investigator-assessed objective response rate was 65.4% overall (including 38.5% with a complete and 26.9% with a partial response), 50.0% in HCT, and 83.3% in SOT. The estimated 1- and 2-year OS rates (95% CI) were both 70.0% (46.5, 84.7) overall, both 61.5% (30.8, 81.8) in HCT, and both 81.5% (43.5, 95.1) in SOT (median follow-up: 8.2, 2.8, and 22.5 months, respectively). Patients responding to tabelecleucel had higher 1- and 2-year OS rates (94.1%) than non-responders (0%). Treatment was well tolerated with no reports of tumor flare, cytokine release syndrome, or rejection of marrow and SOT. Results demonstrate clinically meaningful outcomes across a broad population treated with tabelecleucel, indicating a potentially transformative and accessible treatment advance for relapsed/refractory EBV+ PTLD following HCT or SOT.
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Affiliation(s)
- Sarah Nikiforow
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | | | - Ran Reshef
- Columbia University Medical Center, New York, New York, United States
| | - Donald E Tsai
- University of Pennsylvania, Springfield, Pennsylvania, United States
| | - Nancy J Bunin
- Children's Hospital of Philadelphia, Ambler, Pennsylvania, United States
| | | | | | - Wen-Kai Weng
- Stanford University School of Medicine, Palo Alto, California, United States
| | | | - David Loeb
- Children's Hospital at Montefiore, Bronx, New York, United States
| | - Sunita D Nasta
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Eneida R Nemecek
- Oregon Health & Science University, Portland, Oregon, United States
| | - Weizhi Zhao
- Atara Biotherapeutics, Thousand Oaks, California, United States
| | - Yan Sun
- Atara Biotherapeutics, Thousand Oaks, California, United States
| | | | | | - Aditi Mehta
- Atara Biotherapeutics, Thousand Oaks, California, United States
| | | | - Rajani Dinavahi
- Atara Biotherapeutics, Thousand Oaks, California, United States
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2
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Leiding JW, Arnold DE, Parikh S, Logan B, Marsh RA, Griffith LM, Wu R, Kidd S, Mallhi K, Chellapandian D, Si Lim SJ, Grunebaum E, Falcone EL, Murguia-Favela L, Grossman D, Prasad VK, Heimall JR, Touzot F, Burroughs LM, Bleesing J, Kapoor N, Dara J, Williams O, Kapadia M, Oshrine BR, Bednarski JJ, Rayes A, Chong H, Cuvelier GDE, Forbes Satter LR, Martinez C, Vander Lugt MT, Yu LC, Chandrakasan S, Joshi A, Prockop SE, Dávila Saldaña BJ, Aquino V, Broglie LA, Ebens CL, Madden LM, DeSantes K, Milner J, Rangarajan HG, Shah AJ, Gillio AP, Knutsen AP, Miller HK, Moore TB, Graham P, Bauchat A, Bunin NJ, Teira P, Petrovic A, Chandra S, Abdel-Azim H, Dorsey MJ, Birbrayer O, Cowan MJ, Dvorak CC, Haddad E, Kohn DB, Notarangelo LD, Pai SY, Puck JM, Pulsipher MA, Torgerson TR, Malech HL, Kang EM. Genotype, oxidase status, and preceding infection or autoinflammation do not affect allogeneic HCT outcomes for CGD. Blood 2023; 142:2105-2118. [PMID: 37562003 PMCID: PMC10862239 DOI: 10.1182/blood.2022019586] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/10/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 08/12/2023] Open
Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by life-threatening infections and inflammatory conditions. Hematopoietic cell transplantation (HCT) is the definitive treatment for CGD, but questions remain regarding patient selection and impact of active disease on transplant outcomes. We performed a multi-institutional retrospective and prospective study of 391 patients with CGD treated either conventionally (non-HCT) enrolled from 2004 to 2018 or with HCT from 1996 to 2018. Median follow-up after HCT was 3.7 years with a 3-year overall survival of 82% and event-free survival of 69%. In a multivariate analysis, a Lansky/Karnofsky score <90 and use of HLA-mismatched donors negatively affected survival. Age, genotype, and oxidase status did not affect outcomes. Before HCT, patients had higher infection density, higher frequency of noninfectious lung and liver diseases, and more steroid use than conventionally treated patients; however, these issues did not adversely affect HCT survival. Presence of pre-HCT inflammatory conditions was associated with chronic graft-versus-host disease. Graft failure or receipt of a second HCT occurred in 17.6% of the patients and was associated with melphalan-based conditioning and/or early mixed chimerism. At 3 to 5 years after HCT, patients had improved growth and nutrition, resolved infections and inflammatory disease, and lower rates of antimicrobial prophylaxis or corticosteroid use compared with both their baseline and those of conventionally treated patients. HCT leads to durable resolution of CGD symptoms and lowers the burden of the disease. Patients with active infection or inflammation are candidates for transplants; HCT should be considered before the development of comorbidities that could affect performance status. This trial was registered at www.clinicaltrials.gov as #NCT02082353.
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Affiliation(s)
- Jennifer W. Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
- Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | | | - Suhag Parikh
- Aflac Cancer and Blood Disorders Center, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Brent Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Rebecca A. Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Linda M. Griffith
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Ruizhe Wu
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Sharon Kidd
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, UCSF Benioff Children’s Hospital, San Francisco, CA
| | - Kanwaldeep Mallhi
- Fred Hutchinson Cancer Research Center, Department of Pediatrics, University of Washington, and Seattle Children’s Hospital, Seattle, WA
| | - Deepak Chellapandian
- Center for Cell and Gene Therapy for Non-Malignant Conditions, Johns Hopkins All Children’s Hospital, St Petersburg, FL
| | - Stephanie J. Si Lim
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i Cancer Center, University of Hawai'i at Mānoa, Honolulu, HI
| | - Eyal Grunebaum
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - E. Liana Falcone
- Center for Inflammation, Immunity and Infectious Diseases, Montreal Clinical Research Institute, Montreal, QC, Canada
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Luis Murguia-Favela
- Section of Hematology/Immunology, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Debbi Grossman
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Vinod K. Prasad
- Division of Pediatric Transplant and Cellular Therapy, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Jennifer R. Heimall
- Division of Allergy and Immunology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Fabien Touzot
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Lauri M. Burroughs
- Fred Hutchinson Cancer Research Center, Department of Pediatrics, University of Washington, and Seattle Children’s Hospital, Seattle, WA
| | - Jack Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Neena Kapoor
- Division of Hematology, Oncology and Blood and Marrow Transplant, Children’s Hospital, Los Angeles, CA
| | - Jasmeen Dara
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, UCSF Benioff Children’s Hospital, San Francisco, CA
| | - Olatundun Williams
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Morgan Stanley Children's Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Malika Kapadia
- Division of Hematology-Oncology, Boston Children's Hospital, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Benjamin R. Oshrine
- Center for Cell and Gene Therapy for Non-Malignant Conditions, Johns Hopkins All Children’s Hospital, St Petersburg, FL
| | | | - Ahmad Rayes
- Division of Pediatric Hematology and Oncology, Intermountain Primary Children’s Hospital, Huntsman Cancer Institute at the University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT
| | - Hey Chong
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Geoffrey D. E. Cuvelier
- Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa R. Forbes Satter
- Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Caridad Martinez
- Department of Pediatrics, Baylor College of Medicine, and Texas Children's Hospital Center for Gene and Cell Therapy, Houston, TX
| | | | - Lolie C. Yu
- Louisiana State University, Children’s Hospital, New Orleans, LA
| | | | - Avni Joshi
- Division of Pediatric Allergy and Immunology, Mayo Clinic, Rochester, MN
| | - Susan E. Prockop
- Division of Hematology-Oncology, Boston Children's Hospital, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
- Stem Cell Transplantation and Cellular Therapy, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
| | - 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
| | - Victor Aquino
- Division of Hematology and Oncology, Department of Pediatrics, UT Southwestern Medical Center Dallas, Dallas, TX
| | - Larisa A. Broglie
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Christen L. Ebens
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN
| | - Lisa M. Madden
- Pediatric Bone Marrow Transplant Program, Texas Transplant Institute, San Antonio, TX
| | - Kenneth DeSantes
- American Family Children's Hospital, University of Wisconsin, Madison, WI
| | - Jordan Milner
- Hematology and Oncology, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY
| | | | - Ami J. Shah
- Pediatric Stem Cell Transplantation Program and Division of Pediatric Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford University, Stanford, CA
| | - 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 and SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Holly K. Miller
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, and The University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Theodore B. Moore
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Pamela Graham
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Andrea Bauchat
- Division of Pediatric Transplant and Cellular Therapy, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Nancy J. Bunin
- Division of Oncology, Children's Hospital of Philadelphia, and University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Pierre Teira
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Aleksandra Petrovic
- Fred Hutchinson Cancer Research Center, Department of Pediatrics, University of Washington, and Seattle Children’s Hospital, Seattle, WA
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood and Marrow Transplant, Children’s Hospital, Los Angeles, CA
- Cancer Center, Children's Hospital and Medical Center, Loma Linda University School of Medicine, Loma Linda, CA
| | - Morna J. Dorsey
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, UCSF Benioff Children’s Hospital, San Francisco, CA
| | - Olga Birbrayer
- Division of Hematology-Oncology, Boston Children's Hospital, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Morton J. Cowan
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, UCSF Benioff Children’s Hospital, San Francisco, CA
| | - Christopher C. Dvorak
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, UCSF Benioff Children’s Hospital, San Francisco, CA
| | - Elie Haddad
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Donald B. Kohn
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Luigi D. Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sung-Yun Pai
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer M. Puck
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, UCSF Benioff Children’s Hospital, San Francisco, CA
| | - Michael A. Pulsipher
- Division of Pediatric Hematology and Oncology, Intermountain Primary Children’s Hospital, Huntsman Cancer Institute at the University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT
| | | | - Harry L. Malech
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Elizabeth M. Kang
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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3
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Grunebaum E, Arnold DE, Logan B, Parikh S, Marsh RA, Griffith LM, Mallhi K, Chellapandian D, Lim SS, Deal CL, Murguía-Favela L, Mousallem TI, Prasad PVK, Teira P, Touzot F, Bunin NJ, Heimall JR, Burroughs LM, Kapadia M, Prockop S, Chandra S, Chandrakasan S, Chaudhury S, Broglie L, O’Reilly RJ, Dávila Saldaña BJ, Schaefer E, Chong H, Bednarski JJ, Rayes A, DeSantes K, Kohn DB, Notarangelo LD, Pai SY, Puck J, Torgerson T, Cowan MJ, Dvorak CC, Satter LF, Haddad E, Pulsipher M, Malech HL, Kang EM, Leiding JW. Allogenic Hematopoietic Cell Transplantations Are Effective in Patients with p47phox Chronic Granulomatous Disease: A Primary Immune Deficiency Treatment Consortium Study. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00451-7] [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: 02/07/2023]
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4
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Pulsipher MA, Ahn KW, Bunin NJ, Lalefar N, Anderson E, Flower A, Cairo MS, Talano JA, Chaudhury S, Kitko CL, Duke JL, Monos D, Leung W, Dvorak CC, Abdel-Azim H. KIR-favorable TCR-αβ/CD19-depleted haploidentical HCT in children with ALL/AML/MDS: primary analysis of the PTCTC ONC1401 trial. Blood 2022; 140:2556-2572. [PMID: 35776909 PMCID: PMC9918850 DOI: 10.1182/blood.2022015959] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 02/28/2022] [Revised: 06/01/2022] [Accepted: 06/17/2022] [Indexed: 11/20/2022] Open
Abstract
We performed a prospective multicenter study of T-cell receptor αβ (TCR-αβ)/CD19-depleted haploidentical hematopoietic cell transplantation (HCT) in children with acute leukemia and myelodysplastic syndrome (MDS), to determine 1-year disease-free survival (DFS) and compare 2-year outcomes with recipients of other donor cell sources. Fifty-one patients aged 0.7 to 21 years were enrolled; donors were killer immunoglobulin-like receptor (KIR) favorable based on ligand mismatch and/or high B content. The 1-year DFS was 78%. Superior 2-year DFS and overall survival (OS) were noted in patients <10 years of age, those treated with reduced toxicity conditioning (RTC) rather than myeloablative conditioning, and children with minimal residual disease <0.01% before HCT. Multivariate analysis comparing the KIR-favorable haploidentical cohort with controls showed similar DFS and OS compared with other donor cell sources. Multivariate analysis also showed a marked decrease in the risk of grades 2 to 4 and 3 to 4 acute graft versus host disease (aGVHD), chronic GVHD, and transplant-related mortality vs other donor cell sources. Ethnic and racial minorities accounted for 53% of enrolled patients, and data from a large cohort of recipients/donors screened for KIR showed that >80% of recipients had a KIR-favorable donor by our definition, demonstrating that this approach is broadly applicable to groups often unable to find donors. This prospective, multicenter study showed improved outcomes using TCR-αβ/CD19-depleted haploidentical donors using RTC for children with acute leukemia and MDS. Randomized trials comparing this approach with matched unrelated donors are warranted. This trial was registered at https://clinicaltrials.gov as #NCT02646839.
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Affiliation(s)
- Michael A. Pulsipher
- Division of Hematology and Oncology, Intermountain Primary Children’s Hospital, Huntsman Cancer Institute at the University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT
- Section of Transplantation and Cellular Therapy, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Kwang W. Ahn
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Nancy J. Bunin
- Division of Oncology, Center for Childhood Cancer Research and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Nahal Lalefar
- Department of Pediatrics, UCSF Benioff Children’s Hospital, Oakland, CA
| | - Eric Anderson
- Rady Children’s Hospital San Diego and UC San Diego School of Medicine, San Diego, CA
| | | | | | - Julie-An Talano
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Carrie L. Kitko
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Jamie L. Duke
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Dimitrios Monos
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Wing Leung
- Department of Pediatrics, Duke-National University Singapore (NUS), Singapore
- University of Hong Kong, Hong Kong
| | - Christopher C. Dvorak
- Division of Pediatric Allergy, Immunology and Bone Marrow Transplantation, UCSF Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA
| | - Hisham Abdel-Azim
- Section of Transplantation and Cellular Therapy, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
- Loma Linda University, School of Medicine Cancer Center, Children Hospital and Medical Center, Loma Linda, CA
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Duncan CN, Kühl JS, Chiesa R, Boelens JJ, Eichler F, Sevin C, Dalle JH, De Oliveira SN, Amartino HM, Kapoor N, Prasad VK, Jones S, Algeri M, Bunin NJ, Diaz-de-Heredia C, Thrasher AJ, Fernandes JF, Smith N, Shah AJ, Locatelli F, Engelen M, Lindemans CA, Dietz AC, Pan L, Sieker J, Williams DA, Orchard PJ. Comparison of Outcomes in Patients with Cerebral Adrenoleukodystrophy (CALD) Receiving Elivaldogene Autotemcel (eli-cel; Lenti-D) Gene Therapy in Clinical Trials Versus Those Receiving Allogeneic Hematopoietic Stem Cell Transplant in a Contemporaneous Comparator Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00164-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Milner J, Talano JA, Harrison L, Ayello J, Flower A, Chu Y, Rigot O, Johnson BD, Li Y, Lee DA, Abu-Arja R, Chu J, Dvorak CC, O’Donnell LC, Wang Y, Bunin NJ, Cairo MS. Feasibility, Safety and Efficacy of Haploidentical Viral Cytotoxic T-Lymphocytes for Children, Adolescents, and Young Adults (CAYA) with Refractory Viral Infections in Primary Immunodeficiencies (PID) Post Solid Organ Transplant (SOT) or Allogeneic Hematopoietic Stem Cell Transplantation (AlloHSCT). Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00292-5] [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: 11/16/2022]
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Sun D, Heimall JR, Greenhawt MJ, Bunin NJ, Shaker MS, Romberg N. Cost Utility of Lifelong Immunoglobulin Replacement Therapy vs Hematopoietic Stem Cell Transplant to Treat Agammaglobulinemia. JAMA Pediatr 2022; 176:176-184. [PMID: 34779842 PMCID: PMC8593831 DOI: 10.1001/jamapediatrics.2021.4583] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Lifelong immunoglobulin replacement therapy (IRT) is standard-of-care treatment for congenital agammaglobulinemia but accrues high annual costs ($30 000-$90 000 per year) and decrements to quality of life over patients' life spans. Hematopoietic stem cell transplant (HSCT) offers an alternative 1-time therapy, but has high morbidity and mortality. OBJECTIVE To evaluate the cost utility of IRT vs matched sibling donor (MSD) and matched unrelated donor (MUD) HSCT to treat patients with agammaglobulinemia in the US. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used Markov analysis to model the base-case scenario of a patient aged 12 months with congenital agammaglobulinemia receiving lifelong IRT vs MSD or MUD HSCT. Costs, probabilities, and quality-of-life measures were derived from the literature. Microsimulations estimated premature deaths for each strategy in a virtual cohort. One-way sensitivity and probabilistic sensitivity analyses evaluated uncertainty around parameter estimates performed from a societal perspective over a 100-year time horizon. The threshold for cost-effective care was set at $100 000 per quality-adjusted life-year (QALY). This study was conducted from 2020 across a 100-year time horizon. EXPOSURES Immunoglobulin replacement therapy vs MSD or MUD HSCT for treatment of congenital agammaglobulinemia. MAIN OUTCOMES AND MEASURES The primary outcomes were incremental cost-effectiveness ratio (ICER) expressed in 2020 US dollars per QALY gained and premature deaths associated with each strategy. RESULTS In this economic evaluation of patients with congenital agammaglobulinemia, lifelong IRT cost more than HSCT ($1 512 946 compared with $563 776 [MSD] and $637 036 [MUD]) and generated similar QALYs (20.61 vs 17.25 [MSD] and 17.18 [MUD]). Choosing IRT over MSD or MUD HSCT yielded ICERs of $282 166 per QALY gained over MSD and $255 633 per QALY gained over MUD HSCT, exceeding the US willingness-to-pay threshold of $100 000/QALY. However, IRT prevented at least 2488 premature deaths per 10 000 microsimulations compared with HSCT. When annual IRT price was reduced from $60 145 to below $29 469, IRT became the cost-effective strategy. Findings remained robust in sensitivity and probabilistic sensitivity analyses. CONCLUSIONS AND RELEVANCE In the US, IRT is more expensive than HSCT for agammaglobulinemia treatment. The findings of this study suggest that IRT prevents more premature deaths but does not substantially increase quality of life relative to HSCT. Reducing US IRT cost by 51% to a value similar to IRT prices in countries implementing value-based pricing may render it the more cost-effective strategy.
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Affiliation(s)
- Di Sun
- Department of Pediatrics, Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer R. Heimall
- Department of Pediatrics, Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Matthew J. Greenhawt
- Children's Hospital Colorado, Section of Allergy and Immunology, Food Challenge and Research Unit, Aurora,Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Nancy J. Bunin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Pediatrics, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marcus S. Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, New Hampshire
| | - Neil Romberg
- Department of Pediatrics, Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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8
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Arnold DE, Nofal R, Wakefield C, Lehmberg K, Wustrau K, Albert MH, Morris EC, Heimall JR, Bunin NJ, Kumar A, Jordan MB, Cole T, Choo S, Brettig T, Speckmann C, Ehl S, Salamonowicz M, Wahlstrom J, Rao K, Booth C, Worth A, Marsh RA. Reduced-Intensity/Reduced-Toxicity Conditioning Approaches Are Tolerated in XIAP Deficiency but Patients Fare Poorly with Acute GVHD. J Clin Immunol 2021; 42:36-45. [PMID: 34586554 PMCID: PMC8478634 DOI: 10.1007/s10875-021-01103-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
X-linked inhibitor of apoptosis (XIAP) deficiency is an inherited primary immunodeficiency characterized by chronic inflammasome overactivity and associated with hemophagocytic lymphohistiocytosis (HLH) and inflammatory bowel disease (IBD). Allogeneic hematopoietic cell transplantation (HCT) with fully myeloablative conditioning may be curative but has been associated with poor outcomes. Reports of reduced-intensity conditioning (RIC) and reduced-toxicity conditioning (RTC) regimens suggest these approaches are well tolerated, but outcomes are not well established. Retrospective data were collected from an international cohort of 40 patients with XIAP deficiency who underwent HCT with RIC or RTC. Thirty-three (83%) patients had a history of HLH, and thirteen (33%) patients had IBD. Median age at HCT was 6.5 years. Grafts were from HLA-matched (n = 30, 75%) and HLA-mismatched (n = 10, 25%) donors. There were no cases of primary graft failure. Two (5%) patients experienced secondary graft failure, and three (8%) patients ultimately received a second HCT. Nine (23%) patients developed grade II–IV acute GVHD, and 3 (8%) developed extensive chronic GVHD. The estimated 2-year overall and event-free survival rates were 74% (CI 55–86%) and 64% (CI 46–77%), respectively. Recipient and donor HLA mismatch and grade II–IV acute GVHD were negatively associated with survival on multivariate analysis with hazard ratios of 5.8 (CI 1.5–23.3, p = 0.01) and 8.2 (CI 2.1–32.7, p < 0.01), respectively. These data suggest that XIAP patients tolerate RIC and RTC with survival rates similar to HCT of other genetic HLH disorders. Every effort should be made to prevent acute GVHD in XIAP-deficient patients who undergo allogeneic HCT.
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Affiliation(s)
- Danielle E Arnold
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | | | - Connor Wakefield
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Kai Lehmberg
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg, Hamburg, Germany
| | - Katharina Wustrau
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg, Hamburg, Germany
| | - Michael H Albert
- Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Emma C Morris
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nancy J Bunin
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ashish Kumar
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Michael B Jordan
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sharon Choo
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Tim Brettig
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Carsten Speckmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Malgorzata Salamonowicz
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | - Justin Wahlstrom
- Blood and Marrow Transplantation Program, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Kanchan Rao
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, UK
| | - Claire Booth
- Department of Pediatric Immunology, Great Ormond Street Hospital, London, UK
| | - Austen Worth
- Department of Pediatric Immunology, Great Ormond Street Hospital, London, UK
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
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9
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Abdel-Azim H, Dvorak CC, Bunin NJ, Lalefar N, Anderson E, Flower A, Talano JA, Ahn KW, Chaudhury S, Kitko CL, Monos D, Wing L, Pulsipher MA. High OS, PFS and EFS with Low Rates of Rejection and GVHD after KIR-Favorable abCD3/CD19 Depleted Haploidentical HCT in Children with ALL/AML/MDS: Primary Analysis of the Pediatric Transplantation and Cellular Therapy Consortium ONC1401 Trial. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00032-4] [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: 10/22/2022]
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10
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Ayello J, Flower A, Kuhns R, Colon LM, Fallon B, Rigot O, Shaw R, Harrison L, Morris E, Sturhahn M, Gonzalez ID, Wang Y, O’Donnell LC, Lee DA, Talano JA, Johnson BD, Bunin NJ, Cairo MS. Safety and Efficacy of GMP Clinical Grade Manufacturing of Virus Specific Cytotoxic T Lymphocytes (vCTLS) Against Cytomegalovirus (CMV), Epstein Barr Virus ( EBV), Adenovirus (ADV) and BKV to Treat Medically Refractory Viral Infections Post Allogeneic Hematopoietic Stem Cell Transplantation (AlloHSCT) in Children, Adolescents and Young Adults (CAYA) (IND# 17449). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00435-8] [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: 11/26/2022]
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11
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Boelens JJ, Chiesa R, Duncan CN, Kühl JS, Sevin C, Kapoor N, Prasad VK, Lindemans CA, Jones SA, Amartino HM, Algeri M, Bunin NJ, Diaz-de-Heredia C, Shamir E, Timm A, Dietz AC, McNeil E, Orchard PJ. Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Cerebral Adrenoleukodystrophy: Effects of Donor Cell Source and Match, Conditioning Regimen, and Stage of Cerebral Disease. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00407-3] [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]
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12
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Elgarten CW, Chandra A, Dinh A, Monos D, Bunin NJ, Seif AE. Chimerism Trends in Pediatric Patients Transplanted for Hematologic Malignancies. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00193-7] [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: 10/22/2022]
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13
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Arnold DE, MacMath D, Seif AE, Heimall JR, Wang Y, Monos D, Grupp SA, Bunin NJ. Immune Reconstitution Following TCRαβ/CD19-Depleted Hematopoietic Cell Transplantation for Hematologic Malignancy in Pediatric Patients. Transplant Cell Ther 2020; 27:169.e1-169.e9. [PMID: 33830028 DOI: 10.1016/j.jtct.2020.10.006] [Citation(s) in RCA: 8] [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: 08/19/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
TCRαβ/CD19-depleted HCT has been used with excellent outcomes in pediatric patients with hematologic malignancies, and several studies have demonstrated rapid immune reconstitution in the nonmalignant setting. However, immune recovery following TCRαβ/CD19-depleted hematopoietic cell transplantation (HCT) for malignancy remains incompletely elucidated. Furthermore, the majority of studies to date have used haploidentical and matched unrelated donors. Here we report results of immune reconstitution following TCRαβ/CD19-depleted HCT for hematologic malignancy in 51 pediatric patients with hematologic malignancies, the majority of whom received grafts from unrelated donors. Grafts were from matched unrelated (n = 20), mismatched unrelated (n = 20), and haploidentical (n = 11) donors. The median CD34+ cell dose was 10.2 × 106/kg (range, 4.54 to 20 × 106/kg), and the median TCRαβ+ cell dose was 2.53 × 104/kg (range, 0 to 44.9 × 104/kg). Conditioning was myeloablative with either busulfan or total body irradiation, cyclophosphamide, and thiotepa. Thirty-three patients also received rabbit antithymocyte globulin. No prophylactic post-transplantation immune suppression was routinely given. Forty-three patients received rituximab on day +1 for recipient positive Epstein-Barr virus serology. Forty-nine patients (96%) engrafted with a median time to neutrophil recovery of 13 days (range, 8 to 30 days). Thirty-seven patients (73%) are alive at a median follow-up of 25 months (range, 6 to 50 months). Nine patients (18%) developed grade II-IV acute graft-versus-host disease (GVHD), and 5 patients (11%) developed extensive chronic GVHD. Twenty-six patients (51%) experienced viral reactivation. T cell reconstitution was rapid with significant numbers of CD3+, CD4+, and CD8+ T cells present on first assessment at 4 months post-HCT, and significant numbers of naïve CD4+ T cells were present by 8 months post-HCT. Chronic GVHD was associated with delayed T cell recovery; however, T cell reconstitution was not affected by underlying diagnosis, donor source, TCRαβ+ T cell dose, conditioning regimen, or use of antithymocyte globulin. B cell recovery mirrored T cell recovery, and i.v. Ig was discontinued at a median of 8 months (range, 4 to 22 months) post-HCT in patients alive and relapse-free at last follow-up. Immune reconstitution is rapid following TCRαβ/CD19-depleted HCT in pediatric patients with hematologic malignancies. Donor graft source, haploidentical or unrelated, did not affect immune reconstitution. Viral reactivation is common in the first 100 days post-HCT, indicating that improved T cell defense is needed in the early post-HCT period.
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Affiliation(s)
- Danielle E Arnold
- Division of Allergy & Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Derek MacMath
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alix E Seif
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer R Heimall
- Division of Allergy & Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yongping Wang
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dimitri Monos
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephan A Grupp
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy J Bunin
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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14
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Dorsey M, Wright NAM, Chaimowitz NS, Dávila Saldaña BJ, Miller H, Keller MD, Thakar MS, Shah AJ, Abu-Arja R, Andolina J, Aquino V, Barnum JL, Bednarski JJ, Bhatia M, Bonilla FA, Butte MJ, Bunin NJ, Burroughs LM, Chandra S, Chaudhury S, Chen K, Chong H, Cuvelier G, Dalal J, DeFelice ML, DeSantes KB, Forbes LR, Gillio A, Goldman F, Joshi AY, Kapoor N, Knutsen AP, Kobrynski L, Lieberman JA, Leiding JW, Oshrine B, Patel KP, Prockop S, Quigg TC, Quinones R, Schultz KR, Seroogy C, Shyr D, Siegel S, Smith AR, Torgerson TR, Vander Lugt MT, Yu LC, Cowan MJ, Buckley RH, Dvorak CC, Griffith LM, Haddad E, Kohn DB, Logan B, Notarangelo LD, Pai SY, Puck J, Pulsipher MA, Heimall J. Correction to: Infections in Infants with SCID: Isolation, Infection Screening and Prophylaxis in PIDTC Centers. J Clin Immunol 2020; 41:498-500. [PMID: 33274413 DOI: 10.1007/s10875-020-00917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Morna Dorsey
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Nicola A M Wright
- Division of Hematology/Immunology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Natalia S Chaimowitz
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Blachy J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC, USA.,Department of Pediatrics, George Washington University, Washington, DC, USA
| | - Holly Miller
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Michael D Keller
- Division of Allergy & Immunology, Children's National Health System, and Division of Pediatrics, George Washington University, Washington, DC, USA
| | - Monica S Thakar
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Lucille Packard Children's Hospital, Stanford School of Medicine, Stanford, CA, USA
| | | | - Jeffrey Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | | | - J L Barnum
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey J Bednarski
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Monica Bhatia
- Pediatric Stem Cell Transplant Columbia, University Irving Medical Center, New York, NY, USA
| | - Francisco A Bonilla
- Northeast Allergy, Asthma & Immunology (private practice), Leominster, MA, USA
| | - Manish J Butte
- Division of Immunology, Allergy, and Rheumatology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Nancy J Bunin
- Cellular Therapy and Transplant Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lauri M Burroughs
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sonali Chaudhury
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karin Chen
- Division of Allergy and Immunology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hey Chong
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Geoff Cuvelier
- Pediatric Blood and Marrow Transplant Program, CancerCare Manitoba, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jignesh Dalal
- Pediatric Bone Marrow Transplant, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Magee L DeFelice
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA
| | - Kenneth B DeSantes
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Lisa R Forbes
- William T Shearer Center for Human Immunobiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Alfred Gillio
- Joseph M Sanzari's Childrens Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Fred Goldman
- Department of Pediatrics, Division of Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Avni Y Joshi
- Pediatric and Adult Allergy/Immunology, Mayo Clinic, Rochester, MN, USA
| | - Neena Kapoor
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Diseases Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Alan P Knutsen
- Pediatric Allergy and Immunology, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Lisa Kobrynski
- Children's Healthcare of Atlanta, Emory University Department of Pediatrics, Allergy and Immunology, Atlanta, GA, USA
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.,Johns Hopkins All Children's Hospital, Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | - Benjamin Oshrine
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | | | - Susan Prockop
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Troy C Quigg
- Pediatric Blood and Marrow Transplantation Program, Methodist Children's Hospital, San Antonio, TX, USA
| | - Ralph Quinones
- Pediatric Hematology, Oncology and Bone Marrow Transplant, Children's Hospital Colorado, Aurora, CO, USA
| | - Kirk R Schultz
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital and Research Institute, Vancouver, British Columbia, Canada
| | - Christine Seroogy
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Shyr
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, USA.,Division of Stem Cell Transplant, Department of Pediatrics, Stanford Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Subhadra Siegel
- Division of Pediatric Pulmonology, Allergy and Immunology and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Angela R Smith
- Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Troy R Torgerson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Mark T Vander Lugt
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA
| | - Lolie C Yu
- Division of Heme-Onc/HSCT, Children's Hospital/LSUHSC, New Orleans, LA, USA
| | - Morton J Cowan
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca H Buckley
- Division of Allergy and Immunology, Department of Pediatrics and Department of Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Elie Haddad
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, Department of Pediatrics, Department of Microbiology, Immunology and Infectious Disease, University of Montreal, Montreal, QC, Canada
| | - Donald B Kohn
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brent Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Puck
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Diseases Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Wood 3301, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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15
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Dorsey MJ, Wright NAM, Chaimowitz NS, Dávila Saldaña BJ, Miller H, Keller MD, Thakar MS, Shah AJ, Abu-Arja R, Andolina J, Aquino V, Barnum JL, Bednarski JJ, Bhatia M, Bonilla FA, Butte MJ, Bunin NJ, Chandra S, Chaudhury S, Chen K, Chong H, Cuvelier GDE, Dalal J, DeFelice ML, DeSantes KB, Forbes LR, Gillio A, Goldman F, Joshi AY, Kapoor N, Knutsen AP, Kobrynski L, Lieberman JA, Leiding JW, Oshrine B, Patel KP, Prockop S, Quigg TC, Quinones R, Schultz KR, Seroogy C, Shyr D, Siegel S, Smith AR, Torgerson TR, Vander Lugt MT, Yu LC, Cowan MJ, Buckley RH, Dvorak CC, Griffith LM, Haddad E, Kohn DB, Logan B, Notarangelo LD, Pai SY, Puck J, Pulsipher MA, Heimall J. Infections in Infants with SCID: Isolation, Infection Screening, and Prophylaxis in PIDTC Centers. J Clin Immunol 2020; 41:38-50. [PMID: 33006109 DOI: 10.1007/s10875-020-00865-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/07/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The Primary Immune Deficiency Treatment Consortium (PIDTC) enrolled children with severe combined immunodeficiency (SCID) in a prospective natural history study of hematopoietic stem cell transplant (HSCT) outcomes over the last decade. Despite newborn screening (NBS) for SCID, infections occurred prior to HSCT. This study's objectives were to define the types and timing of infection prior to HSCT in patients diagnosed via NBS or by family history (FH) and to understand the breadth of strategies employed at PIDTC centers for infection prevention. METHODS We analyzed retrospective data on infections and pre-transplant management in patients with SCID diagnosed by NBS and/or FH and treated with HSCT between 2010 and 2014. PIDTC centers were surveyed in 2018 to understand their practices and protocols for pre-HSCT management. RESULTS Infections were more common in patients diagnosed via NBS (55%) versus those diagnosed via FH (19%) (p = 0.012). Outpatient versus inpatient management did not impact infections (47% vs 35%, respectively; p = 0.423). There was no consensus among PIDTC survey respondents as to the best setting (inpatient vs outpatient) for pre-HSCT management. While isolation practices varied, immunoglobulin replacement and antimicrobial prophylaxis were more uniformly implemented. CONCLUSION Infants with SCID diagnosed due to FH had lower rates of infection and proceeded to HSCT more quickly than did those diagnosed via NBS. Pre-HSCT management practices were highly variable between centers, although uses of prophylaxis and immunoglobulin support were more consistent. This study demonstrates a critical need for development of evidence-based guidelines for the pre-HSCT management of infants with SCID following an abnormal NBS. TRIAL REGISTRATION NCT01186913.
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Affiliation(s)
- Morna J Dorsey
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Nicola A M Wright
- Division of Hematology/Immunology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Natalia S Chaimowitz
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Blachy J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC, USA.,Department of Pediatrics, George Washington University, Washington, DC, USA
| | - Holly Miller
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Michael D Keller
- Division of Allergy & Immunology, Children's National Health System, and Division of Pediatrics, George Washington University, Washington, DC, USA
| | - Monica S Thakar
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Lucille Packard Children's Hospital, Stanford School of Medicine, Stanford, CA, USA
| | | | - Jeffrey Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | | | - J L Barnum
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey J Bednarski
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Monica Bhatia
- Pediatric Stem Cell Transplant Columbia, University Irving Medical Center, New York, NY, USA
| | - Francisco A Bonilla
- Northeast Allergy, Asthma & Immunology (private practice), Leominster, MA, USA
| | - Manish J Butte
- Division of Immunology, Allergy, and Rheumatology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Nancy J Bunin
- Cellular Therapy and Transplant Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sonali Chaudhury
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karin Chen
- Division of Allergy and Immunology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hey Chong
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Geoffrey D E Cuvelier
- Pediatric Blood and Marrow Transplant Program, CancerCare Manitoba, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jignesh Dalal
- Pediatric Bone Marrow Transplant, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Magee L DeFelice
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA
| | - Kenneth B DeSantes
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Lisa R Forbes
- William T Shearer Center for Human Immunobiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Alfred Gillio
- Joseph M Sanzari's Childrens Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Fred Goldman
- Department of Pediatrics, Division of Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Avni Y Joshi
- Pediatric and Adult Allergy/Immunology, Mayo Clinic, Rochester, MN, USA
| | - Neena Kapoor
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Diseases Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Alan P Knutsen
- Pediatric Allergy and Immunology, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Lisa Kobrynski
- Children's Healthcare of Atlanta, Emory University Department of Pediatrics, Allergy and Immunology, Atlanta, GA, USA
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.,Johns Hopkins All Children's Hospital, Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | - Benjamin Oshrine
- Johns Hopkins All Children's Hospital, Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | | | - Susan Prockop
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Troy C Quigg
- Pediatric Blood and Marrow Transplantation Program, Methodist Children's Hospital, San Antonio, TX, USA
| | - Ralph Quinones
- Pediatric Hematology, Oncology and Bone Marrow Transplant, Children's Hospital Colorado, Aurora, CO, USA
| | - Kirk R Schultz
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital and Research Institute, Vancouver, British Columbia, Canada
| | - Christine Seroogy
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Shyr
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, USA.,Division of Stem Cell Transplant, Department of Pediatrics, Stanford Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Subhadra Siegel
- Division of Pediatric Pulmonology, Allergy and Immunology and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Angela R Smith
- Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Troy R Torgerson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Mark T Vander Lugt
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA
| | - Lolie C Yu
- Division of Heme-Onc/HSCT, Children's Hospital/LSUHSC, New Orleans, LA, USA
| | - Morton J Cowan
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca H Buckley
- Division of Allergy and Immunology, Department of Pediatrics and Department of Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Elie Haddad
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, Department of Pediatrics, Department of Microbiology, Immunology and Infectious Disease, University of Montreal, Montreal, QC, Canada
| | - Donald B Kohn
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brent Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Puck
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Diseases Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Wood 3301, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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16
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Seif AE, Li Y, Monos DS, Heidemann SC, Aplenc R, Barrett DM, Casper JT, Freedman JL, Grupp SA, Margolis DA, Olson TS, Teachey DT, Keever-Taylor CA, Wang Y, Talano JAM, Bunin NJ. Partially CD3 +-Depleted Unrelated and Haploidentical Donor Peripheral Stem Cell Transplantation Has Favorable Graft-versus-Host Disease and Survival Rates in Pediatric Hematologic Malignancy. Biol Blood Marrow Transplant 2019; 26:493-501. [PMID: 31765697 DOI: 10.1016/j.bbmt.2019.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 11/12/2022]
Abstract
Most children who may benefit from stem cell transplantation lack a matched related donor. Alternative donor transplantations with an unrelated donor (URD) or a partially matched related donor (PMRD) carry an increased risk of graft-versus-host-disease (GVHD) and mortality compared with matched related donor transplantations. We hypothesized that a strategy of partial CD3+/CD19+ depletion for URD or PMRD peripheral stem cell transplantation (PSCT) would attenuate the risks of GVHD and mortality. We enrolled 84 pediatric patients with hematologic malignancies at the Children's Hospital of Philadelphia and the Children's Hospital of Wisconsin between April 2005 and February 2015. Two patients (2.4%) experienced primary graft failure. Relapse occurred in 23 patients (27.4%; cumulative incidence 26.3%), and 17 patients (20.2%) experienced nonrelapse mortality (NRM). Grade III-IV acute GVHD was observed in 18 patients (21.4%), and chronic GVHD was observed and graded as limited in 24 patients (35.3%) and extensive in 8 (11.7%). Three-year overall survival (OS) was 61.8% (95% confidence interval [CI], 50.2% to 71.4%) and event-free survival (EFS) was 52.0% (95% CI, 40.3% to 62.4%). Age ≥15 years was associated with decreased OS (P= .05) and EFS (P= .05). Relapse was more common in children in second complete remission (P = .03). Partially CD3+-depleted alternative donor PSCT NRM, OS, and EFS compare favorably with previously published studies of T cell-replete PSCT. Historically, T cell-replete PSCT has been associated with a higher incidence of extensive chronic GVHD compared with limited chronic GVHD, which may explain the comparatively low relapse and NRM rates in our study cohort despite similar overall rates of chronic GVHD. Partial T cell depletion may expand donor options for children with malignant transplantation indications lacking a matched related donor by mitigating, but not eliminating, chronic GVHD.
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Affiliation(s)
- Alix E Seif
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yimei Li
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dimitri S Monos
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie C Heidemann
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard Aplenc
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David M Barrett
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James T Casper
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jason L Freedman
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephan A Grupp
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Margolis
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy S Olson
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David T Teachey
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carolyn A Keever-Taylor
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yongping Wang
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie-An M Talano
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nancy J Bunin
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
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17
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Pulsipher MA, Logan BR, Kiefer DM, Chitphakdithai P, Riches ML, Rizzo JD, Anderlini P, Leitman SF, Varni JW, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Ball ED, Bolwell BJ, Bunin NJ, Cheerva A, Delgado DC, Dvorak CC, Gillio AP, Hahn TE, Hale GA, Haight AE, Hayes-Lattin BM, Kasow KA, Linenberger M, Magalhaes-Silverman M, Mori S, Prasad VK, Quigg TC, Sahdev I, Schriber JR, Shenoy S, Tse WT, Yanik GA, Navarro WH, Horowitz MM, Confer DL, Shaw BE, Switzer GE. Higher Risks of Toxicity and Incomplete Recovery in 13- to 17-Year-Old Females after Marrow Donation: RDSafe Peds Results. Biol Blood Marrow Transplant 2019; 25:955-964. [PMID: 30605731 PMCID: PMC6511296 DOI: 10.1016/j.bbmt.2018.12.765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/27/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
Although donation of bone marrow (BM) or peripheral blood stem cells (PBSCs) from children to family members undergoing allogeneic transplantation are well-established procedures, studies detailing levels of pain, symptoms, and long-term recovery are lacking. To address this lack, we prospectively enrolled 294 donors age <18 years at 25 pediatric transplantation centers in North America, assessing them predonation, peridonation, and at 1 month, 6 months, and 1 year postdonation. We noted that 71% of children reported pain and 59% reported other symptoms peridonation, with resolution to 14% and 12% at 1 month postdonation. Both older age (age 13 to 17 years versus younger) and female sex were associated with higher levels of pain peridonation, with the highest rates in older females (57% with grade 2-4 pain and 17% with grade 3-4 pain). Multivariate analyses showed a 4-fold increase in risk for older females compared with males age <13 years (P <.001). At 1 year, 11% of 13- to 17-year-old females reported grade 2-4 pain, compared with 3% of males age 13 to 17 years, 0% of females age <13 years, and 1% of males age <13 years (P = .01). Males and females age 13 to 17 years failed to return to predonation pain levels at 1 year 22% and 23% of the time, respectively, compared with 3% and 10% in males and females age <13 years (P = .002). Our data show that females age 13 to 17 years are at increased risk of grade 2-4 pain at 1 year and >20% of females and males age 13 to 17 years do not return to baseline pain levels by 1 year after BM donation. Studies aimed at decreasing symptoms and improving recovery in older children are warranted.
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Affiliation(s)
- Michael A Pulsipher
- Children's Hospital Los Angeles, Center for Children's Cancer and Blood Diseases, USC Keck School of Medicine, Los Angeles, California.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Marcie L Riches
- University of North Carolina Hospitals, Chapel Hill, North Carolina, Division of Hematology and Oncology
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cell Transplantation and Cellular Therapy, Division of Cancer Medicine. M.D. Anderson Cancer Center, Houston, Texas
| | - Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - James W Varni
- Department of Landscape Architecture & Urban Planning, Center for Health Systems & Design, Texas A&M University, College Station, Texas
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Aly Abdel-Mageed
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Ibrahim A Ahmed
- Department of Hematology and Oncology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, California
| | - Brian J Bolwell
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nancy J Bunin
- Blood and Marrow Transplant Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexandra Cheerva
- Blood and Marrow Transplant Program, Kosair Children's Hospital, Louisville, Kentucky
| | - David C Delgado
- Indiana University Hospital/Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher C Dvorak
- Division of Pediatric Blood and Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | - Alfred P Gillio
- Pediatric Hematology-Oncology, Hackensack Meridian University Medical Center, Hackensack, New Jersey
| | - Theresa E Hahn
- Department of Medicine. Cancer Prevention and Population Sciences CCSG Program. Roswell Park Cancer Institute, Buffalo, New York
| | - Gregory A Hale
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Division of Hematology/Oncology-Bone Marrow Pediatric Hematology & Medical Oncology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | | | - Kimberly A Kasow
- Pediatric Hematology Oncology Program, Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Healthcare, Chapel Hill, North Carolina
| | - Michael Linenberger
- Division of Hematology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, Florida
| | - Vinod K Prasad
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - Shalini Shenoy
- Hematology and Oncology, St. Louis Children's Hospital, St. Louis, Missouri
| | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Galen E Switzer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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18
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Pulsipher MA, Logan BR, Chitphakdithai P, Kiefer DM, Riches ML, Rizzo JD, Anderlini P, Leitman SF, Varni JW, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Bunin NJ, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Shaw BE, Confer DL. Effect of Aging and Predonation Comorbidities on the Related Peripheral Blood Stem Cell Donor Experience: Report from the Related Donor Safety Study. Biol Blood Marrow Transplant 2019; 25:699-711. [PMID: 30423480 PMCID: PMC6453753 DOI: 10.1016/j.bbmt.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/27/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
The development of reduced-intensity approaches for allogeneic hematopoietic cell transplantation has resulted in growing numbers of older related donors (RDs) of peripheral blood stem cells (PBSCs). The effects of age on donation efficacy, toxicity, and long-term recovery in RDs are poorly understood. To address this we analyzed hematologic variables, pain, donation-related symptoms, and recovery in 1211 PBSC RDs aged 18 to 79 enrolled in the Related Donor Safety Study. RDs aged > 60 had a lower median CD34+ level before apheresis compared with younger RDs (age > 60, 59 × 106/L; age 41 to 60, 81 × 106/L; age 18 to 40, 121 × 106/L; P < .001). This resulted in older donors undergoing more apheresis procedures (49% versus 30% ≥ 2 collections, P < .001) and higher collection volumes (52% versus 32% > 24 L, P < .001), leading to high percentages of donors aged > 60 with postcollection thrombocytopenia <50 × 109/L (26% and 57% after 2 and 3days of collection, respectively). RDs aged 18 to 40 had a higher risk of grades 2 to 4 pain and symptoms pericollection, but donors over age 40 had more persistent pain at 1, 6, and 12 months (odds ratio [OR], 1.7; P = 0.02) and a higher rate of nonrecovery to predonation levels (OR, 1.7; P = .01). Donors reporting comorbidities increased significantly with age, and those with comorbidities that would have led to deferral by National Marrow Donor Program unrelated donor standards had an increased risk for persistent grades 2 to 4 pain (OR, 2.41; P < .001) and failure to recover to predonation baseline for other symptoms (OR, 2.34; P = .004). This information should be used in counseling RDs regarding risk and can assist in developing practice approaches aimed at improving the RD experience for high-risk individuals.
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Affiliation(s)
- Michael A Pulsipher
- Children's Hospital Los Angeles, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Los Angeles, California.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Marcie L Riches
- University of North Carolina Hospitals, Division of Hematology and Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paolo Anderlini
- M.D. Anderson Cancer Center, Department of Stem Cell Transplantation and Cellular Therapy, Houston, Texas
| | - Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - James W Varni
- Texas A & M University, Department of Pediatrics, College Station, Texas
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - Ibrahim A Ahmed
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, Indiana
| | | | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, California
| | | | - Carolyn Bigelow
- University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | - Nancy J Bunin
- Children's Hospital of Philadelphia, Division of Oncology, Philadelphia, Pennsylvania
| | - David C Delgado
- Indiana University Hospital/Riley Hospital for Children, Indianapolis, Indiana
| | - Katharine Duckworth
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Christopher C Dvorak
- University of California San Francisco Benioff Children's Hospital, Division of Pediatric Blood and Marrow Transplantation San Francisco, California
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Ann A Jakubowski
- Memorial Sloan Kettering Cancer Center-Adult, New York, New York
| | - Kimberly A Kasow
- University of North Carolina Healthcare, Chapel Hill, North Carolina
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jane L Liesveld
- Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | | | | | - Walter Longo
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | - John M McCarty
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, Virginia
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, Florida
| | | | | | - Witold B Rybka
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK
| | | | | | | | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | - Daniel J Weisdorf
- University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
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19
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Elgarten CW, Myers RM, Levy E, Freedman JL, Bunin NJ, Fisher BT, Olson TS. Cytomegalovirus Reactivation in Children with Hemoglobinopathies Who Undergo Hematopoietic Cell Transplantation with Distal Alemtuzumab. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.650] [Citation(s) in RCA: 1] [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: 11/26/2022]
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20
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Oved JH, Wang Y, Barrett DM, Levy EM, Huang Y, Monos DS, Grupp SA, Bunin NJ, Olson TS. CD3 +/CD19 + Depleted Matched and Mismatched Unrelated Donor Hematopoietic Stem Cell Transplant with Targeted T Cell Addback Is Associated with Excellent Outcomes in Pediatric Patients with Nonmalignant Hematologic Disorders. Biol Blood Marrow Transplant 2019; 25:549-555. [PMID: 30312755 PMCID: PMC7122955 DOI: 10.1016/j.bbmt.2018.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/15/2018] [Accepted: 10/02/2018] [Indexed: 01/19/2023]
Abstract
Unrelated donor hematopoietic stem cell transplantation (HSCT) is increasingly being used to cure nonmalignant hematologic diseases (NMHD) in patients who lack HLA matched related donors. Both graft rejection and graft-versus-host disease (GVHD) remain major barriers to safe and effective transplant for these patients requiring unrelated donors. Partial T cell depletion combined with peripheral stem cell transplantation (pTCD-PSCT) has the potential advantages of providing a high stem cell dose to facilitate rapid engraftment, maintaining cells that may facilitate engraftment, and decreasing GVHD risk compared with T cell-replete HSCT. Here, we report a single-institution, retrospective experience of unrelated donor pTCD-PSCT for pediatric patients with NMHD. From 2014 to 2017, 12 pediatric patients with transfusion-dependent NMHD underwent matched unrelated donor (MUD) or mismatched unrelated donor (MMUD) pTCD HSCT in our center using disease-specific conditioning. Donor PSCs underwent CD3+ T cell and CD19+ B cell depletion using CliniMACS, followed by a targeted addback of 1 × 105 CD3+ T cells/kg to the graft before infusion. All 12 patients demonstrated rapid trilinear engraftment. At a median follow-up of 740days (range, 279 to 1466), all patients were alive with over 92% total peripheral blood donor chimerism and without transfusion dependence or recurrence of their underlying hematologic disease. Immune reconstitution was rapid and comparable with T cell-replete HSCT. No patients developed severe acute GVHD (grades III to IV) or chronic extensive GVHD, and all patients had discontinued systemic immune suppression. Viral reactivations were common, but no patient developed symptoms of life-threatening infectious disease. Our data indicate that MUD and MMUD pTCD-PSCTs are safe and effective approaches that enable rapid engraftment and immune reconstitution, prevent severe GVHD, and expand availability of HSCT to any patients with NMHD who have closely MUDs.
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Affiliation(s)
- Joseph H Oved
- Cellular Therapy and Transplant Section, Division of Oncology Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatric Hematology/Oncology Fellowship Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yongping Wang
- Cellular Therapy and Transplant Section, Division of Oncology Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David M Barrett
- Cellular Therapy and Transplant Section, Division of Oncology Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellen M Levy
- Cellular Therapy and Transplant Section, Division of Oncology Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yanping Huang
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dimitrios S Monos
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephan A Grupp
- Cellular Therapy and Transplant Section, Division of Oncology Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy J Bunin
- Cellular Therapy and Transplant Section, Division of Oncology Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy S Olson
- Cellular Therapy and Transplant Section, Division of Oncology Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
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21
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Arnold DE, Seif AE, Jyonouchi S, Sullivan KE, Bunin NJ, Heimall JR. Allogeneic hematopoietic stem cell transplantation in adolescent patients with chronic granulomatous disease. The Journal of Allergy and Clinical Immunology: In Practice 2019; 7:1052-1054.e2. [DOI: 10.1016/j.jaip.2018.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022]
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22
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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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23
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Laskin B, Seif AE, Bunin NJ, Wang Y, Beier U, Altrich M, Kleiboeker S, Jodele S, Davies SM, Denburg M. BK Viremia is Common in Children after Allogeneic Hematopoietic Cell Transplant. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.669] [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: 12/01/2022]
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Prockop SE, Li A, Baiocchi R, Bunin NJ, Mahadeo KM, Nemecek ER, Nikiforow S, Reshef R, Tsai DE, Navarro WH, O'Reilly RJ. Efficacy and Safety of ATA129, Partially Matched Allogeneic Third-Party Epstein-Barr Virus-Targeted Cytotoxic T Lymphocytes in a Multicenter Study for Post-Transplant Lymphoproliferative Disorder. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kerby EH, Li Y, Getz KD, Smith EC, Smith LT, Bunin NJ, Seif AE. Nutritional risk factors predict severe acute graft-versus-host disease and early mortality in pediatric allogeneic hematopoietic stem cell transplantation. Pediatr Blood Cancer 2018; 65. [PMID: 29080380 DOI: 10.1002/pbc.26853] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 05/03/2017] [Accepted: 09/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malnutrition is a pro-inflammatory state, yet data on nutritional risk factors and development of acute graft-versus-host disease (aGVHD) are extremely limited. PROCEDURE We conducted a retrospective cohort analysis of pediatric patients up to age 21 years who underwent allogeneic hematopoietic stem cell transplantation (HSCT) at the Children's Hospital of Philadelphia from January 2011 to September 2014 to determine whether malnutrition was associated with development of aGVHD and early mortality. We identified body mass index (BMI) percentile and serum albumin levels as potential markers of malnutrition and defined two composite nutritional risk variables as any of the following: albumin < 2.8 g/dl, weight loss ≥10% from baseline, and low BMI [<25th (NUT25) or <5th percentile (NUT5)]. Nutritional markers and GVHD grade were assessed at baseline, 30, 60, and 90 days post-HSCT, and patients were censored upon development of GVHD. RESULTS BMI <25th or <5th percentile, NUT25, and NUT5 at the beginning of any 30-day period predicted a three- to fourfold risk of developing of severe (grade III-IV) aGVHD in the subsequent 30 days in models adjusted for age, sex, donor source, and degree of human leukocyte antigen matching. Mortality at day 100 was low, but NUT25 risk at baseline conferred an increased risk of death (7.9% vs. 1%, P = 0.035). CONCLUSIONS Malnutrition is a targetable risk factor in pediatric HSCT; prospective trials are needed to investigate this relationship further and identify effective nutritional interventions.
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Affiliation(s)
- Eva H Kerby
- Department of Dermatology, Hofstra Northwell Health School of Medicine, New Hyde Park, New York
| | - Yimei Li
- Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kelly D Getz
- Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth C Smith
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura T Smith
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy J Bunin
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alix E Seif
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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Elgarten CW, Arnold DE, Bunin NJ, Seif AE. Outcomes of matched sibling donor bone marrow transplantation in children using single-agent calcineurin inhibitors as prophylaxis for graft versus host disease. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26726. [PMID: 28748621 PMCID: PMC5699955 DOI: 10.1002/pbc.26726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Optimal graft versus host disease (GVHD) prophylaxis prevents severe manifestations without excess immunosuppression. Standard prophylaxis includes a calcineurin inhibitor (CNI) with low-dose methotrexate. However, single-agent CNI may be sufficient prophylaxis for a defined group of patients. Single-agent CNI has been used for GVHD prophylaxis for human leukocyte antigen (HLA)-matched sibling donor (MSD) bone marrow transplants (BMTs) in young patients at the Children's Hospital of Philadelphia for over 20 years. Here, we describe outcomes using this prophylactic strategy in a recent cohort. PROCEDURE We performed a single-institution chart review and retrospective analysis of consecutive children undergoing MSD BMT who received single-agent CNI for GVHD prophylaxis between January 2002 and December 2014. RESULTS Fifty-two children with a median age of 6.1 years (interquartile range [IQR] 2.5-8.3) and donor age of 6 years (IQR 3-10), with malignant and nonmalignant diseases (n = 35 and 17, respectively) were evaluated. Forty-three (82.6%) received oral prophylaxis with single-agent tacrolimus after initial intravenous therapy. Rates of GVHD were consistent with reported rates on dual prophylaxis: the overall incidence of grades 2-4 acute GVHD was 25.5%, grades 3-4 GVHD 9.8%, and chronic GVHD 10.4%. The cumulative incidence of relapse among children with malignancy was 20% at a median of 237 days (IQR 194-318) post-transplant. Two-year overall survival was 82.7% (95% confidence interval [CI]: 69.4-90.6%) and event-free survival was 78.9% (95% CI: 65.1-87.7%). No patient experienced graft failure. CONCLUSIONS Single-agent CNI is a safe, effective approach to GVHD prophylaxis in young patients undergoing HLA-identical sibling BMT. Additionally, single-agent oral tacrolimus is a reasonable alternative to cyclosporine in this population.
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Affiliation(s)
- Caitlin W. Elgarten
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Danielle E. Arnold
- Division of Immunology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy J. Bunin
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alix E. Seif
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Slavich LD, Huang Y, Bunin NJ, Monos DS. OR37 Persistence of T cells from the first donor after a second allogeneic stem cell transplantation. Hum Immunol 2017. [DOI: 10.1016/j.humimm.2017.06.043] [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: 11/29/2022]
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Freedman JL, Wang Y, Monos DS, Li Y, Barrett DM, Olson TS, Seif AE, Teachey DT, Grupp SA, Bunin NJ. Unrelated and Haploidentical Hematopoietic Stem Cell Transplantation (HSCT) Using TCR αβ+CD3+Depletion in Pediatric Patients with Hematologic Malignancies. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.663] [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: 10/22/2022]
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29
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Seif AE, Li Y, Aplenc R, Barrett DM, Casper JT, Freedman JL, Grupp SA, Margolis DA, Olson TS, Teachey DT, Wang Y, Talano JAM, Bunin NJ. Favorable Chronic Graft-Versus-Host-Disease (GVHD), Event-Free (EFS), and Overall Survival (OS) Rates Following Partially CD3-Depleted Alternative Donor Peripheral Stem Cell Transplantation (PSCT) for Pediatric Hematologic Malignancies. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.356] [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: 10/22/2022]
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Bride KL, Freedman JL, Bunin NJ, Hunger SP, Rheingold SR, Seif AE. Hematopoietic Stem Cell Transplantation (HSCT) for Acute Lymphoblastic Leukemia (ALL) in First Remission (CR1): A Single-Institution Retrospective Cohort Study Demonstrating Excellent Event-Free (EFS) and Overall Survival (OS). Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.651] [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: 10/22/2022]
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31
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Talekar MK, Wang Y, Monos DS, Grupp SA, Bunin NJ, Olson TS. CD3/CD19 Depletion with Targeted T Cell Add-Back Results in Stable Engraftment and Minimal GVHD in Pediatric Patients with Bone Marrow Failure Undergoing Unrelated Donor Peripheral Blood Stem Cell Transplantation. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.693] [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: 10/22/2022]
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Guinan E, Avigan DE, Soiffer RJ, Bunin NJ, Brennan LL, Bergelson I, Brightman S, Ozonoff A, Scannon PJ, Levy O. Pilot experience with opebacan/rBPI 21 in myeloablative hematopoietic cell transplantation. F1000Res 2016; 4:1480. [PMID: 26835003 PMCID: PMC4722698 DOI: 10.12688/f1000research.7558.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 12/26/2022] Open
Abstract
Bacterial infection and inflammation contribute significantly to the morbidity and mortality of myeloablative allogeneic hematopoietic cell transplantation (HCT). Endotoxin, a component of the outer membrane of Gram-negative bacteria, is a potent inflammatory stimulus in humans. Bactericidal/permeability increasing protein (BPI), a constituent of human neutrophil granules, binds endotoxin thereby precluding endotoxin-induced inflammation and also has direct anti-infective properties against bacteria. As a consequence of myeloablative therapy used in preparation for hematopoietic cell infusion, patients experience gastrointestinal leak of bacteria and bacterial toxins into the systemic circulation and a period of inflammatory cytokine elevation associated with subsequent regimen-related toxicities. Patients frequently become endotoxemic and febrile as well as BPI-deficient due to sustained neutropenia. To examine whether enhancing endotoxin-neutralizing and anti-infective activity by exogenous administration of a recombinant N-terminal fragment of BPI (rBPI
21, generic name opebacan) might ameliorate regimen-related toxicities including infection, we recruited patients scheduled to undergo myeloablative HCT to participate in a proof-of-concept prospective phase I/II trial. After the HCT preparative regimen was completed, opebacan was initiated 18-36 hours prior to administration of allogeneic hematopoietic stem cells (defined as Day 0) and continued for 72 hours. The trial was to have included escalation of rBPI
21 dose and duration but was stopped prematurely due to lack of further drug availability. Therefore, to better understand the clinical course of opebacan-treated patients (n=6), we compared their outcomes with a comparable cohort meeting the same eligibility criteria and enrolled in a non-interventional myeloablative HCT observational study (n = 35). Opebacan-treated participants had earlier platelet engraftment (p=0.005), mirroring beneficial effects of rBPI
21 previously observed in irradiated mice, fewer documented infections (p=0.03) and appeared less likely to experience significant regimen-related toxicities (p=0.05). This small pilot experience supports the potential utility of rBPI
21 in ameliorating HCT-related morbidity and merits further exploration.
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Affiliation(s)
- Eva Guinan
- Dana-Farber Cancer Institute, Boston, USA; Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, USA
| | - David E Avigan
- Harvard Medical School, Boston, USA; Beth Israel Deaconess Medical Center, Boston, USA
| | - Robert J Soiffer
- Dana-Farber Cancer Institute, Boston, USA; Harvard Medical School, Boston, USA; Brigham and Women's Hospital, Boston, USA
| | - Nancy J Bunin
- Children's Hospital of Philadelphia, Philadelphia, USA
| | | | | | | | - Al Ozonoff
- Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, USA
| | | | - Ofer Levy
- Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, USA
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Desai AV, Li Y, Heneghan M, Huang YS, Fisher B, Mante A, Grupp SA, Bunin NJ, Aplenc R, Bagatell R, Seif AE. Resource utilization (RU) and toxicities after carboplatin/etoposide/melphalan (CEM) and busulfan/melphalan (BuMel) for autologous stem cell rescue (ASCR) in high-risk neuroblastoma (HRNB). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e21009] [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
Affiliation(s)
| | - Yimei Li
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Brian Fisher
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Nancy J. Bunin
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Richard Aplenc
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Alix Eden Seif
- The Children's Hospital of Philadelphia, Philadelphia, PA
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Stieglitz E, Ward AF, Gerbing RB, Alonzo TA, Arceci RJ, Liu YL, Emanuel PD, Widemann BC, Cheng JW, Jayaprakash N, Balis FM, Castleberry RP, Bunin NJ, Loh ML, Cooper TM. Phase II/III trial of a pre-transplant farnesyl transferase inhibitor in juvenile myelomonocytic leukemia: a report from the Children's Oncology Group. Pediatr Blood Cancer 2015; 62:629-36. [PMID: 25704135 PMCID: PMC4339233 DOI: 10.1002/pbc.25342] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 10/01/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Juvenile myelomonocytic leukemia (JMML) is not durably responsive to chemotherapy, and approximately 50% of patients relapse after hematopoietic stem cell transplant (HSCT). Here we report the activity and acute toxicity of the farnesyl transferase inhibitor tipifarnib, the response rate to 13-cis retinoic acid (CRA) in combination with cytoreductive chemotherapy, and survival following HSCT in children with JMML. PROCEDURE Eighty-five patients with newly diagnosed JMML were enrolled on AAML0122 between 2001 and 2006. Forty-seven consented to receive tipifarnib in a phase II window before proceeding to a phase III trial of CRA in combination with fludarabine and cytarabine followed by HSCT and maintenance CRA. Thirty-eight patients enrolled only in the phase III trial. RESULTS Overall response rate was 51% after tipifarnib and 68% after fludarabine/cytarabine/CRA. Tipifarnib did not increase pre-transplant toxicities. Forty-six percent of the 44 patients who received protocol compliant HSCT relapsed. Five-year overall survival was 55 ± 11% and event-free survival was 41 ± 11%, with no significant difference between patients who did or did not receive tipifarnib. CONCLUSIONS Administration of tipifarnib in the window setting followed by HSCT in patients with newly diagnosed JMML was safe and yielded a 51% initial response rate as a single agent, but failed to reduce relapse rates or improve long-term overall survival.
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Affiliation(s)
- Elliot Stieglitz
- Department of Pediatrics, University of California San Francisco School of Medicine and Benioff Children’s Hospital, Helen Diller Comprehensive Cancer Center, San Francisco, CA, USA
| | - Ashley F. Ward
- Department of Pediatrics, University of California San Francisco School of Medicine and Benioff Children’s Hospital, Helen Diller Comprehensive Cancer Center, San Francisco, CA, USA
| | | | | | - Robert J. Arceci
- Ronald A. Matricaria Institute of Molecular Medicine, Phoenix Children’s Hospital, University of Arizona, Phoenix, AZ, USA
| | - Y. Lucy Liu
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Peter D. Emanuel
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | - Frank M. Balis
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Nancy J. Bunin
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mignon L. Loh
- Department of Pediatrics, University of California San Francisco School of Medicine and Benioff Children’s Hospital, Helen Diller Comprehensive Cancer Center, San Francisco, CA, USA
| | - Todd M. Cooper
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine/Children’s Healthcare of Atlanta, Atlanta, GA, USA
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Maude SL, Frey N, Shaw PA, Aplenc R, Barrett DM, Bunin NJ, Chew A, Gonzalez VE, Zheng Z, Lacey SF, Mahnke YD, Melenhorst JJ, Rheingold SR, Shen A, Teachey DT, Levine BL, June CH, Porter DL, Grupp SA. Chimeric antigen receptor T cells for sustained remissions in leukemia. N Engl J Med 2014; 371:1507-17. [PMID: 25317870 PMCID: PMC4267531 DOI: 10.1056/nejmoa1407222] [Citation(s) in RCA: 3831] [Impact Index Per Article: 383.1] [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: 12/11/2022]
Abstract
BACKGROUND Relapsed acute lymphoblastic leukemia (ALL) is difficult to treat despite the availability of aggressive therapies. Chimeric antigen receptor-modified T cells targeting CD19 may overcome many limitations of conventional therapies and induce remission in patients with refractory disease. METHODS We infused autologous T cells transduced with a CD19-directed chimeric antigen receptor (CTL019) lentiviral vector in patients with relapsed or refractory ALL at doses of 0.76×10(6) to 20.6×10(6) CTL019 cells per kilogram of body weight. Patients were monitored for a response, toxic effects, and the expansion and persistence of circulating CTL019 T cells. RESULTS A total of 30 children and adults received CTL019. Complete remission was achieved in 27 patients (90%), including 2 patients with blinatumomab-refractory disease and 15 who had undergone stem-cell transplantation. CTL019 cells proliferated in vivo and were detectable in the blood, bone marrow, and cerebrospinal fluid of patients who had a response. Sustained remission was achieved with a 6-month event-free survival rate of 67% (95% confidence interval [CI], 51 to 88) and an overall survival rate of 78% (95% CI, 65 to 95). At 6 months, the probability that a patient would have persistence of CTL019 was 68% (95% CI, 50 to 92) and the probability that a patient would have relapse-free B-cell aplasia was 73% (95% CI, 57 to 94). All the patients had the cytokine-release syndrome. Severe cytokine-release syndrome, which developed in 27% of the patients, was associated with a higher disease burden before infusion and was effectively treated with the anti-interleukin-6 receptor antibody tocilizumab. CONCLUSIONS Chimeric antigen receptor-modified T-cell therapy against CD19 was effective in treating relapsed and refractory ALL. CTL019 was associated with a high remission rate, even among patients for whom stem-cell transplantation had failed, and durable remissions up to 24 months were observed. (Funded by Novartis and others; CART19 ClinicalTrials.gov numbers, NCT01626495 and NCT01029366.).
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Affiliation(s)
- Shannon L Maude
- From the Division of Oncology, Children's Hospital of Philadelphia (S.L.M., R.A., D.M.B., N.J.B., S.R.R., D.T.T., S.A.G.), the Departments of Pediatrics (S.L.M., R.A., D.M.B., N.J.B., S.R.R., D.T.T., S.A.G.), Biostatistics and Epidemiology (P.A.S., R.A.), and Pathology and Laboratory Medicine (J.J.M., B.L.L., C.H.J., S.A.G.), the Division of Hematology-Oncology (N.F., D.L.P.), and Abramson Cancer Center (N.F., A.C., V.E.G., Z.Z., S.F.L., Y.D.M., J.J.M., B.L.L., C.H.J., D.L.P., S.A.G.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; and Novartis Pharmaceuticals, East Hanover, NJ (A.S.)
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Mostoufi-Moab S, Sun W, Magland J, Isaacoff E, Bunin NJ, Ginsberg JP, Wehrli F, Shults J, Leonard MB. Abstract B29: Increased vertebral marrow adiposity in long-term survivors of pediatric allogeneic hematopoietic stem cell transplant is associated with deficits in trabecular microarchitecture. Cancer Res 2014. [DOI: 10.1158/1538-7445.pedcan-b29] [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: 11/16/2022]
Abstract
Abstract
Background: As treatment-related mortality following allogeneic hematopoietic stem-cell transplantation (alloHSCT) declines, a major unmet need is the identification and prevention of late effects. Long-term survivors of hematologic malignancies requiring alloHSCT show impaired bone density and structure with excess whole body adiposity (Mostoufi-Moab, JBMR, 2012). Marrow adipocytes share common mesenchymal stem cells (MSC) with bone-forming osteoblasts, with an inverse relation between MSC differentiation into osteoblasts or adipocytes. The impact of alloHSCT and total body irradiation (TBI) on marrow adipose tissue (MAT) and trabecular bone microarchitecture (TBA) has not been addressed.
Methods: Magnetic resonance spectroscopic imaging (MRSI) and high-resolution structural imaging were used to quantify vertebral MAT and distal tibia TBA on a 1.5 Tesla magnet. Twenty-five alloHSCT recipients with underlying diagnosis of acute leukemia, ages 12-24 years, were enrolled, a median of 11 years (range 5-19) after alloHSCT and TBI, and compared with age-, sex- and race-matched healthy controls.
Results: AlloHSCT survivors had lower height Z-scores (-1.39 ± 0.98 vs. -0.04 ± 0.98; p < 0.001), compared with controls, while BMI Z-scores did not differ. Overall, greater MAT was associated with lower bone volume fraction (BVF), R = -0.57, p < 0.001. AlloHSCT was associated with higher mean (± SD) vertebral fat fraction (59.0 ± 11.3 vs. 29.3 ± 9.9; p < 0.001) and trabecular deficits including lower bone volume fraction (β -0.01; 95% CI -0.12, -0.00; p=0.02) and evidence of abnormal microarchitecture [greater erosion (p=0.01) with a more rod like structure (p=0.02)], vs. controls. TBA deficits were more pronounced in female alloHSCT recipients. Growth hormone deficiency was not associated with MAT or bone deficits.
Conclusion: Survivors of childhood alloHSCT after TBI demonstrate marked increases in vertebral MAT combined with abnormal trabecular bone microarchitecture. Future studies are needed to determine the metabolic effects and fracture implications of excess MAT, and to identify therapies for improved bone accrual following childhood alloHSCT.
Citation Format: Sogol Mostoufi-Moab, Wenli Sun, Jeremy Magland, Elizabeth Isaacoff, Nancy J. Bunin, Jill P. Ginsberg, Felix Wehrli, Justine Shults, Mary B. Leonard. Increased vertebral marrow adiposity in long-term survivors of pediatric allogeneic hematopoietic stem cell transplant is associated with deficits in trabecular microarchitecture. [abstract]. In: Proceedings of the AACR Special Conference on Pediatric Cancer at the Crossroads: Translating Discovery into Improved Outcomes; Nov 3-6, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;74(20 Suppl):Abstract nr B29.
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Affiliation(s)
| | - Wenli Sun
- 2University of Pennsylvania, Philadelphia, PA
| | | | | | - Nancy J. Bunin
- 1The Children's Hospital of Philadelphia, Philadelphia, PA,
| | | | | | - Justine Shults
- 1The Children's Hospital of Philadelphia, Philadelphia, PA,
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Seif AE, Naranjo A, Baker DL, Bunin NJ, Kletzel M, Kretschmar CS, Maris JM, McGrady PW, von Allmen D, Cohn SL, London WB, Park JR, Diller LR, Grupp SA. A pilot study of tandem high-dose chemotherapy with stem cell rescue as consolidation for high-risk neuroblastoma: Children's Oncology Group study ANBL00P1. Bone Marrow Transplant 2013; 48:947-52. [PMID: 23334272 PMCID: PMC3638062 DOI: 10.1038/bmt.2012.276] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 12/04/2012] [Accepted: 12/05/2012] [Indexed: 11/17/2022]
Abstract
Increasing treatment intensity has improved outcomes for children with neuroblastoma. We performed a pilot study in the Children’s Oncology Group (COG) to assess feasibility and toxicity of a tandem myeloablative regimen without total body irradiation (TBI) supported by autologous CD34 selected peripheral blood stem cells. Forty-one patients with high-risk neuroblastoma were enrolled; eight patients did not receive any myeloablative consolidation procedure, and seven received only one. Two patients out of 41 (4.9%) experienced transplant-related mortality. CD34 selection was discontinued after subjects were enrolled due to serious viral illness. From the time of study enrollment, the overall 3-year event-free survival (EFS) and overall survival (OS) were 44.8±9.6% and 59.2±9.2% (N=41). These results demonstrate that tandem transplantation in the cooperative group setting is feasible and support a randomized comparison of single versus tandem myeloablative consolidation with PBSC support for high-risk neuroblastoma.
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Affiliation(s)
- A E Seif
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Niemeyer CM, Kang MW, Shin DH, Furlan I, Erlacher M, Bunin NJ, Bunda S, Finklestein JZ, Gorr TA, Mehta P, Schmid I, Kropshofer G, Corbacioglu S, Lang PJ, Klein C, Schlegel PG, Heinzmann A, Schneider M, Starý J, van den Heuvel-Eibrink MM, Hasle H, Locatelli F, Sakai D, Archambeault S, Chen L, Russell RC, Sybingco SS, Ohh M, Braun BS, Flotho C, Loh ML. Germline CBL mutations cause developmental abnormalities and predispose to juvenile myelomonocytic leukemia. Nat Genet 2010; 42:794-800. [PMID: 20694012 PMCID: PMC4297285 DOI: 10.1038/ng.641] [Citation(s) in RCA: 247] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 07/12/2010] [Indexed: 01/23/2023]
Abstract
CBL encodes a member of the Cbl family of proteins, which functions as an E3 ubiquitin ligase. We describe a dominant developmental disorder resulting from germline missense CBL mutations, which is characterized by impaired growth, developmental delay, cryptorchidism and a predisposition to juvenile myelomonocytic leukemia (JMML). Some individuals experienced spontaneous regression of their JMML but developed vasculitis later in life. Importantly, JMML specimens from affected children show loss of the normal CBL allele through acquired isodisomy. Consistent with these genetic data, the common p.371Y>H altered Cbl protein induces cytokine-independent growth and constitutive phosphorylation of ERK, AKT and S6 only in hematopoietic cells in which normal Cbl expression is reduced by RNA interference. We conclude that germline CBL mutations have developmental, tumorigenic and functional consequences that resemble disorders that are caused by hyperactive Ras/Raf/MEK/ERK signaling and include neurofibromatosis type 1, Noonan syndrome, Costello syndrome, cardiofaciocutaneous syndrome and Legius syndrome.
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Affiliation(s)
- Charlotte M. Niemeyer
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
- Corresponding author: Mignon L Loh, University of California, Rm HSD-302 Box 0519, San Francisco, CA 94143; . Or: Charlotte M. Niemeyer, Department of Pediatrics, University of Freiburg, Mathildenstrasse 1, 79106 Freiburg, Germany;
| | - Michelle W. Kang
- Department of Pediatrics and the Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Danielle H. Shin
- Department of Pediatrics and the Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Ingrid Furlan
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Erlacher
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Nancy J Bunin
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Severa Bunda
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Jerry Z. Finklestein
- Miller Children's Hospital/Harbor-UCLA, Jonathan Jaques Cancer Center, Long Beach, CA, United States
| | - Thomas A. Gorr
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Parinda Mehta
- Division of Hematology-Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Irene Schmid
- von Hauner Children's Hospital, LMU Munich University, Munich, Germany
| | - Gabriele Kropshofer
- University, Innsbruck, Austria; Department of Pediatrics and Adolescent Medicine, Medical
| | | | - Peter J Lang
- Dept. of Pediatrics, University of Tubingen, Germany
| | | | | | - Andrea Heinzmann
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Michaela Schneider
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Starý
- Department of Pediatric Hematology and Oncology, Charles University Prague, Prague, Czech Republic
| | | | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Franco Locatelli
- Pediatric Hematology/Oncology, University of Pavia Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Debbie Sakai
- Department of Pediatrics and the Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Sophie Archambeault
- Department of Pediatrics and the Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Leslie Chen
- Department of Pediatrics and the Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Ryan C. Russell
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Stephanie S. Sybingco
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Michael Ohh
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Benjamin S. Braun
- Department of Pediatrics and the Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Christian Flotho
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Mignon L. Loh
- Department of Pediatrics and the Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
- Corresponding author: Mignon L Loh, University of California, Rm HSD-302 Box 0519, San Francisco, CA 94143; . Or: Charlotte M. Niemeyer, Department of Pediatrics, University of Freiburg, Mathildenstrasse 1, 79106 Freiburg, Germany;
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Bunin NJ, Davies SM, Aplenc R, Camitta BM, DeSantes KB, Goyal RK, Kapoor N, Kernan NA, Rosenthal J, Smith FO, Eapen M. Unrelated donor bone marrow transplantation for children with acute myeloid leukemia beyond first remission or refractory to chemotherapy. J Clin Oncol 2008; 26:4326-32. [PMID: 18779619 DOI: 10.1200/jco.2008.16.4442] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [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
PURPOSE Identify prognostic factors that influence outcome after unrelated donor bone marrow transplantation in children with acute myeloid leukemia (AML). PATIENTS AND METHODS Included are 268 patients (age <or= 18 years) with AML in second complete remission (n = 142), relapse (n = 90), or primary induction failure (n = 36) at transplantation. All patients received bone marrow grafts from an unrelated donor and a myeloablative conditioning regimen. Cox regression models were constructed to identify risk factors that influence outcome after transplantation. RESULTS In this analysis, the only risk factor that predicted leukemia recurrence and overall and leukemia-free survival was disease status at transplantation. The 5-year probabilities of leukemia-free survival were 45%, 20%, and 12% for patients who underwent transplantation at second complete remission, relapse, and primary induction failure, respectively. As expected, risk of acute but not chronic graft-versus-host disease (GVHD) was lower with T-cell-depleted bone marrow grafts; T-cell-depleted grafts were not associated with higher risks of leukemia recurrence. We observed similar risks of leukemia relapse in patients with and without acute and chronic GVHD. CONCLUSION Children who underwent transplantation in remission had a superior outcome compared with children who underwent transplantation during relapse or persistent disease. Nevertheless, 20% of children who underwent transplantation in relapse are long-term survivors, suggesting that unrelated donor bone marrow transplantation is an effective therapy in a significant proportion of children with recurrent or primary refractory AML.
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Affiliation(s)
- Nancy J Bunin
- Children's Hospital of Philadelphia, Philadelphia, USA
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Abstract
Marrow relapse is the major obstacle to cure for 10-15% of young patients with acute lymphoblastic leukaemia (ALL). Recent investigations into the biology of minimal residual disease indicate that many early relapses derive from residual cells present at first diagnosis, but some late relapses might represent new mutations in leukaemic cells not eliminated by conventional therapy. Treatment of marrow relapse involves higher doses and more intensive schedules of the drugs used for initial therapy with or without haemopoietic stem cell transplantation. In most reports, transplantation is better than continuation chemotherapy in early marrow relapse, but its role in later relapse is less clear. Current therapy cures 10% of patients with early marrow relapses and 50% of those with late relapses, but outcomes have changed little in the past two decades. Understanding the molecular biology of ALL underlies development of improved risk stratification and new therapies. Although better drugs are needed, introduction of new agents into clinical trials in paediatric disease has been difficult. Innovative trial designs and use of valid surrogate endpoints may expedite this process.
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Affiliation(s)
- L Charles Bailey
- Division of Oncology, Children's Hospital of Philadelphia, and University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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41
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Kalwinsky DK, Raimondi SC, Bunin NJ, Fairclough D, Pui CH, Relling MV, Ribeiro R, Rivera GK. Clinical and biological characteristics of acute lymphocytic leukemia in children with Down syndrome. Am J Med Genet Suppl 2005; 7:267-71. [PMID: 2149960 DOI: 10.1002/ajmg.1320370753] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Twenty-eight children with Down syndrome (DS) and acute lymphocytic leukemia (ALL) were compared to non-DS control leukemics matched by age, white blood cell (WBC) count, and treatment protocol to evaluate presenting manifestations, toxicity, and outcome. The DS children with ALL did not have unique clinical or biologic characteristics to distinguish their disease from that of non-DS patients. Eleven of the DS patients had successfully banded cytogenetic studies of their leukemic cells with the distribution of model chromosome number of 46 (n = 1), 47 (2), 48 (5), and greater than 50 (3). The abnormal leukemic line involved an isochromosome of the long arm of chromosome 9[i(9q)] in 3 cases. Multiagent chemotherapies induced complete remissions in 25 patients (85%), yet overall 5 year event-free survival was only 23 +/- 8% when compared to 64 +/- 9% for control children receiving similar therapies (P less than 0.01). A significant cause of treatment failure was late marrow recurrence in the DS children. Host toxicity was striking in these children. Severe congenital heart disease present in one-third contributed to 2 deaths during antileukemia therapy. Hyperglycemia secondary to diabetogenic agents and repeated bronchitis were common toxicities. Intolerance to the antifolate methotrexate with severe gastrointestinal and skin toxicities was universal. We conclude that the poor prognosis for the child with DS and ALL stems in part from their increased risk of complications and toxicity from intensive modern leukemia therapies, specifically antifolates.
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Affiliation(s)
- D K Kalwinsky
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennesse 38101
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42
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Powell JL, Bunin NJ, Callahan C, Aplenc R, Griffin G, Grupp SA. An unexpectedly high incidence of Epstein-Barr virus lymphoproliferative disease after CD34+ selected autologous peripheral blood stem cell transplant in neuroblastoma. Bone Marrow Transplant 2004; 33:651-7. [PMID: 14730339 PMCID: PMC7091929 DOI: 10.1038/sj.bmt.1704402] [Citation(s) in RCA: 36] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The risk of Epstein–Barr virus lymphoproliferative disease (EBV-LPD) increases with the use of highly immunosuppressive therapies. Allogeneic BMT, especially supported by T-cell-depleted stem cell products, is a risk factor for EBV-LPD. Although the risk of EBV-LPD after autologous transplantation is low, case reports of this complication in the autologous setting exist. We report a higher incidence than previously described of EBV-LPD in children undergoing sequential high-dose chemotherapy supported with CD34 selected peripheral blood stem cells (CD34+ PBSC). The median time to LPD after tandem transplant was 3 months (range 1–5 months). Five patients out of 156 (3.5%) developed EBV-LPD while enrolled on two trials of tandem autologous SCT in high-risk pediatric malignancies. Both studies employed five cycles of induction therapy, followed by tandem autologous PBSC transplants. In all, 108 out of 156 patients received CD34+ PBSC; 48 received unselected PBSC. All patients contracting LPD were from the CD34 selected group. Treatment of EBV-LPD included rituximab in four out of five patients, IVIg in two out of five patients, and gancyclovir in two out of five patients. EBV-LPD resolved in four out of five patients. We conclude that the combination of tandem SCT and CD34 selection may have increased immunosuppression in these patients to a point where there is an elevated risk of EBV-LPD.
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Affiliation(s)
- J L Powell
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA USA
| | - N J Bunin
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA USA
- University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - C Callahan
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA USA
| | - R Aplenc
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA USA
- University of Pennsylvania School of Medicine, Philadelphia, PA USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA USA
| | - G Griffin
- A.I. Dupont Children's Hospital, Wilmington, DE USA
| | - S A Grupp
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA USA
- University of Pennsylvania School of Medicine, Philadelphia, PA USA
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Abstract
BACKGROUND Despite improvements in the treatment of pediatric acute lymphoblastic leukemia, approximately one in five patients will develop recurrent disease. The majority of these patients do not survive. This limited institution study sought to improve event-free survival (EFS) by intensification of chemotherapy. PROCEDURE Twenty-one patients with either an isolated marrow (n = 16) or a combined marrow and central nervous system relapse (n = 5) received treatment according to Children's Hospital of Philadelphia protocol CHP-540. Six patients had an initial remission of <36 months, and five patients had relapsed within 1 year of completion of phase III therapy. Induction and reinduction therapy consisted of idarubicin, vincristine, dexamethasone, asparaginase, and triple intrathecal chemotherapy. Consolidation and reconsolidation therapy employed high-dose cytarabine, etoposide, and asparaginase given in a sequential manner. Maintenance therapy included courses of high- or low-dose cytarabine followed by sequential etoposide and asparaginase pulse, moderate-dose methotrexate with delayed leukovorin rescue, and vincristine/dexamethasone pulses. Therapy continued for 2 years from the start of interim maintenance in the 16 patients who did not receive a bone marrow transplant (BMT). Two patients underwent an HLA-identical sibling BMT specified by protocol. Four received a nonprotocol-prescribed alternative donor BMT. RESULTS The complete remission induction rate was 95%. With a median follow-up from date of relapse of 49 months in survivors, the actuarial EFS based on intent to treat is 75%. There were three toxic deaths in patients in CR and two deaths from relapse. CONCLUSIONS This regimen is toxic but effective and deserves study in a larger setting.
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Affiliation(s)
- A M Leahey
- Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia 19104, USA
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Abstract
Eleven children underwent BMT for therapy-related MDS or leukemia, four from HLA-identical siblings and seven from unrelated donors. Ten of the 11 were conditioned with busulfan and cyclophosphamide as the majority had received prior irradiation to the chest and/or abdomen. All patients engrafted. Regimen-related toxicity was more common when compared to historical controls. Eight patients developed acute GVHD and four of eight who survived 100 days post transplant developed extensive chronic GVHD. Non-relapse related mortality occurred in three patients. Five patients developed recurrent malignancy: one died from recurrence of osteosarcoma, three died of recurrent leukemia or MDS and another developed two subsequent malignancies (duodenal carcinoma and anaplastic astrocytoma). Three survive disease-free at 14+, 22+ and 43+ months for a 2 year actuarial cancer-free survival of 24% (95% confidence interval = 5-53%). Although allogeneic BMT can be curative, regimen-related toxicity is frequent and recurrent malignancy remains the major obstacle.
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Affiliation(s)
- A M Leahey
- Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania, USA
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45
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Leahey AM, Bunin NJ, Schears GJ, Smith CA, Flake AW, Sullivan KE. Successful use of extracorporeal membrane oxygenation (ECMO) during BMT for SCID. Bone Marrow Transplant 1998; 21:839-40. [PMID: 9603412 DOI: 10.1038/sj.bmt.1701185] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 02/07/2023]
Abstract
An 8-month-old girl with SCID presented with severe bronchiolitis. She received an HLA-identical sibling BMT without conditioning or GVHD prophylaxis. She deteriorated despite mechanical ventilation but had normal cardiac, hepatic and renal function. ECMO was instituted on day +3 and subsequent improvement was seen concurrently with emergence of CD4+ cells on day +11. She was taken off ECMO on day +18 and suffered a left-sided stroke evidenced by a dense left hemiplegia. She was extubated on day +25 and weaned from supplemental oxygen on day +36 and at day +100 has recovered strength in her extremities. This is the first successful use of ECMO as a bridge to engraftment in a BMT patient.
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Affiliation(s)
- A M Leahey
- Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania, 19104, USA
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Abstract
PURPOSE The purpose of this study was to evaluate the effect of busulfan and cyclophosphamide (BUCY) as conditioning regimen for bone marrow transplantation (BMT) on growth of children following BMT. PATIENTS AND METHODS Growth assessment was prospectively done in all 25 children who underwent BMT following BUCY conditioning from 1989 to 1994 at Children's Hospital of Philadelphia. The height and growth rates were expressed as standard deviation scores (SDS). The height SDS prior to BMT were compared with 1, 2, and 3 years post-BMT. The growth rate SDS 1 year and 2 years post-BMT were also compared. Pubertal children were excluded from the analysis of growth rate. Median age of patients was 7 years (range, 1.3-15 years). A total of 22/25 patients were transplanted for AML, and three patients had myelodysplastic syndrome. Equal numbers of patients had autologous and allogeneic transplants. Seven patients received corticosteroids for varying lengths of time. The pre-BMT height SDS (mean +/- SD) for the group was -0.4 +/- 1.3. The mean height SDS for 19 children at 1 year post-BMT was +/- 0.1 +/- 1.2 and for 10 children, 2 years post-BMT was -0.3 +/- 1.6. Seven children who were 3 years post-BMT had the mean height SDS of -0.2 +/- 1.5. There was no statistically significant difference between pre-BMT height SDS and 1 year post-BMT (p = 0.49) and 2 years post-BMT (p = 0.42). The mean growth rate at 1 year post-BMT was -0.1 +/- 2.7 and at 2 years post-BMT was -0.9 +/- 2.3. The difference was not statistically different (p = 0.15). Somatomedin-C (insulin growth factor 1, IGF-1) levels were normal in all 13 children tested at 1 year post-BMT. IGF binding protein (BP)-3 levels were done in 10 children at 1 year and were found to be normal in all. Thyroid function studies were done in all patients pre-BMT and 1 year post-BMT and were normal for all. Bone age assessment was appropriate for age in all 14 patients tested at 1 year post-BMT. CONCLUSIONS There was no evidence of growth failure following BMT with BUCY conditioning in this group of patients.
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Affiliation(s)
- S M Shankar
- Division of Oncology, Children's Hospital of Philadelphia, PA 19104, USA
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47
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Leahey AM, Bunin NJ. Recombinant human tissue plasminogen activator for the treatment of severe hepatic veno-occlusive disease in pediatric bone marrow transplant patients. Bone Marrow Transplant 1996; 17:1101-4. [PMID: 8807121] [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: 02/02/2023]
Abstract
Nine pediatric patients were treated with recombinant human tissue plasminogen activator (tPA) for severe hepatic veno-occlusive disease (VOD) which developed after bone marrow transplantation. Recombinant human tPA (5-10 mg/day x 2-4 days) and heparin were begun a median of 15 days (range, 11-32 days) post-transplant. A second course was given if the patient did not respond. The median total serum bilirubin and percent weight gain above baseline were 5.5 mg/dl (range, 1.3-26.1 mg/dl) and 22% (range, 7-44%) respectively at the start of tPA administration. Three patients had their heparin infusion interrupted or discontinued for bleeding symptoms, none of which were life-threatening. Five of the nine patients had complete resolution of their VOD. Another patient was salvaged with a partial maternal liver transplant. We conclude that the incidence and severity of bleeding complications with these doses of tPA and heparin do not preclude their use in pediatric patients. Further study in a larger group setting will be necessary to determine the optimal dosing regimen as well as treatment efficacy.
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Affiliation(s)
- A M Leahey
- Department of Pediatrics, University of Pennsylvania, Philadelphia, USA
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48
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Gross SB, Robertson WW, Lange BJ, Bunin NJ, Drummond DS. Primary Hodgkin's disease of bone. A report of two cases in adolescents and review of the literature. Clin Orthop Relat Res 1992:276-80. [PMID: 1395259] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The presentation of Hodgkin's disease as a primary bony lesion is unusual. Seventeen such cases have been reported, only three of which appear in the orthopedic literature. The prognosis for survival in these patients is poor, possibly because of difficulty in arriving at the correct early diagnosis. In two adolescent girls (ages 12 and 17) with primary Hodgkin's disease of bone, the diagnosis was made with uncertainty or delay. One of the patients died and the other has progressive disease, two and one-half years after the diagnosis was established. Earlier recognition may lead to better outcomes.
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Affiliation(s)
- S B Gross
- Children's Hospital of Philadelphia, Pennsylvania
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49
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Bunin NJ, Casper JT, Lawton C, Murray K, Camitta BM, Greenwood M, Geil J, Ash RC. Allogeneic marrow transplantation using T cell depletion for patients with juvenile chronic myelogenous leukemia without HLA-identical siblings. Bone Marrow Transplant 1992; 9:119-22. [PMID: 1571710] [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: 12/27/2022]
Abstract
Six children with clinical and hematologic features of juvenile chronic myelogenous leukemia (JCML) underwent bone marrow transplantation (BMT) using T cell-depleted marrow from non-HLA-matched related or closely HLA-matched unrelated donors. Patient ages ranged from 1.2 to 5 years. Four patients received cytoreductive chemotherapy prior to BMT conditioning, and four had undergone pretransplant splenectomies. The donor-recipient matching included: four transplants disparate at one HLA locus (three from unrelated donors and one from a related donor), one transplant disparate at two HLA loci, and one transplant from a one haplotype-mismatched donor. All patients were MLC reactive with their donors. Graft-versus-host disease (GVHD) prophylaxis consisted of in vitro T cell depletion with a monoclonal antibody directed against CD3, and complement in conjunction with cyclosporin A begun on day -1. Conditioning included busulfan, cytosine arabinoside, cyclophosphamide, methyl-prednisolone, and hyperfractionated total body irradiation. All patients engrafted, with median time to neutrophils greater than 500 x 10(6)/l and platelets greater than 25 x 10(9)/l of 20 and 21 days, respectively. Acute GVHD was less than or equal to grade II in all patients. Two patients died of infection (Candida, CMV) at days 74, 157. One patient relapsed at day 177, and subsequently died on day 939. Three patients are alive and disease free at 180 +, 1610 + and 2400 + days from BMT. Although intensive chemotherapy may play a role in providing transient disease control in patients with JCML, allogeneic BMT is the only curative therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N J Bunin
- Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee
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50
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Bunin NJ, Raimondi SC, Mirro J, Behm FG, Goorha R, Kitchingman GR. Alterations in immunoglobulin or T cell receptor gene rearrangement at relapse: involvement of 11q23 and changes in immunophenotype. Leukemia 1990; 4:727-31. [PMID: 2172664] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We studied the organization of immunoglobulin (Ig) genes and the beta-chain gene of the T cell receptor (TCR) along with the clinical features, immunophenotypes, and karyotypes of 14 children with acute leukemia at diagnosis and relapse. The median time to relapse was 23 months. Eleven children had identical gene rearrangement patterns at diagnosis and relapse. All three patients whose blast cells showed variations in gene rearrangement patterns between diagnosis and relapase also demonstrated a change in the immunophenotype: one from cALLA+ to cALLA- B precursor cell ALL; one from T-ALL to AML; and one showed a marked increase in myeloid characteristics at relapse. Blast cells from these three patients at relapse showed the presence of chromosomal translocations involving 11q23; for two patients, this involved replacement of the original karyotype. We conclude that while most relapses are the result of reemergence of the original clone, new clones that differ in immunophenotype, karyotype, and gene rearrangement are occasionally present at relapse. Relapses may also occur in which the original clone has undergone major changes in gene expression and arrangement of the Ig heavy chain genes in the absence of karyotypic replacement.
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Affiliation(s)
- N J Bunin
- Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN
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