1
|
Hwang A, Hayden P, Pawlyn C, McLornan D, Garderet L. The role of maintenance therapy following autologous stem cell transplantation in newly diagnosed multiple myeloma: Considerations on behalf of the Chronic Malignancies Working Party of the EBMT. Br J Haematol 2024; 204:1159-1175. [PMID: 38390784 DOI: 10.1111/bjh.19353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
Recent treatment advancements in multiple myeloma have led to significant improvements in patient outcomes. Maintenance therapy following autologous haematopoietic stem cell transplantation (AHCT) is now standard of care and has been demonstrated to prolong and deepen treatment responses. Currently, lenalidomide remains the single agent that has been approved for maintenance post-AHCT in Europe and the USA which, if tolerated, is continued until disease progression. The treatment landscape is rapidly expanding however, and the optimal personalised maintenance approach for a patient is becoming more complex. Treatment outcomes for patients with high-risk disease remain poor and choice of maintenance in this population also remains unclear. This review article evaluates up-to-date literature regarding established maintenance approaches. It further analyses ongoing studies exploring maintenance regimens using combination and novel agents, approaches to maintenance in patients with cytogenetic high-risk disease and minimal residual disease response-adapted strategies that reflect the current evolving treatment paradigm.
Collapse
Affiliation(s)
- Angela Hwang
- Department of Haematology, University College London Hospital NHS Foundation Trust, London, UK
| | - Patrick Hayden
- Department of Haematology, St James's Hospital, Dublin, Ireland
| | | | - Donal McLornan
- Department of Haematology, University College London Hospital NHS Foundation Trust, London, UK
| | - Laurent Garderet
- Département d'Hématologie, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| |
Collapse
|
2
|
Rovó A, Gras L, Piepenbroek B, Kröger N, Reinhardt HC, Radujkovic A, Blaise D, Kobbe G, Niityvuopio R, Platzbecker U, Sockel K, Hunault-Berger M, Cornelissen JJ, Forcade E, Bourhis JH, Chalandon Y, Kinsella F, Nguyen-Quoc S, Maertens J, Elmaagacli A, Mordini N, Hayden P, Raj K, Drozd-Sokolowska J, de Wreede LC, McLornan DP, Robin M, Yakoub-Agha I, Onida F. Outcomes of CMML patients undergoing allo-HCT are significantly worse compared to MDS-a study of the CMWP of the EBMT. Am J Hematol 2024; 99:203-215. [PMID: 38009469 DOI: 10.1002/ajh.27150] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023]
Abstract
Although CMML since long has been separated from MDS, many studies continue to evaluate the outcomes of both diseases after hematopoietic cell transplantation (allo-HCT) together. Data evaluating outcomes of a large CMML cohort after allo-HCT compared to MDS are limited. We aim to compare outcomes of CMML to MDS patients who underwent allo-HCT between 2010 and 2018. Patients ≥18 years with CMML and MDS undergoing allo-HCT reported to the EBMT registry were analyzed. Progression to AML before allo-HCT was an exclusion criterion. Overall survival (OS), progression/relapse-free survival (PFS), relapse incidence (including progression) (REL), and non-relapse mortality (NRM) were evaluated in univariable and multivariable (MVA) Cox proportional hazard models including interaction terms between disease and confounders. In total, 10832 patients who underwent allo-HCT were included in the study, there were a total of 1466 CMML, and 9366 MDS. The median age at time of allo-HCT in CMML (median 60.5, IQR 54.3-65.2 years) was significantly higher than in the MDS cohort (median 58.8, IQR 50.2-64.5 years; p < .001). A significantly higher percentage of CMML patients were male (69.4%) compared to MDS (61.2%; p < .001). There were no clinically meaningful differences in the distribution of Karnofsky score, Sorror HCT-CI score at allo-HCT, and donor type, between the CMML and MDS patients. RIC platforms were utilized in 63.9% of CMML allo-HCT, and in 61.4% of MDS patients (p = .08). In univariable analyses, we found that OS, PFS, and REL were significantly worse in CMML when compared with MDS (all p < .0001), whereas no significant difference was observed in NRM (p = .77). In multivariable analyses, the HR comparing MDS versus CMML for OS was 0.81 (95% CI, 0.74-0.88, p < .001), PFS 0.76 (95% CI 0.70-0.82, p < .001), relapse 0.66 (95% CI 0.59-0.74, p < .001), and NRM 0.87 (95% CI 0.78-0.98, p = .02), respectively. The association between baseline variables and outcome was found to be similar in MDS and CMML (all interaction p > .05) except for a decreasing trend over time of the risk of relapse in CMML (HR allo-HCT per year later 0.94, 95% CI 0.90-0.98), whereas no such trend was observed in MDS (HR 1.00, 95% CI 0.98-1.02). The poor outcome observed for CMML could be related to variables not measured in this study or to factors inherent to the disease itself. This study demonstrates that outcomes of CMML patients after allo-HCT are significantly worse compared to MDS. The results of this study may contribute to future recommendations for allo-HCT in CMML patients.
Collapse
Affiliation(s)
- Alicia Rovó
- Department of Hematology and Central Hematology Laboratory, University Hospital of Bern, Bern, Switzerland
| | - Luuk Gras
- EBMT Statistical Unit, Leiden, Netherlands
| | | | | | - H Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | | | - Didier Blaise
- Programme de Transplantation&Therapie Cellulaire, Marseille, France
| | - Guido Kobbe
- Heinrich Heine Universitaet, Duesseldorf, Germany
| | | | | | - Katja Sockel
- Medical Clinic and Policlinic I, University Hospital Dresden, Dresden, Germany
| | | | - J J Cornelissen
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | | | - Yves Chalandon
- Département d'Oncologie, Service d'Hématologie, Hôpitaux Universitaire de Genève and Faculty of Medicine of Geneva, University of Geneva, Geneva, Switzerland
| | | | | | | | | | | | - Patrick Hayden
- St. James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Kavita Raj
- Department of Stem Cell Transplantation, University College Hospital London, London, UK
| | | | | | - Donal P McLornan
- Department of Stem Cell Transplantation, University College Hospital London, London, UK
| | | | | | - Francesco Onida
- ASST Fatebenefratelli-Sacco-University of Milan, Milano, Italy
| |
Collapse
|
3
|
Potter V, Gras L, Koster L, Kroger N, Sockel K, Ganser A, Finke J, Labussiere-Wallet H, Peffault de Latour R, Koc Y, Salmenniemi U, Smidstrup Friis L, Jindra P, Schroeder T, Tischer J, Arat M, Pascual Cascon M, de Wreede LC, Hayden P, Raj K, Drozd-Sokolowska J, Scheid C, McLornan DP, Robin M, Yakoub-Agha I. Sequential vs myeloablative vs reduced intensity conditioning for patients with myelodysplastic syndromes with an excess of blasts at time of allogeneic haematopoietic cell transplantation: a retrospective study by the chronic malignancies working party of the EBMT. Bone Marrow Transplant 2024; 59:224-231. [PMID: 37993503 DOI: 10.1038/s41409-023-02111-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/27/2023] [Accepted: 09/15/2023] [Indexed: 11/24/2023]
Abstract
The optimal conditioning for patients with higher risk MDS receiving potentially curative allogeneic haematopoietic stem cell transplant(allo-HCT) remains to be defined. This is particularly the case for patients with excess of blasts at time of allo-HCT. Sequential (Seq) conditioning, whereby chemotherapy is followed rapidly by transplant conditioning, offers an opportunity to decrease disease burden, potentially improving outcomes allo-HCT outcomes. Herein we present the only analysis comparing Seq to myeloablative (MAC) and reduced intensity conditioning (RIC) specifically focussed on MDS patients with excess of blasts at allo-HCT. 303 patients were identified in the EBMT registry, receiving RIC (n = 158), Seq (n = 105), and MAC (n = 40). Median follow-up was 67.2 months and median age at allo-HCT was 59.5 years (IQR 53.5-65.6). For the entire cohort, 3 y overall survival (OS) was 50% (95% CI 45-56%) and relapse free survival (RFS) 45% (95% CI 40-51%). No significant differences in OS (log-rank p = 0.13) and RFS (log-rank p = 0.18) were observed between conditioning protocols. On multivariable analysis, lower performance status, worse IPSS-R cytogenetics, sibling donor (compared to 8/8 MUD) and ≥20% blasts at allo-HCT were associated with worse outcomes. In conclusion, the Seq protocol did little to influence the outcome in this high-risk group of patients, with outcomes mostly determined by baseline disease risk and patient characteristics such as performance status.
Collapse
Affiliation(s)
- V Potter
- Kings College Hospital NHS Foundation Trust, London, UK.
| | - L Gras
- EBMT Statistical Unit, Leiden, Netherlands
| | - L Koster
- EBMT Leiden Study Unit, Leiden, Netherlands
| | - N Kroger
- University Hospital Eppendorf, Hamburg, Germany
| | - K Sockel
- Universitaetsklinikum Dresden, Dresden, Germany
| | - A Ganser
- Hannover Medical School, Hannover, Germany
| | - J Finke
- University of Freiburg, Freiburg, Germany
| | | | | | - Y Koc
- Medicana International Hospital Istanbul, Istanbul, Turkey
| | | | | | - P Jindra
- Charles University Hospital, Pilsen, Czech Republic
| | - T Schroeder
- University Hospital Essen, Dusseldorf, Germany
| | - J Tischer
- Klinikum Grosshadern, Munich, Germany
| | - M Arat
- Demiroglu Bilim University Istanbul Florence Nightingale Hospital, Stanbul, Turkey
| | | | - L C de Wreede
- Leiden University Medical Center, Dept of Biomedical Data Sciences, Leiden, Netherlands
| | - P Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - K Raj
- University College London Hospitals NHS Trust, London, UK
| | | | - C Scheid
- University of Cologne, Cologne, Germany
| | - D P McLornan
- University College London Hospitals NHS Trust, London, UK
| | - M Robin
- Saint-Louis Hospital, BMT Unit, Paris, France
| | - I Yakoub-Agha
- CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000, Lille, France
| |
Collapse
|
4
|
Wallace J, Jackson R, Kaluzhny Y, Ayehunie S, Lansley AB, Roper C, Hayden P. Evaluation of in Vitro Rat and Human Airway Epithelial Models for Acute Inhalation Toxicity Testing. Toxicol Sci 2023:7191021. [PMID: 37280087 DOI: 10.1093/toxsci/kfad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
In vivo models (mostly rodents) are currently accepted by regulatory authorities for assessing acute inhalation toxicity. Considerable efforts have been made in recent years to evaluate in vitro human airway epithelial models (HAEM) as replacements for in vivo testing. In the current work, an organotypic in vitro rat airway epithelial model (RAEM), rat EpiAirway™, was developed and characterized to allow a direct comparison with the available HAEM, human EpiAirway™, in order to address potential interspecies variability in responses to harmful agents. The rat and human models were evaluated in two independent laboratories with 14 reference chemicals, selected to cover a broad range of chemical structures and reactive groups, as well as known acute animal and human toxicity responses, in three replicate rounds of experiments. Toxicity endpoints included changes in tissue viability (MTT assay), epithelial barrier integrity (TEER, transepithelial electrical resistance), and tissue morphology (histopathology). The newly developed rat EpiAirway™ model produced reproducible results across all replicate experiments in both testing laboratories. Furthermore, a high level of concordance was observed between the RAEM and HAEM toxicity responses (determined by IC25) in both laboratories, with R2 = 0.78 and 0.88 when analyzed by TEER; and R2 = 0.92 for both when analyzed by MTT. These results indicate that rat and human airway epithelial tissues respond similarly to acute exposures to chemicals. The new in vitro RAEM will help extrapolate to in vivo rat toxicity responses and support screening as part of a 3Rs program.
Collapse
Affiliation(s)
- Joanne Wallace
- Charles River Laboratories Edinburgh Ltd, Elphinstone Research Centre, Tranent, East Lothian, EH33 2NE, UK
| | - Robert Jackson
- MatTek Life Sciences, 200 Homer Avenue, Ashland, Massachusetts, 01721, USA
| | - Yulia Kaluzhny
- MatTek Life Sciences, 200 Homer Avenue, Ashland, Massachusetts, 01721, USA
| | - Seyoum Ayehunie
- MatTek Life Sciences, 200 Homer Avenue, Ashland, Massachusetts, 01721, USA
| | - Alison B Lansley
- Centre for Stress and Age-Related Disease and Biomaterials and Drug Delivery Research and Enterprise Group, School of Applied Sciences, University of Brighton, Lewes Road, Brighton, BN2 4GJ, UK
| | - Clive Roper
- Charles River Laboratories Edinburgh Ltd, Elphinstone Research Centre, Tranent, East Lothian, EH33 2NE, UK
| | - Patrick Hayden
- MatTek Life Sciences, 200 Homer Avenue, Ashland, Massachusetts, 01721, USA
| |
Collapse
|
5
|
Beksac M, Hayden P. Upfront autologous transplantation still improving outcomes in patients with multiple myeloma. Lancet Haematol 2023; 10:e80-e82. [PMID: 36529146 DOI: 10.1016/s2352-3026(22)00360-x] [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] [Received: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Meral Beksac
- Department of Hematology, Cebeci Hospital, Ankara University, Ankara 06620, Türkiye.
| | - Patrick Hayden
- Department of Haematology, Trinity College Dublin, St James's Hospital, Dublin, Ireland
| |
Collapse
|
6
|
Polverelli N, Hernández-Boluda JC, Czerw T, Barbui T, D'Adda M, Deeg HJ, Ditschkowski M, Harrison C, Kröger NM, Mesa R, Passamonti F, Palandri F, Pemmaraju N, Popat U, Rondelli D, Vannucchi AM, Verstovsek S, Robin M, Colecchia A, Grazioli L, Damiani E, Russo D, Brady J, Patch D, Blamek S, Damaj GL, Hayden P, McLornan DP, Yakoub-Agha I. Splenomegaly in patients with primary or secondary myelofibrosis who are candidates for allogeneic hematopoietic cell transplantation: a Position Paper on behalf of the Chronic Malignancies Working Party of the EBMT. Lancet Haematol 2023; 10:e59-e70. [PMID: 36493799 DOI: 10.1016/s2352-3026(22)00330-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/25/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022]
Abstract
Splenomegaly is a hallmark of myelofibrosis, a debilitating haematological malignancy for which the only curative option is allogeneic haematopoietic cell transplantation (HCT). Considerable splenic enlargement might be associated with a higher risk of delayed engraftment and graft failure, increased non-relapse mortality, and worse overall survival after HCT as compared with patients without significantly enlarged splenomegaly. Currently, there are no standardised guidelines to assist transplantation physicians in deciding optimal management of splenomegaly before HCT. Therefore, the aim of this Position Paper is to offer a shared position statement on this issue. An international group of haematologists, transplantation physicians, gastroenterologists, surgeons, radiotherapists, and radiologists with experience in the treatment of myelofibrosis contributed to this Position Paper. The key issues addressed by this group included the assessment, prevalence, and clinical significance of splenomegaly, and the need for a therapeutic intervention before HCT for the control of splenomegaly. Specific scenarios, including splanchnic vein thrombosis and COVID-19, are also discussed. All patients with myelofibrosis must have their spleen size assessed before allogeneic HCT. Myelofibrosis patients with splenomegaly measuring 5 cm and larger, particularly when exceeding 15 cm below the left costal margin, or with splenomegaly-related symptoms, could benefit from treatment with the aim of reducing the spleen size before HCT. In the absence of, or loss of, response, patients with increasing spleen size should be evaluated for second-line options, depending on availability, patient fitness, and centre experience. Splanchnic vein thrombosis is not an absolute contraindication for HCT, but a multidisciplinary approach is warranted. Finally, prevention and treatment of COVID-19 should adhere to standard recommendations for immunocompromised patients.
Collapse
Affiliation(s)
- Nicola Polverelli
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.
| | | | - Tomasz Czerw
- Department of Hematology, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mariella D'Adda
- Hematology Division, Department of Oncology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Hans Joachim Deeg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Markus Ditschkowski
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | - Claire Harrison
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio, San Antonio, TX, USA
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Francesca Palandri
- Institute of Hematology L and A Seràgnoli, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Damiano Rondelli
- Blood and Marrow Transplant Program, and Center for Global Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Alessandro Maria Vannucchi
- Center for Innovation and Research in Myeloproliferative Neoplasms, Hematology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marie Robin
- Hôpital Saint-Louis, APHP, Université de Paris Cité, Paris, France
| | | | - Luigi Grazioli
- Department of Radiology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Enrico Damiani
- 2nd Division of General Surgery, Department of Medical and Surgical Sciences, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Domenico Russo
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Jessica Brady
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David Patch
- Hepatology and Liver Transplantation, Royal Free London NHS Foundation Trust, London, UK
| | - Slawomir Blamek
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Gandhi Laurent Damaj
- Unit of Hematology, Centre Hospitalier Universitaire de Caen, University of Caen-Normandie, Caen, France
| | - Patrick Hayden
- Department of Haematology, Trinity College Dublin, St James's Hospital, Dublin, Ireland
| | - Donal P McLornan
- Department of Stem Cell Transplantation and Haematology, University College London Hospitals, London, UK
| | | |
Collapse
|
7
|
Armstrong P, Hayden P, Jeffers M, Fitzpatrick L, Mcknight A, Armstrong J. Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy: A Case Report and Review of the Literature. Case Rep Oncol 2023; 16:1528-1535. [PMID: 38045431 PMCID: PMC10691828 DOI: 10.1159/000534802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Mucosa-associated lymphoid tissue lymphoma (MALT lymphoma or MALToma) is a prevalent type of primary pulmonary lymphoma. Typically, the primary therapeutic approaches involve surgery or chemotherapy, although there have been instances of radiation therapy being employed. Case Report We present a case of pulmonary MALToma that exhibited progression despite rituximab therapy. Subsequently, the patient demonstrated a positive response to radiation therapy. Conclusion This case highlights the potential efficacy of radiation therapy as a treatment option for pulmonary MALToma, especially in cases where other conventional treatments like rituximab have proven ineffective. Further research and studies are warranted to better understand the role of radiation therapy in managing pulmonary MALToma and to determine optimal treatment strategies for patients with this condition.
Collapse
Affiliation(s)
- Paul Armstrong
- Medical Student, University College Dublin, Dublin, Ireland
| | - Patrick Hayden
- Consultant Haematologist, St. James Hospital, Dublin, Ireland
| | - Michael Jeffers
- Consultant Histopathologist, Beacon Hospital, Dublin, Ireland
| | | | | | - John Armstrong
- Consultant Radiation Oncologist, Beacon Hospital, Dublin, Ireland
| |
Collapse
|
8
|
Gagelmann N, Sureda A, Montoto S, Murray J, Bolaños N, Kenyon M, Beksac M, Schönland S, Hayden P, Scheurer H, Morgan K, Garderet L, McLornan DP, Ruggeri A. Access to and affordability of CAR T-cell therapy in multiple myeloma: an EBMT position paper. Lancet Haematol 2022; 9:e786-e795. [PMID: 36174641 DOI: 10.1016/s2352-3026(22)00226-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/21/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a promising immunotherapeutic approach in the treatment of multiple myeloma, and the recent approval of the first two CAR T-cell products could result in improved outcomes. However, it remains a complex and expensive technology, which poses challenges to health-care systems and society in general, especially in times of crises. This potentially accelerates pre-existing inequalities as access to CAR T-cell therapy varies, both between countries, depending on the level of economic development, and within countries, due to structural disparities in access to quality health care-a parameter strongly correlated with socioeconomic status, ethnicity, and lifestyle. Here, we identify two important issues: affordability and access to CAR T-cell treatment. This consensus statement from clinical investigators, clinicians, nurses, and patients from the European Society for Blood and Marrow Transplantation (EBMT) proposes solutions as part of an innovative collaborative strategy to make CAR T-cell therapy accessible to all patients with multiple myeloma.
Collapse
Affiliation(s)
- Nico Gagelmann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Anna Sureda
- Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - Silvia Montoto
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - John Murray
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Michelle Kenyon
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Stefan Schönland
- Medical Department V, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Hayden
- Department of Hematology, Trinity College Dublin, St James's Hospital, Dublin, Ireland
| | | | | | - Laurent Garderet
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Donal P McLornan
- Department of Haematology and Stem Cell Transplantation, University College Hospital, London, UK
| | - Annalisa Ruggeri
- Hematology and BMT Unit, San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
9
|
Robin M, de Wreede LC, Padron E, Bakunina K, Fenaux P, Koster L, Nazha A, Beelen DW, Rampal RK, Sockel K, Komrokji RS, Gagelmann N, Eikema DJ, Radujkovic A, Finke J, Potter V, Killick SB, Legrand F, Solary E, Broom A, Garcia-Manero G, Rizzoli V, Hayden P, Patnaik MM, Onida F, Yakoub-Agha I, Itzykson R. Role of allogeneic transplantation in chronic myelomonocytic leukemia: an international collaborative analysis. Blood 2022; 140:1408-1418. [PMID: 35667047 DOI: 10.1182/blood.2021015173] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
Abstract
To determine the survival benefit of allogeneic hematopoietic cell transplantation (allo-HCT) in chronic myelomonocytic leukemias (CMML), we assembled a retrospective cohort of CMML patients 18-70 years old diagnosed between 2000 and 2014 from an international CMML dataset (n = 730) and the EBMT registry (n = 384). The prognostic impact of allo-HCT was analyzed through univariable and multivariable time-dependent models and with a multistate model, accounting for age, sex, CMML prognostic scoring system (low or intermediate-1 grouped as lower-risk, intermediate-2 or high as higher-risk) at diagnosis, and AML transformation. In univariable analysis, lower-risk CMMLs had a 5-year overall survival (OS) of 20% with allo-HCT vs 42% without allo-HCT (P < .001). In higher-risk patients, 5-year OS was 27% with allo-HCT vs 15% without allo-HCT (P = .13). With multistate models, performing allo-HCT before AML transformation reduced OS in patients with lower-risk CMML, and a survival benefit was predicted for men with higher-risk CMML. In a multivariable analysis of lower-risk patients, performing allo-HCT before transformation to AML significantly increased the risk of death within 2 years of transplantation (hazard ratio [HR], 3.19; P < .001), with no significant change in long-term survival beyond this time point (HR, 0.98; P = .92). In higher-risk patients, allo-HCT significantly increased the risk of death in the first 2 years after transplant (HR 1.46; P = .01) but not beyond (HR, 0.60; P = .09). Performing allo-HCT before AML transformation decreases life expectancy in lower-risk patients but may be considered in higher-risk patients.
Collapse
Affiliation(s)
- Marie Robin
- Department of Hematology, Transplantation Division, Hôpital Saint-Louis, Paris, France
| | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Eric Padron
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Katerina Bakunina
- European Bone Marrow Transplantation (EBMT) Statistical Unit, Leiden, Netherlands
| | - Pierre Fenaux
- Department of Hematology and Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Linda Koster
- European Bone Marrow Transplantation (EBMT) Data Office Leiden, Leiden, Netherlands
| | | | - Dietrich W Beelen
- Department of Bone Marrow Transplantation, University Hospital Essen, Essen, Germany
| | - Raajit K Rampal
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Katja Sockel
- Division of Hematology, Medical Clinic and Policlinic I, University Hospital Dresden, Technical University (TU) Dresden, Dresden, Germany
| | - Rami S Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk-Jan Eikema
- European Bone Marrow Transplantation (EBMT) Statistical Unit, Leiden, Netherlands
| | - Aleksandar Radujkovic
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - Jürgen Finke
- Department of Medicine-Hematology, Oncology, Freiburg University Hospital and Medical Faculty, Freiburg, Germany
| | - Victoria Potter
- King's College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Sally B Killick
- The Royal Bournemouth and Christchurch Hospitals National Health Service (NHS) Foundation Trust, Bournemouth, United Kingdom
| | - Faezeh Legrand
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Eric Solary
- INSERM U1287, Université Paris-Saclay, Gustave Roussy Cancer Center, Villejuif, France
| | - Angus Broom
- Western General Hospital, Edinburg, United Kingdom
| | | | - Vittorio Rizzoli
- Department of Hematology, U.O. Ematologia Centro Trapianti Midollo Osseo (CTMO) of Hematology, Parma, Italy
| | - Patrick Hayden
- Department of Hematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Francesco Onida
- Bone Marrow Transplantation (BMT) Center - Hematology Unit, Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Maggiore Policlinico Di Milano-University of Milan, Milano, Italy
| | - Ibrahim Yakoub-Agha
- INSERM U1286, Centre Hospitalo-Universitaire (CHU) de Lille, Univ. Lille, Infinite, Lille, France; and
| | - Raphael Itzykson
- European Bone Marrow Transplantation (EBMT) Statistical Unit, Leiden, Netherlands
- Génomes, biologie cellulaire et thérapeutique U944, Université Paris Cité, INSERM, Centre National de la Recherche Scientifique (CNRS), Paris, France
- Service Hématologie Adultes, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris France
| |
Collapse
|
10
|
Sun J, Endo S, Lin H, Hayden P, Vedral V, Yuan X. Perturbative Quantum Simulation. Phys Rev Lett 2022; 129:120505. [PMID: 36179156 DOI: 10.1103/physrevlett.129.120505] [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] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/27/2022] [Accepted: 08/17/2022] [Indexed: 06/16/2023]
Abstract
Approximation based on perturbation theory is the foundation for most of the quantitative predictions of quantum mechanics, whether in quantum many-body physics, chemistry, quantum field theory, or other domains. Quantum computing provides an alternative to the perturbation paradigm, yet state-of-the-art quantum processors with tens of noisy qubits are of limited practical utility. Here, we introduce perturbative quantum simulation, which combines the complementary strengths of the two approaches, enabling the solution of large practical quantum problems using limited noisy intermediate-scale quantum hardware. The use of a quantum processor eliminates the need to identify a solvable unperturbed Hamiltonian, while the introduction of perturbative coupling permits the quantum processor to simulate systems larger than the available number of physical qubits. We present an explicit perturbative expansion that mimics the Dyson series expansion and involves only local unitary operations, and show its optimality over other expansions under certain conditions. We numerically benchmark the method for interacting bosons, fermions, and quantum spins in different topologies, and study different physical phenomena, such as information propagation, charge-spin separation, and magnetism, on systems of up to 48 qubits only using an 8+1 qubit quantum hardware. We demonstrate our scheme on the IBM quantum cloud, verifying its noise robustness and illustrating its potential for benchmarking large quantum processors with smaller ones.
Collapse
Affiliation(s)
- Jinzhao Sun
- Center on Frontiers of Computing Studies, Peking University, Beijing 100871, China
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, United Kingdom
- Quantum Advantage Research, Beijing 100080, China
| | - Suguru Endo
- NTT Computer & Data Science Laboratories, NTT corporation, Musashino, Tokyo 180-8585, Japan
| | - Huiping Lin
- Center on Frontiers of Computing Studies, Peking University, Beijing 100871, China
- School of Computer Science, Peking University, Beijing 100871, China
| | - Patrick Hayden
- Stanford Institute for Theoretical Physics, Stanford University, Stanford, California 94305, USA
| | - Vlatko Vedral
- Clarendon Laboratory, University of Oxford, Parks Road, Oxford OX1 3PU, United Kingdom
- Centre for Quantum Technologies, National University of Singapore, Singapore 117543, Singapore
| | - Xiao Yuan
- Center on Frontiers of Computing Studies, Peking University, Beijing 100871, China
- School of Computer Science, Peking University, Beijing 100871, China
- Stanford Institute for Theoretical Physics, Stanford University, Stanford, California 94305, USA
| |
Collapse
|
11
|
Onida F, Sbianchi G, Radujkovic A, Sockel K, Kröger N, Sierra J, Socié G, Cornelissen J, Poiré X, Raida L, Bourhis JH, Finke J, Passweg J, Salmenniemi U, Schouten HC, Beguin Y, Martin S, Deconinck E, Ganser A, Zver S, Lioure B, Rohini R, Koster L, Hayden P, Iacobelli S, Robin M, Yakoub-Agha I. Prognostic value of a new clinically-based classification system in patients with CMML undergoing allogeneic HCT: a retrospective analysis of the EBMT-CMWP. Bone Marrow Transplant 2022; 57:896-902. [PMID: 35352038 DOI: 10.1038/s41409-021-01555-9] [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: 12/08/2020] [Revised: 08/25/2021] [Accepted: 12/15/2021] [Indexed: 11/09/2022]
Abstract
Recently a new three-group clinical classification was reported by an International Consortium to stratify CMML patients with regard to prognosis. The groups were defined as follows: (1) Myelodysplastic (MD)-CMML: WBC ≤ 10 × 109/l, circulating immature myeloid cells (IMC) = 0, no splenomegaly; (2) MD/MP (overlap)-CMML: WBC 10-20 × 109/l or WBC ≤ 10 × 109/l but IMC > 0 and/or splenomegaly; (3) Myeloproliferative (MP)-CMML: WBC > 20 × 109/l. By analysing EBMT Registry patients who underwent allo-HCT for CMML between 1997 and 2016, we aimed to determine the impact of this classification on transplantation outcome and to make a comparison with the conventional WHO classification (CMML-0/CMML-1/CMML-2). Patient grouping was based on the data registered at time of transplantation, with IMC replaced by peripheral blasts. Among 151 patients included in the analysis, 38% were classified as MD-CMML, 42% as MD/MP-CMML and 20% as MP-CMML. With a median survival of 17 months in the whole series, MD-CMML patients were distinguished as a low-risk group with higher CR rate at transplant and a longer post-transplant 2-year progression-free survival in comparison to others (44.5% vs 33.5%, respectively), whereas the WHO classification was superior in identifying high-risk patients (CMML-2) with inferior survival outcomes.
Collapse
Affiliation(s)
- Francesco Onida
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-University of Milan, Milan, Italy.
| | | | | | - Katja Sockel
- University Hospital Dresden, TU Dresden, Dresden, Germany
| | | | - Jorge Sierra
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Luděk Raida
- Department of Hemato-Oncology-Faculty Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic
| | - Jean Henri Bourhis
- Gustave Roussy, Institut de Cancérologie, Val-de-Marne, Villejuif, France
| | | | | | | | | | - Yves Beguin
- CHU of Liege and University of Liege, Liege, Belgium
| | | | | | | | - Samo Zver
- University Medical Center, Ljubljana, Slovenia
| | | | | | - Linda Koster
- EBMT Data Office Leiden, Leiden, The Netherlands
| | - Patrick Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | | | | | | |
Collapse
|
12
|
Schetelig J, Baldauf H, Koster L, Kuxhausen M, Heidenreich F, de Wreede LC, Spellman S, van Gelder M, Bruno B, Onida F, Lange V, Massalski C, Potter V, Ljungman P, Schaap N, Hayden P, Lee SJ, Kröger N, Hsu K, Schmidt AH, Yakoub-Agha I, Robin M. Corrigendum: Haplotype Motif-Based Models for KIR-Genotype Informed Selection of Hematopoietic Cell Donors Fail to Predict Outcome of Patients With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia. Front Immunol 2022; 12:813838. [PMID: 34992613 PMCID: PMC8724253 DOI: 10.3389/fimmu.2021.813838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Johannes Schetelig
- Medizinische Klinik und Poliklinik I, University Hospital Dresden, Dresden, Germany.,DKMS Clinical Trials Unit, Dresden, Germany
| | | | | | - Michelle Kuxhausen
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, United States
| | - Falk Heidenreich
- Medizinische Klinik und Poliklinik I, University Hospital Dresden, Dresden, Germany.,DKMS Clinical Trials Unit, Dresden, Germany
| | - Liesbeth C de Wreede
- DKMS Clinical Trials Unit, Dresden, Germany.,Leiden University Medical Center, Department of Biomedical Data Sciences, Leiden, Netherlands
| | - Stephen Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, United States
| | - Michel van Gelder
- Maastricht University Medical Center, Department of Internal Medicine, Maastricht, Netherlands
| | - Benedetto Bruno
- A.O.U. Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Onida
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | - Per Ljungman
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | - Stephanie J Lee
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | | | - Kathy Hsu
- Memorial Sloan Kettering Cancer Center, New York & Scientific Director, CIBMTR Immunobiology Working Committee, New York City, NY, United States
| | - Alexander H Schmidt
- DKMS Clinical Trials Unit, Dresden, Germany.,DKMS Life Science Lab, Dresden, Germany
| | | | - Marie Robin
- Hopital Saint-Louis, APHP, Universite´ de Paris, Paris, France
| |
Collapse
|
13
|
Masouridi-Levrat S, Olavarria E, Iacobelli S, Aljurf M, Morozova E, Niittyvuopio R, Sengeloev H, Reményi P, Helbig G, Browne P, Ganser A, Nagler A, Snowden JA, Robin M, Passweg J, Van Gorkom G, Wallet HL, Hoek J, Blok HJ, De Witte T, Kroeger N, Hayden P, Chalandon Y, Agha IY. Outcomes and toxicity of allogeneic hematopoietic cell transplantation in chronic myeloid leukemia patients previously treated with second-generation tyrosine kinase inhibitors: a prospective non-interventional study from the Chronic Malignancy Working Party of the EBMT. Bone Marrow Transplant 2022; 57:23-30. [PMID: 34599284 PMCID: PMC8732279 DOI: 10.1038/s41409-021-01472-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/17/2021] [Accepted: 09/14/2021] [Indexed: 02/08/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) remains a treatment option for patients with chronic myeloid leukemia (CML) who fail to respond to tyrosine kinase inhibitors (TKIs). While imatinib seems to have no adverse impact on outcomes after transplant, little is known on the effects of prior use of second-generation TKI (2GTKI). We present the results of a prospective non-interventional study performed by the EBMT on 383 consecutive CML patients previously treated with dasatinib or nilotinib undergoing allo-HCT from 2009 to 2013. The median age was 45 years (18-68). Disease status at transplant was CP1 in 139 patients (38%), AP or >CP1 in 163 (45%), and BC in 59 (16%). The choice of 2GTKI was: 40% dasatinib, 17% nilotinib, and 43% a sequential treatment of dasatinib and nilotinib with or without bosutinib/ponatinib. With a median follow-up of 37 months (1-77), 8% of patients developed either primary or secondary graft failure, 34% acute and 60% chronic GvHD. There were no differences in post-transplant complications between the three different 2GTKI subgroups. Non-relapse mortality was 18% and 24% at 12 months and at 5 years, respectively. Relapse incidence was 36%, overall survival 56% and relapse-free survival 40% at 5 years. No differences in post-transplant outcomes were found between the three different 2GTKI subgroups. This prospective study demonstrates the feasibility of allo-HCT in patients previously treated with 2GTKI with a post-transplant complications rate comparable to that of TKI-naive or imatinib-treated patients.
Collapse
Affiliation(s)
- Stavroula Masouridi-Levrat
- Hematology Division and Faculty of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland.
| | | | | | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Elena Morozova
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | | | | | | | | | | | | | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | | | - Gwendolyn Van Gorkom
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | - Theo De Witte
- Nijmegen Medical Centre, Radboud University, Nijmegen, Netherlands
| | - Nicolaus Kroeger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Yves Chalandon
- Hematology Division and Faculty of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | | |
Collapse
|
14
|
Czerw T, Iacobelli S, Malpassuti V, Koster L, Kröger N, Robin M, Maertens J, Chevallier P, Watz E, Poiré X, Snowden JA, Kuball J, Kinsella F, Blaise D, Reményi P, Mear JB, Cammenga J, Rubio MT, Maury S, Daguindau E, Finnegan D, Hayden P, Hernández-Boluda JC, McLornan D, Yakoub-Agha I. Impact of donor-derived CD34 + infused cell dose on outcomes of patients undergoing allo-HCT following reduced intensity regimen for myelofibrosis: a study from the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant 2021; 57:261-270. [PMID: 34853433 DOI: 10.1038/s41409-021-01540-2] [Citation(s) in RCA: 8] [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] [Received: 05/27/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Abstract
The optimal CD34 + cell dose in the setting of RIC allo-HCT for myelofibrosis (MF) remains unknown. We retrospectively analyzed 657 patients with primary or secondary MF transplanted with use of peripheral blood (PB) stem cells after fludarabine/melphalan or fludarabine/busulfan RIC regimen. Median patient age was 58 (range, 22-76) years. Donors were HLA-identical sibling (MSD) or unrelated (UD). Median follow-up was 46 (2-194) months. Patients transplanted with higher doses of CD34 + cells (>7.0 × 106/kg), had an increased chance of achievement of both neutrophil (hazard ratio (HR), 1.46; P < 0.001) and platelet engraftment (HR, 1.43; P < 0.001). In a model with interaction, for patients transplanted from a MSD, higher CD34 + dose was associated with improved overall survival (HR, 0.63; P = 0.04) and relapse-free survival (HR, 0.61; P = 0.02), lower risk of non-relapse mortality (HR, 0.57; P = 0.04) and higher rate of platelet engraftment. The combined effect of higher cell dose and UD was apparent only for higher neutrophil and platelet recovery rate. We did not document any detrimental effect of high CD34 + dose on transplant outcomes. More bulky splenomegaly was an adverse factor for survival, engraftment and NRM. Our analysis suggests a potential benefit for MF patients undergoing RIC PB-allo-HCT receiving more than 7.0 × 106/kg CD34 + cells.
Collapse
Affiliation(s)
- Tomasz Czerw
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland.
| | | | | | | | | | - Marie Robin
- Hopital Saint Louis, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | | | | | - Emma Watz
- Karolinska University Hospital, Stockholm, Sweden
| | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | - Patrick Hayden
- Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Donal McLornan
- Guys' and St. Thomas' NHS Foundation Trust and University College London Hospitals, London, UK
| | - Ibrahim Yakoub-Agha
- CHfU de Lille, Université de Lille, INSERM U1286, Infinite, 59000, Lille, France
| |
Collapse
|
15
|
Kröger N, Sbianchi G, Sirait T, Wolschke C, Beelen D, Passweg J, Robin M, Vrhovac R, Helbig G, Sockel K, Conneally E, Rubio MT, Beguin Y, Finke J, Bernasconi P, Morozova E, Clausen J, von dem Borne P, Schaap N, Schroyens W, Patriarca F, Di Renzo N, Yeğin ZA, Hayden P, McLornan D, Yakoub-Agha I. Impact of prior JAK-inhibitor therapy with ruxolitinib on outcome after allogeneic hematopoietic stem cell transplantation for myelofibrosis: a study of the CMWP of EBMT. Leukemia 2021; 35:3551-3560. [PMID: 34023851 PMCID: PMC8632691 DOI: 10.1038/s41375-021-01276-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/07/2021] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Abstract
JAK1/2 inhibitor ruxolitinib (RUX) is approved in patients with myelofibrosis but the impact of pretreatment with RUX on outcome after allogeneic hematopoietic stem cell transplantation (HSCT) remains to be determined. We evaluated the impact of RUX on outcome in 551 myelofibrosis patients who received HSCT without (n = 274) or with (n = 277) RUX pretreatment. The overall leukocyte engraftment on day 45 was 92% and significantly higher in RUX responsive patients than those who had no or lost response to RUX (94% vs. 85%, p = 0.05). The 1-year non-relapse mortality was 22% without significant difference between the arms. In a multivariate analysis (MVA) RUX pretreated patients with ongoing spleen response at transplant had a significantly lower risk of relapse (8.1% vs. 19.1%; p = 0.04)] and better 2-year event-free survival (68.9% vs. 53.7%; p = 0.02) in comparison to patients without RUX pretreatment. For overall survival the only significant factors were age > 58 years (p = 0.03) and HLA mismatch donor (p = 0.001). RUX prior to HSCT did not negatively impact outcome after transplantation and patients with ongoing spleen response at time of transplantation had best outcome.
Collapse
Affiliation(s)
- Nicolaus Kröger
- Department of Stem Cell Transplantation University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Giulia Sbianchi
- Department of Biology, University of Rome "Tor Vergata", Rome, Italy
| | | | - Christine Wolschke
- Department of Stem Cell Transplantation University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | | | - Yves Beguin
- University of Liege and CHU of Liege, Liege, Belgium
| | | | | | - Elena Morozova
- First State Pavlov Medical University of St. Petersburg, St. Petersburg, Russia
| | | | | | | | | | - Francesca Patriarca
- Division of Hematology and Stem Cell Transplantation Center, University Hospital and DAME, Udine, Italy
| | - Nicola Di Renzo
- Unita Operativa di Ematologia e Trapianto di Cellule Staminali, Lecce, Italy
| | | | - Patrick Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Donal McLornan
- Department of Haematology, Guy's Hospital and Department of Stem Cell Transplantation, University College London Hospital, London, England
| | | |
Collapse
|
16
|
Hernández‐Boluda J, Pereira A, Kröger N, Cornelissen JJ, Finke J, Beelen D, Witte M, Wilson K, Platzbecker U, Sengeloev H, Blaise D, Einsele H, Sockel K, Krüger W, Lenhoff S, Salaroli A, Martin H, García‐Gutiérrez V, Pavone V, Alvarez‐Larrán A, Raya J, Zinger N, Gras L, Hayden P, Czerw T, P. McLornan D, Yakoub‐Agha I. Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry. Am J Hematol 2021; 96:1186-1194. [PMID: 34152630 DOI: 10.1002/ajh.26279] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 01/13/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly used in older myelofibrosis (MF) patients, but its risk/benefit ratio compared to non-transplant approaches has not been evaluated in this population. We analyzed the outcomes of allo-HCT in 556 MF patients aged ≥65 years from the EBMT registry, and determined the excess mortality over the matched general population of MF patients ≥65 years managed with allo-HCT (n = 556) or conventional drug treatment (n = 176). The non-transplant cohort included patients with intermediate-2 or high risk DIPSS from the Spanish Myelofibrosis Registry. After a median follow-up of 3.4 years, the estimated 5-year survival rate, non-relapse mortality (NRM), and relapse incidence after transplantation was 40%, 37%, and 25%, respectively. Busulfan-based conditioning was associated with decreased mortality (HR: 0.7, 95% CI: 0.5-0.9) whereas the recipient CMV+/donor CMV- combination (HR: 1.7, 95% CI: 1.2-2.4) and the JAK2 mutated genotype (HR: 1.9, 95% CI: 1.1-3.5) predicted higher mortality. Busulfan-based conditioning correlated with improved survival due to less NRM, despite its higher relapse rate when compared with melphalan-based regimens. Excess mortality was higher in transplanted patients than in the non-HCT cohort in the first year of follow-up (ratio: 1.93, 95% CI: 1.13-2.80), whereas the opposite occurred between the fourth and eighth follow-up years (ratio: 0.31, 95% CI: 0.18-0.53). Comparing the excess mortality of the two treatments, male patients seemed to benefit more than females from allo-HCT, mainly due to their worse prognosis with non-transplant approaches. These findings could potentially enhance counseling and treatment decision-making in elderly transplant-eligible MF patients.
Collapse
Affiliation(s)
| | - Arturo Pereira
- Department of Hemotherapy and Hemostasis Hospital Clínic Barcelona Spain
| | - Nicolaus Kröger
- Hematology Department University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Jan J. Cornelissen
- Erasmus MC Cancer Center University Medical Center Rotterdam the Netherlands
| | - Jürgen Finke
- Medical Center University of Freiburg, Faculty of Medicine Freiburg Germany
| | | | - Moniek Witte
- Hematology Department University Medical Center Utrecht the Netherlands
| | - Keith Wilson
- Hematology Department University Hospital of Wales Cardiff UK
| | - Uwe Platzbecker
- Hematology Department University Hospital Leipzig Leipzig Germany
| | | | - Didier Blaise
- Hematology Department Institut Paoli Calmettes Marseille France
| | - Hermann Einsele
- Hematology Department Universitaetsklinikum Würzburg Wuerzburg Germany
| | - Katja Sockel
- Hematology Department University Hospital Dresden, TU Dresden Dresden Germany
| | - William Krüger
- Hematology Department Universitaetsklinikum Greifswald Greifswald Germany
| | - Stig Lenhoff
- Hematology Department Skanes University Hospital Lund Sweden
| | | | - Hans Martin
- Hematology Department Universitaetsklinikum Frankfurt Frankfurt Germany
| | | | | | | | - José‐María Raya
- Hematology Department Hospital Universitario de Canarias Tenerife Spain
| | | | - Luuk Gras
- EBMT Statistical Unit Leiden The Netherlands
| | - Patrick Hayden
- Hematology Department Trinity College Dublin, St. James's Hospital Dublin Ireland
| | - Tomasz Czerw
- Hematology Department Maria Skłodowska‐Curie National Research Institute of Oncology, Gliwice Branch Gliwice Poland
| | - Donal P. McLornan
- Hematology Department Guys' and St. Thomas' NHS Foundation Trust and University College London Hospitals London UK
| | - Ibrahim Yakoub‐Agha
- Hematology Department CHU de Lille, Université de Lille, INSERM U1286 Lille France
| |
Collapse
|
17
|
McLornan DP, Hernandez-Boluda JC, Czerw T, Cross N, Joachim Deeg H, Ditschkowski M, Moonim MT, Polverelli N, Robin M, Aljurf M, Conneally E, Hayden P, Yakoub-Agha I. Allogeneic haematopoietic cell transplantation for myelofibrosis: proposed definitions and management strategies for graft failure, poor graft function and relapse: best practice recommendations of the EBMT Chronic Malignancies Working Party. Leukemia 2021; 35:2445-2459. [PMID: 34040148 DOI: 10.1038/s41375-021-01294-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 01/31/2023]
Abstract
Allogeneic haematopoietic cell transplantation (allo-HCT) remains the only curative approach in myelofibrosis (MF). Despite advances over recent decades, relapse and non-relapse mortality rates remain significant. Relapse rates vary between 15 and 25% across retrospective studies and management strategies vary widely, ranging from palliation to adoptive immunotherapy and, in some cases, a second allo-HCT. Moreover, in allo-HCT, there is a higher incidence of poor graft function and graft failure due to splenomegaly and a hostile "pro-inflammatory" marrow niche. The Practice Harmonisation and Guidelines subcommittee of the Chronic Malignancies Working Party (CMWP) of EBMT convened an international panel consisting of transplant haematologists, histopathologists and molecular biologists to propose practical, clinically relevant definitions of graft failure, poor graft function and relapse as well as management strategies following allo-HCT. A systematic approach to molecular monitoring, histopathological assessment and chimerism testing is proposed. These proposed recommendations aim to increase the accuracy and uniformity of reporting and to thereby facilitate the development of more consistent approaches to these challenging issues. In addition, we propose management strategies for these complications.
Collapse
Affiliation(s)
- Donal P McLornan
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust and University College Hospitals, London, UK.
| | | | - Tomasz Czerw
- Maria Sklodowska-Curie Institute, Gliwice, Poland
| | - Nicholas Cross
- National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, UK
| | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Marcus Ditschkowski
- Department for Bone Marrow Transplantation, University of Essen, Essen, Germany
| | - Mufaddal T Moonim
- Department of Histopathology, Imperial College Healthcare NHS Trust, London, UK
| | - Nicola Polverelli
- Unit of Blood Diseases and Stem Cell Transplantation, Department of Clinical and Experimental Sciences-University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Marie Robin
- Hopital Saint-Louis, APHP, Université de Paris, Paris, France
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Patrick Hayden
- Haematology Department, St. James Hospital, Dublin, Ireland
| | | |
Collapse
|
18
|
Battipaglia G, Mauff K, Wendel L, Angelucci E, Mohty M, Arcese W, Santarone S, Rubio MT, Kroger N, Fox ML, Blaise D, Iori AP, Fanin R, Chalandon Y, Pioltelli P, Marotta G, Chiusolo P, Sever M, Solano C, Contentin N, de Wreede LC, Czerw T, Hernandez-Boluda JC, Hayden P, McLornan D, Yakoub-Agha I. Thiotepa-busulfan-fludarabine (TBF) conditioning regimen in patients undergoing allogeneic hematopoietic cell transplantation for myelofibrosis: an outcome analysis from the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant 2021; 56:1593-1602. [PMID: 33526919 DOI: 10.1038/s41409-021-01222-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/20/2020] [Accepted: 01/11/2021] [Indexed: 01/31/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative option in MF. There is no consensus on the optimal conditioning regimen. We report outcomes of 187 patients with MF transplanted between 2010 and 2017 conditioned with TBF. Median age was 58 years. Median interval from diagnosis to allo-HCT was 44 months. Donors were haploidentical (41%), unrelated (36%) or HLA-identical siblings (23%). Stem cell source was PB in 60%. Conditioning was myeloablative in 48% of cases. Antithymocyte globulin (ATG) was used in 41% of patients. At 100 days, neutrophil and platelet engraftment were 91% and 63% after a median of 21 and 34 days, respectively. Grade II-IV and III-IV acute GVHD occurred in 24% and 12%, while at 3 years, all grade chronic GVHD and chronic extensive GVHD had been diagnosed in 38% and 11%. At 3 years, OS, RFS and GRFS were 55%, 49% and 43%, respectively. RI and NRM were 17% and 33%. On multivariate analysis, poor KPS and the use of unrelated donors were associated with worse GRFS and a higher grade II-IV acute GVHD, respectively. Neither donor type nor intensity of the conditioning regimen influenced survival outcomes. TBF is a feasible conditioning regimen in allo-HCT for MF in all donor settings although longer term outcomes are required.
Collapse
Affiliation(s)
- Giorgia Battipaglia
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
| | | | | | | | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - William Arcese
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy
| | - Stella Santarone
- Ospedale Civile Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy
| | - Marie Therese Rubio
- Department of Hematology, Hôpital Brabois, CHRU Nancy and CNRS UMR 7365, Biopole del'Université del Lorraine, Vendoeuvre les Nancy, France
| | - Nicolaus Kroger
- Department of Stem Cell Transplantation, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Laura Fox
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), University Hospital Vall d'Hebron, Barcelona, Spain
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Anna Paola Iori
- Hematology, Department of Translational and Precision Medicine, University Sapienza, Rome, Italy
| | - Renato Fanin
- Division of Hematology and Stem Cell Transplantation, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Yves Chalandon
- Division of Hematology, University of Geneva Hospitals, Geneva, Switzerland
| | - Pietro Pioltelli
- Hematology Division and Bone Marrow Transplantation Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Marotta
- Department of Oncology, UOSA Transplant and Cellular Therapy Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Patrizia Chiusolo
- Fondazione Policlinico A. Gemelli IRCCS, Roma, Italy.,Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Matjaz Sever
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carlos Solano
- Hematology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | | | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Tomasz Czerw
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
| | | | - Patrick Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - Donal McLornan
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | | |
Collapse
|
19
|
Schetelig J, Baldauf H, Koster L, Kuxhausen M, Heidenreich F, de Wreede LC, Spellman S, van Gelder M, Bruno B, Onida F, Lange V, Massalski C, Potter V, Ljungman P, Schaap N, Hayden P, Lee SJ, Kröger N, Hsu K, Schmidt AH, Yakoub-Agha I, Robin M. Haplotype Motif-Based Models for KIR-Genotype Informed Selection of Hematopoietic Cell Donors Fail to Predict Outcome of Patients With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia. Front Immunol 2021; 11:584520. [PMID: 33542712 PMCID: PMC7851088 DOI: 10.3389/fimmu.2020.584520] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/01/2020] [Accepted: 11/25/2020] [Indexed: 12/18/2022] Open
Abstract
Results from registry studies suggest that harnessing Natural Killer (NK) cell reactivity mediated through Killer cell Immunoglobulin-like Receptors (KIR) could reduce the risk of relapse after allogeneic Hematopoietic Cell Transplantation (HCT). Several competing models have been developed to classify donors as KIR-advantageous or disadvantageous. Basically, these models differ by grouping donors based on distinct KIR–KIR–ligand combinations or by haplotype motif assignment. This study aimed to validate different models for unrelated donor selection for patients with Myelodysplatic Syndromes (MDS) or secondary Acute Myeloid Leukemia (sAML). In a joint retrospective study of the European Society for Blood and Marrow Transplantation (EBMT) and the Center for International Blood and Marrow Transplant Research (CIBMTR) registry data from 1704 patients with secondary AML or MDS were analysed. The cohort consisted mainly of older patients (median age 61 years) with high risk disease who had received chemotherapy-based reduced intensity conditioning and anti-thymocyte globulin prior to allogeneic HCT from well-matched unrelated stem cell donors. The impact of the predictors on Overall Survival (OS) and relapse incidence was tested in Cox regression models adjusted for patient age, a modified disease risk index, performance status, donor age, HLA-match, sex-match, CMV-match, conditioning intensity, type of T-cell depletion and graft type. KIR genes were typed using high-resolution amplicon-based next generation sequencing. In univariable and multivariable analyses none of the models predicted OS and the risk of relapse consistently. Our results do not support the hypothesis that optimizing NK-mediated alloreactivity is possible by KIR-genotype informed selection of HLA-matched unrelated donors. However, in the context of allogeneic transplantation, NK-cell biology is complex and only partly understood. KIR-genes are highly diverse and current assignment of haplotype motifs based on the presence or absence of selected KIR genes is over-simplistic. As a consequence, further research is highly warranted and should integrate cutting edge knowledge on KIR genetics, and NK-cell biology into future studies focused on homogeneous groups of patients and treatment modalities.
Collapse
Affiliation(s)
- Johannes Schetelig
- Medizinische Klinik und Poliklinik I, University Hospital Dresden, Dresden, Germany.,DKMS Clinical Trials Unit, Dresden, Germany
| | | | | | - Michelle Kuxhausen
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, United States
| | - Falk Heidenreich
- Medizinische Klinik und Poliklinik I, University Hospital Dresden, Dresden, Germany.,DKMS Clinical Trials Unit, Dresden, Germany
| | - Liesbeth C de Wreede
- DKMS Clinical Trials Unit, Dresden, Germany.,Leiden University Medical Center, Department of Biomedical Data Sciences, Leiden, Netherlands
| | - Stephen Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, United States
| | - Michel van Gelder
- Maastricht University Medical Center, Department of Internal Medicine, Maastricht, Netherlands
| | - Benedetto Bruno
- A.O.U. Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Onida
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | - Per Ljungman
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | - Stephanie J Lee
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | | | - Kathy Hsu
- Memorial Sloan Kettering Cancer Center, New York & Scientific Director, CIBMTR Immunobiology Working Committee, New York City, NY, United States
| | - Alexander H Schmidt
- DKMS Clinical Trials Unit, Dresden, Germany.,DKMS Life Science Lab, Dresden, Germany
| | | | - Marie Robin
- Hopital Saint-Louis, APHP, Université de Paris, Paris, France
| |
Collapse
|
20
|
Polverelli N, Mauff K, Kröger N, Robin M, Beelen D, Beauvais D, Chevallier P, Mohty M, Passweg J, Rubio MT, Maertens J, Finke J, Bornhäuser M, Vrhovac R, Helbig G, Mear J, Castagna L, Reményi P, Angelucci E, Karakasis D, Rifòn J, Sirait T, Russo D, Wreede L, Czerw T, Hernández‐Boluda JC, Hayden P, McLornan D, Yakoub‐Agha I. Impact of spleen size and splenectomy on outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis: A retrospective analysis by the chronic malignancies working party on behalf of European society for blood and marrow transplantation (EBMT). Am J Hematol 2021; 96:69-79. [PMID: 33064301 DOI: 10.1002/ajh.26020] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
The role of spleen size and splenectomy for the prediction of post-allogeneic hematopoietic stem cell transplant (allo-HCT) outcome in myelofibrosis remains under debate. In EBMT registry, we identified a cohort of 1195 myelofibrosis patients transplanted between 2000-2017 after either fludarabine-busulfan or fludarabine-melphalan regimens. Overall, splenectomy was performed in 202 (16.9%) patients and its use decreased over time (28.3% in 2000-2009 vs 14.1% in 2010-2017 period). By multivariate analysis, splenectomy was associated with less NRM (HR 0.64, 95% CI 0.44-0.93, P = .018) but increased risk of relapse (HR 1.43, 95% CI 1.01-2.02, P = .042), with no significant impact on OS (HR 0.86, 95% CI 0.67-1.12, P = .274). However, in subset analysis comparing the impact of splenectomy vs specific spleen sizes, for patients with progressive disease, an improved survival was seen in splenectomised subjects compared to those patients with a palpable spleen length ≥ 15 cm (HR 0.44, 95% CI 0.28-0.69, P < .001), caused by a significant reduction in NRM (HR 0.26, 95% CI 0.14-0.49, P < .001), without significantly increased relapse risk (HR 1.47, 95% CI 0.87-2.49, P = .147). Overall, despite the possible biases typical of retrospective cohorts, this study highlights the potential detrimental effect of massive splenomegaly in transplant outcome and supports the role of splenectomy for myelofibrosis patients with progressive disease and large splenomegaly.
Collapse
Affiliation(s)
- Nicola Polverelli
- Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences University of Brescia ASST Spedali Civili of Brescia
| | | | - Nicolaus Kröger
- Department of Hematology University Hospital Eppendorf Hamburg Germany
| | - Marie Robin
- Department of Hematology Hôpital Saint‐Louis, APHP Paris France
| | - Dietrich Beelen
- Department of Hematology University Hospital of Essen Essen Germany
| | | | | | - Mohamad Mohty
- Sorbonne University Paris France
- Service d'Hématologie Clinique et Thérapie cellulaire Hopital Saint‐Antoine Paris France
- INSERM Paris France
| | - Jakob Passweg
- Department of Hematology University Hospital Basel Basel Switzerland
| | | | - Johan Maertens
- Department of Hematology University Hospital Gasthuisberg Leuven Belgium
| | - Jürgen Finke
- Department of Hematology University of Freiburg Freiburg Germany
| | - Martin Bornhäuser
- Department of Hematology University Hospital Dresded Dresden Germany
| | - Radovan Vrhovac
- Department of Hematology University Hospital Center Rebro Zagreb Croatia
| | - Grzegorz Helbig
- Department of Hematology Silesian Medical Academy Katowice Poland
| | - Jean‐Baptiste Mear
- Department of Hematology Centre Hospitalier Universitaire de Rennes Rennes France
| | - Luca Castagna
- Department of Hematology Centre de Recherche en Cancérologie de Marseille Marseille France
| | - Péter Reményi
- Department of Hematology Dél‐pesti Centrumkórház Budapest Hungary
| | - Emanuele Angelucci
- Hematology and Transplant Center IRCCS Ospedale Policlinico San Martino Genoa Italy
| | | | - Jose Rifòn
- Department of Hematology Clínica Universitaria de Navarra Pamplona Spain
| | | | - Domenico Russo
- Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences University of Brescia ASST Spedali Civili of Brescia
| | - Liesbeth Wreede
- Department of Biomedical Data Sciences LUMC Leiden Netherlands
| | - Tomasz Czerw
- Department of Bone Marrow Transplantation and Onco‐Hematology Maria Sklodowska‐Curie National Research Institute of Oncology Gliwice Poland
| | | | - Patrick Hayden
- Department of Hematology St. James's Hospital Dublin Ireland
| | - Donal McLornan
- Department of Hematology Guy's and St Thomas' NHS Foundation Trust and University College London Hospitals London UK
| | | |
Collapse
|
21
|
Barosova H, Maione AG, Septiadi D, Sharma M, Haeni L, Balog S, O'Connell O, Jackson GR, Brown D, Clippinger AJ, Hayden P, Petri-Fink A, Stone V, Rothen-Rutishauser B. Correction to Use of EpiAlveolar Lung Model to Predict Fibrotic Potential of Multiwalled Carbon Nanotubes. ACS Nano 2020; 14:17713. [PMID: 33296593 DOI: 10.1021/acsnano.0c09469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
22
|
Cao X, Coyle JP, Xiong R, Wang Y, Heflich RH, Ren B, Gwinn WM, Hayden P, Rojanasakul L. Invited review: human air-liquid-interface organotypic airway tissue models derived from primary tracheobronchial epithelial cells-overview and perspectives. In Vitro Cell Dev Biol Anim 2020; 57:104-132. [PMID: 33175307 PMCID: PMC7657088 DOI: 10.1007/s11626-020-00517-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
The lung is an organ that is directly exposed to the external environment. Given the large surface area and extensive ventilation of the lung, it is prone to exposure to airborne substances, such as pathogens, allergens, chemicals, and particulate matter. Highly elaborate and effective mechanisms have evolved to protect and maintain homeostasis in the lung. Despite these sophisticated defense mechanisms, the respiratory system remains highly susceptible to environmental challenges. Because of the impact of respiratory exposure on human health and disease, there has been considerable interest in developing reliable and predictive in vitro model systems for respiratory toxicology and basic research. Human air-liquid-interface (ALI) organotypic airway tissue models derived from primary tracheobronchial epithelial cells have in vivo–like structure and functions when they are fully differentiated. The presence of the air-facing surface allows conducting in vitro exposures that mimic human respiratory exposures. Exposures can be conducted using particulates, aerosols, gases, vapors generated from volatile and semi-volatile substances, and respiratory pathogens. Toxicity data have been generated using nanomaterials, cigarette smoke, e-cigarette vapors, environmental airborne chemicals, drugs given by inhalation, and respiratory viruses and bacteria. Although toxicity evaluations using human airway ALI models require further standardization and validation, this approach shows promise in supplementing or replacing in vivo animal models for conducting research on respiratory toxicants and pathogens.
Collapse
Affiliation(s)
- Xuefei Cao
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Rd., AR, Jefferson, USA.
| | - Jayme P Coyle
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Rui Xiong
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Rd., AR, Jefferson, USA
| | - Yiying Wang
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Rd., AR, Jefferson, USA
| | - Robert H Heflich
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Rd., AR, Jefferson, USA
| | - Baiping Ren
- Division of Genetic and Molecular Toxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Rd., AR, Jefferson, USA
| | - William M Gwinn
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Durham, NC, USA
| | | | - Liying Rojanasakul
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| |
Collapse
|
23
|
Hare S, Hayden P. Role of critical care in improving outcomes for high-risk surgical patients. Br J Surg 2020; 107:e15-e16. [PMID: 31903590 DOI: 10.1002/bjs.11423] [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] [Received: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022]
Affiliation(s)
- S Hare
- Department of Anaesthesia, Critical Care and Perioperative Medicine, Medway Maritime Hospital, Gillingham, ME7 5NY, UK.,National Emergency Laparotomy Audit, Royal College of Anaesthetists, London, UK
| | - P Hayden
- Department of Anaesthesia, Critical Care and Perioperative Medicine, Medway Maritime Hospital, Gillingham, ME7 5NY, UK
| |
Collapse
|
24
|
Barosova H, Maione AG, Septiadi D, Sharma M, Haeni L, Balog S, O'Connell O, Jackson GR, Brown D, Clippinger AJ, Hayden P, Petri-Fink A, Stone V, Rothen-Rutishauser B. Use of EpiAlveolar Lung Model to Predict Fibrotic Potential of Multiwalled Carbon Nanotubes. ACS Nano 2020; 14:3941-3956. [PMID: 32167743 DOI: 10.1021/acsnano.9b0686010.1021/acsnano.9b06860.s001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Expansion in production and commercial use of nanomaterials increases the potential human exposure during the lifecycle of these materials (production, use, and disposal). Inhalation is a primary route of exposure to nanomaterials; therefore it is critical to assess their potential respiratory hazard. Herein, we developed a three-dimensional alveolar model (EpiAlveolar) consisting of human primary alveolar epithelial cells, fibroblasts, and endothelial cells, with or without macrophages for predicting long-term responses to aerosols. Following thorough characterization of the model, proinflammatory and profibrotic responses based on the adverse outcome pathway concept for lung fibrosis were assessed upon repeated subchronic exposures (up to 21 days) to two types of multiwalled carbon nanotubes (MWCNTs) and silica quartz particles. We simulate occupational exposure doses for the MWCNTs (1-30 μg/cm2) using an air-liquid interface exposure device (VITROCELL Cloud) with repeated exposures over 3 weeks. Specific key events leading to lung fibrosis, such as barrier integrity and release of proinflammatory and profibrotic markers, show the responsiveness of the model. Nanocyl induced, in general, a less pronounced reaction than Mitsui-7, and the cultures with human monocyte-derived macrophages (MDMs) showed the proinflammatory response at later time points than those without MDMs. In conclusion, we present a robust alveolar model to predict inflammatory and fibrotic responses upon exposure to MWCNTs.
Collapse
Affiliation(s)
- Hana Barosova
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
| | - Anna G Maione
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts 01721, United States
| | - Dedy Septiadi
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
| | - Monita Sharma
- PETA International Science Consortium Ltd., 8 All Saints Street, London N1 9RL, U.K
| | - Laetitia Haeni
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
| | - Sandor Balog
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
| | - Olivia O'Connell
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts 01721, United States
| | - George R Jackson
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts 01721, United States
| | - David Brown
- Nano-Safety Research Group, Heriot-Watt University, Edinburgh EH14 4AS, U.K
| | - Amy J Clippinger
- PETA International Science Consortium Ltd., 8 All Saints Street, London N1 9RL, U.K
| | - Patrick Hayden
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts 01721, United States
- BioSurfaces, Inc., 200 Homer Ave, Ashland, Massachusetts 01721, United States
| | - Alke Petri-Fink
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
- Department of Chemistry, University of Fribourg, Chemin du Musée 9, 1700 Fribourg, Switzerland
| | - Vicki Stone
- Nano-Safety Research Group, Heriot-Watt University, Edinburgh EH14 4AS, U.K
| | | |
Collapse
|
25
|
Barosova H, Maione AG, Septiadi D, Sharma M, Haeni L, Balog S, O'Connell O, Jackson GR, Brown D, Clippinger AJ, Hayden P, Petri-Fink A, Stone V, Rothen-Rutishauser B. Use of EpiAlveolar Lung Model to Predict Fibrotic Potential of Multiwalled Carbon Nanotubes. ACS Nano 2020; 14:3941-3956. [PMID: 32167743 DOI: 10.1021/acsnano.9b06860] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Expansion in production and commercial use of nanomaterials increases the potential human exposure during the lifecycle of these materials (production, use, and disposal). Inhalation is a primary route of exposure to nanomaterials; therefore it is critical to assess their potential respiratory hazard. Herein, we developed a three-dimensional alveolar model (EpiAlveolar) consisting of human primary alveolar epithelial cells, fibroblasts, and endothelial cells, with or without macrophages for predicting long-term responses to aerosols. Following thorough characterization of the model, proinflammatory and profibrotic responses based on the adverse outcome pathway concept for lung fibrosis were assessed upon repeated subchronic exposures (up to 21 days) to two types of multiwalled carbon nanotubes (MWCNTs) and silica quartz particles. We simulate occupational exposure doses for the MWCNTs (1-30 μg/cm2) using an air-liquid interface exposure device (VITROCELL Cloud) with repeated exposures over 3 weeks. Specific key events leading to lung fibrosis, such as barrier integrity and release of proinflammatory and profibrotic markers, show the responsiveness of the model. Nanocyl induced, in general, a less pronounced reaction than Mitsui-7, and the cultures with human monocyte-derived macrophages (MDMs) showed the proinflammatory response at later time points than those without MDMs. In conclusion, we present a robust alveolar model to predict inflammatory and fibrotic responses upon exposure to MWCNTs.
Collapse
Affiliation(s)
- Hana Barosova
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
| | - Anna G Maione
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts 01721, United States
| | - Dedy Septiadi
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
| | - Monita Sharma
- PETA International Science Consortium Ltd., 8 All Saints Street, London N1 9RL, U.K
| | - Laetitia Haeni
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
| | - Sandor Balog
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
| | - Olivia O'Connell
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts 01721, United States
| | - George R Jackson
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts 01721, United States
| | - David Brown
- Nano-Safety Research Group, Heriot-Watt University, Edinburgh EH14 4AS, U.K
| | - Amy J Clippinger
- PETA International Science Consortium Ltd., 8 All Saints Street, London N1 9RL, U.K
| | - Patrick Hayden
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts 01721, United States
- BioSurfaces, Inc., 200 Homer Ave, Ashland, Massachusetts 01721, United States
| | - Alke Petri-Fink
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland
- Department of Chemistry, University of Fribourg, Chemin du Musée 9, 1700 Fribourg, Switzerland
| | - Vicki Stone
- Nano-Safety Research Group, Heriot-Watt University, Edinburgh EH14 4AS, U.K
| | | |
Collapse
|
26
|
McLornan DP, Malpassuti V, Lippinkhof‐Kozijn A, Potter V, Beelen D, Bunjes D, Sengeloev H, Radujkovic A, Passweg J, Chalandon Y, Kröger N, Wulf GG, Johansson J, Ciceri F, Bornhäuser M, Holler E, Guffroy B, Martin S, Neubauer A, Gramatski M, Robin M, Iacobelli S, Hayden P, Hernández Boluda JC, Czerw T, Yakoub‐Agha I. Outcome of allogeneic haematopoietic stem cell transplantation in myeloproliferative neoplasm, unclassifiable: a retrospective study by the Chronic Malignancies Working Party of the EBMT. Br J Haematol 2020; 190:437-441. [DOI: 10.1111/bjh.16537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Donal P. McLornan
- Department of Haematology Guy’s and St. Thomas’ NHS Foundation Trust London UK
| | - Vittoria Malpassuti
- Dipartimento di Biologia Università degli Studi di Roma Tor Vergata Rome Italy
| | | | - Victoria Potter
- Department of Haematological Medicine King’s College Hospital London UK
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation West German Cancer Centre University Hospital of Essen University of Duisburg Essen Germany
| | | | | | | | - Jakob Passweg
- Department of Haematology University Hospital Basel Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | - Marie Robin
- Service d’Hématologie‐Greffe Hôpital Saint‐Louis Paris France
| | - Simona Iacobelli
- Dipartimento di Biologia Università degli Studi di Roma Tor Vergata Rome Italy
| | | | | | - Tomasz Czerw
- Maria Sklodowska‐Curie Institute ‐ Oncology CenterGliwice Branch Gliwice Poland
| | | |
Collapse
|
27
|
Morris C, Chabannon C, Masszi T, Russell N, Nahi H, Kobbe G, Krejci M, Auner HW, Pohlreich D, Hayden P, Basak GW, Lenhoff S, Schaap N, van Biezen A, Knol C, Iacobelli S, Liu Q, Celanovic M, Garderet L, Kröger N. Results from a multicenter, noninterventional registry study for multiple myeloma patients who received stem cell mobilization regimens with and without plerixafor. Bone Marrow Transplant 2020; 55:356-366. [PMID: 31534192 PMCID: PMC6995780 DOI: 10.1038/s41409-019-0676-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022]
Abstract
Plerixafor plus granulocyte-colony stimulating factor (G-CSF) enhances the mobilization of hematopoietic stem cells (HSCs) for collection and subsequent autologous hematopoietic stem cell transplantation (HSCT) in patients with multiple myeloma (MM). This international, multicenter, noninterventional registry study (NCT01362972), evaluated long-term outcomes for MM patients who received plerixafor versus other mobilization regimens. The comparisons were: G-CSF + plerixafor (G-CSF + P) versus G-CSF-; G-CSF + P versus G-CSF + chemotherapy (G-CSF + C); and G-CSF + P + C versus G-CSF + C. Propensity score matching was used to balance groups. Primary outcome measures were progression free survival (PFS), overall survival (OS), and cumulative incidence of relapse (CIR) after transplantation. After propensity matching, 77 versus 41 patients in the G-CSF + P versus G-CSF cohorts, 129 versus 129 in the G-CSF + P versus G-CSF + C cohorts, and 117 versus 117 in the G-CSF + P + C versus G-CSF + C cohorts were matched, respectively. Propensity score matching resulted in a smaller sample size and imbalances were not completely overcome. For both PFS and OS, the upper limits of the hazard ratio 95% confidence intervals exceeded prespecified boundaries; noninferiority was not demonstrated. CIR rates were higher in the plerixafor cohorts. G-CSF + P remains an option for the mobilization of HSCs in poor mobilizers with MM with no substantial differences in PFS, OS, and CIR in comparison with other regimens.
Collapse
Affiliation(s)
| | | | | | | | - Hareth Nahi
- Karolinska University Hospital, Stockholm, Sweden
| | - Guido Kobbe
- University Hospital of Dusseldorf, Dusseldorf, Germany
| | - Marta Krejci
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | | | | | | | | | - Nicolaas Schaap
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anja van Biezen
- European Society for Blood and Marrow Transplantation, Leiden, The Netherlands
| | - Cora Knol
- European Society for Blood and Marrow Transplantation, Leiden, The Netherlands
| | | | | | | | | | | |
Collapse
|
28
|
Kaluzhny Y, Kinuthia MW, Lapointe AM, Truong T, Klausner M, Hayden P. Oxidative stress in corneal injuries of different origin: Utilization of 3D human corneal epithelial tissue model. Exp Eye Res 2019; 190:107867. [PMID: 31705899 DOI: 10.1016/j.exer.2019.107867] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/10/2019] [Revised: 10/10/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
The purpose of the current work was to utilize a three dimensional (3D) corneal epithelial tissue model to study dry eye disease and oxidative stress-related corneal epithelial injuries for the advancement of ocular therapeutics. Air-liquid interface cultures of normal human corneal epithelial cells were used to produce 3D corneal epithelial tissues appropriate for physiologically relevant exposure to environmental factors. Oxidative stress was generated by exposing the tissues to non-toxic doses of ultraviolet radiation (UV), hydrogen peroxide, vesicating agent nitrogen mustard, or desiccating conditions that stimulated morphological, cellular, and molecular changes relevant to dry eye disease. Corneal specific responses, including barrier function, tissue viability, reactive oxygen species (ROS) accumulation, lipid peroxidation, cytokine release, histology, and gene expression were evaluated. 3D corneal epithelial tissue model structurally and functionally reproduced key features of molecular responses of various types of oxidative stress-induced ocular damage. The most pronounced effects for different treatments were: UV irradiation - intracellular ROS accumulation; hydrogen peroxide exposure - barrier impairment and IL-8 release; nitrogen mustard exposure - lipid peroxidation and IL-8 release; desiccating conditions - tissue thinning, a decline in mucin expression, increased lipid peroxidation and IL-8 release. Utilizing a PCR gene array, we compared the effects of corneal epithelial damage on the expression of 84 oxidative stress-responsive genes and found specific molecular responses for each type of damage. The topical application of lubricant eye drops improved tissue morphology while decreasing lipid peroxidation and IL-8 release from tissues incubated at desiccating conditions. This model is anticipated to be a valuable tool to study molecular mechanisms of corneal epithelial damage and aid in the development of therapies against dry eye disease, oxidative stress- and vesicant-induced ocular injuries.
Collapse
Affiliation(s)
- Yulia Kaluzhny
- MatTek Corporation, 200 Homer Avenue, Ashland, MA, 01721, USA.
| | | | | | - Thoa Truong
- MatTek Corporation, 200 Homer Avenue, Ashland, MA, 01721, USA.
| | | | - Patrick Hayden
- MatTek Corporation, 200 Homer Avenue, Ashland, MA, 01721, USA.
| |
Collapse
|
29
|
McLornan D, Szydlo R, Koster L, Chalandon Y, Robin M, Wolschke C, Beelen D, Socié G, Bornhäuser M, Angelucci E, Niederwieser D, Gerbitz A, Finke J, Vitek A, Itälä-Remes M, Radujkovic A, Kanz L, Potter V, Chevallier P, Stelljes M, Petersen E, Robinson S, Poiré X, Klyuchnikov E, Hernández-Boluda JC, Czerw T, Hayden P, Kröger N, Yakoub-Agha I. Myeloablative and Reduced-Intensity Conditioned Allogeneic Hematopoietic Stem Cell Transplantation in Myelofibrosis: A Retrospective Study by the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2019; 25:2167-2171. [PMID: 31284069 DOI: 10.1016/j.bbmt.2019.06.034] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 04/09/2019] [Revised: 06/18/2019] [Accepted: 06/28/2019] [Indexed: 11/25/2022]
Abstract
This retrospective study by the European Society for Blood and Marrow Transplantation analyzed the outcome of 2224 patients with myelofibrosis (MF) who underwent allogeneic stem cell transplantation (allo-SCT) between 2000 and 2014; 781 (35%) underwent myeloablative conditioning (MAC) and 1443 (65%) reduced-intensity conditioning (RIC). Median patient age was 52.9 years (range, 18 to 74 years) and 57.5 years (range, 21 to 76 years) in the MAC and RIC cohorts, respectively. Donor type was similar: matched sibling donors (MAC, 317 [41%]; RIC, 552 [38%]) and unrelated donors (MAC, 464 [59%]; RIC, 891 [62%]). Median time to both neutrophil and platelet (>20 × 109/L) engraftment did not differ between cohorts. Rates of grade II to IV acute GVHD were 28% (MAC) and 31% (RIC; P = NS). Cumulative chronic GVHD rates (limited/extensive) were 22%/27% (MAC) and 19%/31% (RIC; P = .10). Cumulative incidences of nonrelapse mortality (NRM) at 1, 3, and 5 years were 25.5%, 32.2%, and 34.6% (MAC) and 26.3%, 32.8%, and 34.4% (RIC), respectively. There was a trend toward a higher relapse rate with RIC regimens compared with MAC (P = .08); rates at 1, 3, and 5 years were 10.9%, 17.2%, and 20.1% (MAC) and 14%, 19.7%, and 23.2% (RIC), respectively. No significant difference in 5-year probabilities of overall survival (OS) was noted: MAC (53.0%; 95% confidence interval [CI], 49.1% to 56.9%) and RIC (51.0%; 95% CI, 48.3% to 53.7%); P = .78. Regarding the composite end point of GVHD-free/relapse-free survival (GRFS), the unadjusted Kaplan-Meier estimate of 5-year GRFS was 32.4% (95% CI, 29.0% to 36.1%) in the MAC group and 26.1% (95% CI, 23.9% to 28.2%) in the RIC group (P = .001). In the MAC cohort, multivariable analysis confirmed worse OS and NRM with older age (>50 years), using an unrelated donor and a Karnofsky Performance Status of 80 or less. For the RIC cohort, worse OS and NRM were associated with age 60 to 70 years compared with younger recipients, use of a mismatched donor, and poor performance status. In conclusion, although similar OS rates existed for both cohorts overall, this study suggests that MAC should still be used for younger individuals suitable for such an approach due to a trend toward less relapse and an overall suggested advantage of improved GRFS, albeit this should be examined in a more homogeneous cohort. RIC allo-SCT still offers significant survival advantage in the older, fitter MF allograft patient, and optimization to reduce significant relapse and NRM rates is required.
Collapse
Affiliation(s)
- Donal McLornan
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Richard Szydlo
- Department of Clinical Sciences, Imperial College, London, United Kingdom
| | - Linda Koster
- Department of Haematology, EBMT Data Office, Leiden, The Netherlands
| | - Yves Chalandon
- Division of Hematology, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Robin
- Department of Haematology, Service d'Hématologie-Greffe, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Christine Wolschke
- Division of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | | | - Gerard Socié
- Department of Haematology, Service d'Hématologie-Greffe, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Martin Bornhäuser
- Department of Haematology, Universitaetsklinikum Dresden, Dresden, Germany
| | | | | | - Arnim Gerbitz
- Department of Haematology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Finke
- Department of Haematology, University of Freiburg, Freiburg, Germany
| | - Antonin Vitek
- Department of Haematology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Maija Itälä-Remes
- Department of Haematology, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | | | - Lothar Kanz
- Department of Haematology, Universität Tübingen, Tübingen, Germany
| | - Victoria Potter
- Department of Haematology, King's College Hospital, London, United Kingdom
| | | | | | - Eefke Petersen
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Stephen Robinson
- Department of Stem Cell Transplantation, University Hospitals, Bristol, United Kingdom
| | - Xavier Poiré
- Department of Haematology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Evgeny Klyuchnikov
- Division of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | | | - Tomasz Czerw
- Department of Haematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Patrick Hayden
- Department of Haematology, St. James Hospital, Dublin, Ireland
| | - Nicolaus Kröger
- Division of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Ibrahim Yakoub-Agha
- Department of Haematology, CHU de Lille, LIRIC, INSERM U995, Universite de Lille, Lille, France
| |
Collapse
|
30
|
Brodie R, Lee G, Broderick V, Higgins E, Flavin R, Gardiner N, Browne P, Hayden P, Conneally E, Tuohy E, Flynn C, Bacon C, Vandenberghe E. A NATIONAL RETROSPECTIVE ANALYSIS OF CLINICAL OUTCOMES FOLLOWING ALLOGENEIC TRANSPLANTATION FOR HIGH GRADE B-CELL LYMPHOMA (HGBL). Hematol Oncol 2019. [DOI: 10.1002/hon.116_2631] [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: 11/06/2022]
Affiliation(s)
- R. Brodie
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - G. Lee
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - V. Broderick
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - E. Higgins
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - R. Flavin
- Histopathology Department; St. James Hospital; Dublin Republic of Ireland
| | - N. Gardiner
- Stem Cell Laboratory; St. James Hospital; Dublin Republic of Ireland
| | - P. Browne
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - P. Hayden
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - E. Conneally
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - E. Tuohy
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - C. Flynn
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - C.L. Bacon
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| | - E. Vandenberghe
- Haematology Department; St. James Hospital; Dublin Republic of Ireland
| |
Collapse
|
31
|
Hayden P, Ayehunie S, Oldach J, Klausner M. 726 Induction of an atopic dermatitis-like phenotype in a full-thickness in vitro human skin model. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.802] [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]
|
32
|
Ayehunie S, Landry T, Hedin C, Armento A, Hayden P, Klausner M. 523 T-cell cytokines (IL-17 and IFN-γ) exacerbates innate immune responses in an organotypic human psoriasis tissue model. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.599] [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]
|
33
|
Hayden P, Jackson G, Vinall J, Storey E, Simpson H, Debatis M, Maione A, Roper C, Klausner M. Comparative inhalation toxicity testing using in vitro organotypic rat and human airway epithelial models. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.673] [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: 11/25/2022]
|
34
|
Clippinger AJ, Allen D, Behrsing H, BéruBé KA, Bolger MB, Casey W, DeLorme M, Gaça M, Gehen SC, Glover K, Hayden P, Hinderliter P, Hotchkiss JA, Iskandar A, Keyser B, Luettich K, Ma-Hock L, Maione AG, Makena P, Melbourne J, Milchak L, Ng SP, Paini A, Page K, Patlewicz G, Prieto P, Raabe H, Reinke EN, Roper C, Rose J, Sharma M, Spoo W, Thorne PS, Wilson DM, Jarabek AM. Pathway-based predictive approaches for non-animal assessment of acute inhalation toxicity. Toxicol In Vitro 2018; 52:131-145. [PMID: 29908304 PMCID: PMC6760245 DOI: 10.1016/j.tiv.2018.06.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 04/24/2018] [Revised: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 01/14/2023]
Abstract
New approaches are needed to assess the effects of inhaled substances on human health. These approaches will be based on mechanisms of toxicity, an understanding of dosimetry, and the use of in silico modeling and in vitro test methods. In order to accelerate wider implementation of such approaches, development of adverse outcome pathways (AOPs) can help identify and address gaps in our understanding of relevant parameters for model input and mechanisms, and optimize non-animal approaches that can be used to investigate key events of toxicity. This paper describes the AOPs and the toolbox of in vitro and in silico models that can be used to assess the key events leading to toxicity following inhalation exposure. Because the optimal testing strategy will vary depending on the substance of interest, here we present a decision tree approach to identify an appropriate non-animal integrated testing strategy that incorporates consideration of a substance's physicochemical properties, relevant mechanisms of toxicity, and available in silico models and in vitro test methods. This decision tree can facilitate standardization of the testing approaches. Case study examples are presented to provide a basis for proof-of-concept testing to illustrate the utility of non-animal approaches to inform hazard identification and risk assessment of humans exposed to inhaled substances.
Collapse
Affiliation(s)
- Amy J Clippinger
- PETA International Science Consortium Ltd., Society Building, 8 All Saints Street, London N1 9RL, United Kingdom.
| | - David Allen
- Integrated Laboratory Systems, Contractor Supporting the NTP Interagency Center for the Evaluation of Alternative Toxicological Methods, Research Triangle Park, NC, United States
| | - Holger Behrsing
- Institute for In Vitro Sciences, 30 West Watkins Mill Road, Suite 100, Gaithersburg, MD 20878, United States
| | - Kelly A BéruBé
- Cardiff School of Biosciences, Museum Avenue, CF10 3AX, Wales, United Kingdom
| | - Michael B Bolger
- Simulations Plus, Inc., 42505 10th Street West, Lancaster, CA 93534, United States
| | - Warren Casey
- NIH/NIEHS/DNTP/NICEATM, Research Triangle Park, North Carolina 27709, United States
| | | | - Marianna Gaça
- British American Tobacco plc, Globe House, 4 Temple Place, London WC2R 2PG, United Kingdom
| | - Sean C Gehen
- Dow AgroSciences, Indianapolis, IN, United States
| | - Kyle Glover
- Defense Threat Reduction Agency, Aberdeen Proving Ground, MD 21010, United States
| | - Patrick Hayden
- MatTek Corporation, 200 Homer Ave, Ashland, MA 01721, United States
| | | | | | - Anita Iskandar
- Philip Morris Products SA, Philip Morris International R&D, Neuchâtel, Switzerland
| | - Brian Keyser
- RAI Services Company, 401 North Main Street, Winston-Salem, NC 27101, United States
| | - Karsta Luettich
- Philip Morris Products SA, Philip Morris International R&D, Neuchâtel, Switzerland
| | - Lan Ma-Hock
- BASF SE, Carl-Bosch-Strasse 38, 67056 Ludwigshafen am Rhein, Germany
| | - Anna G Maione
- MatTek Corporation, 200 Homer Ave, Ashland, MA 01721, United States
| | - Patrudu Makena
- RAI Services Company, 401 North Main Street, Winston-Salem, NC 27101, United States
| | - Jodie Melbourne
- PETA International Science Consortium Ltd., Society Building, 8 All Saints Street, London N1 9RL, United Kingdom
| | | | - Sheung P Ng
- E.I. du Pont de Nemours and Company, DuPont Haskell Global Center for Health Sciences, P. O. Box 30, Newark, DE 19714, United States
| | - Alicia Paini
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Kathryn Page
- The Clorox Company, 4900 Johnson Dr, Pleasanton, CA 94588, United States
| | - Grace Patlewicz
- U.S. Environmental Protection Agency, Office of Research and Development, National Center for Computational Toxicology, Research Triangle Park, NC, United States
| | - Pilar Prieto
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Hans Raabe
- Institute for In Vitro Sciences, 30 West Watkins Mill Road, Suite 100, Gaithersburg, MD 20878, United States
| | - Emily N Reinke
- U.S. Army Public Health Center, 8252 Blackhawk Rd. Bldg. E-5158, ATTN: MCHB-PH-HEF Gunpowder, MD 21010-5403, United States
| | - Clive Roper
- Charles River Edinburgh Ltd., Edinburgh EH33 2NE, United Kingdom
| | - Jane Rose
- Procter & Gamble Co, 11530 Reed Hartman Highway, Cincinnati, OH 45241, United States
| | - Monita Sharma
- PETA International Science Consortium Ltd., Society Building, 8 All Saints Street, London N1 9RL, United Kingdom
| | - Wayne Spoo
- RAI Services Company, 401 North Main Street, Winston-Salem, NC 27101, United States
| | - Peter S Thorne
- University of Iowa College of Public Health, Iowa City, IA, United States
| | | | - Annie M Jarabek
- U.S. Environmental Protection Agency, Office of Research and Development, National Center for Environmental Assessment, Research Triangle Park, NC, United States
| |
Collapse
|
35
|
Markus J, Landry T, Stevens Z, Klausner M, Hayden P, Ayehunie S. Modeling of ligand-induced acute and chronic inflammation in the gastrointestinal tract using In vitro 3D-human small intestinal microtissues. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.685] [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]
|
36
|
Kaluzhny Y, Kinuthia M, Truong T, Lapointe A, Klausner M, Letasiova S, Hayden P. Characterization of drug metabolizing enzymes, transporters and permeation in a human organotypic corneal tissue model. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.690] [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: 10/28/2022]
|
37
|
Gilbert B, Hill E, Aragon M, Frentzel S, Hoeng J, Ito S, Ishikawa S, Budde J, Maione A, Hayden P, Fields W, Keyser B, Haswell L, Azzopardi D, Behrsing H. Human In Vitro models for respiratory toxicology: evaluation of goblet cell hyperplasia, mucus production, and ciliary beating assays. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Kaluzhny Y, Kinuthia MW, Truong T, Lapointe AM, Hayden P, Klausner M. New Human Organotypic Corneal Tissue Model for Ophthalmic Drug Delivery Studies. ACTA ACUST UNITED AC 2018; 59:2880-2898. [DOI: 10.1167/iovs.18-23944] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Yulia Kaluzhny
- MatTek Corporation, Ashland, Massachusetts, United States
| | | | - Thoa Truong
- MatTek Corporation, Ashland, Massachusetts, United States
| | | | - Patrick Hayden
- MatTek Corporation, Ashland, Massachusetts, United States
| | | |
Collapse
|
39
|
Bachelor M, Guntur K, Oldach J, Hayden P. 715 Development of a do-it-yourself skin equivalent system for use as a research tool. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.724] [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: 10/17/2022]
|
40
|
Ayehunie S, Landry T, Stevens Z, Armento A, Hayden P, Klausner M. Human Primary Cell-Based Organotypic Microtissues for Modeling Small Intestinal Drug Absorption. Pharm Res 2018; 35:72. [PMID: 29476278 PMCID: PMC6599640 DOI: 10.1007/s11095-018-2362-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 10/27/2017] [Accepted: 02/02/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The study evaluates the use of new in vitro primary human cell-based organotypic small intestinal (SMI) microtissues for predicting intestinal drug absorption and drug-drug interaction. METHODS The SMI microtissues were reconstructed using human intestinal fibroblasts and enterocytes cultured on a permeable support. To evaluate the suitability of the intestinal microtissues to model drug absorption, the permeability coefficients across the microtissues were determined for a panel of 11 benchmark drugs with known human absorption and Caco-2 permeability data. Drug-drug interactions were examined using efflux transporter substrates and inhibitors. RESULTS The 3D-intestinal microtissues recapitulate the structural features and physiological barrier properties of the human small intestine. The microtissues also expressed drug transporters and metabolizing enzymes found on the intestinal wall. Functionally, the SMI microtissues were able to discriminate between low and high permeability drugs and correlated better with human absorption data (r2 = 0.91) compared to Caco-2 cells (r2 = 0.71). Finally, the functionality of efflux transporters was confirmed using efflux substrates and inhibitors which resulted in efflux ratios of >2.0 fold and by a decrease in efflux ratios following the addition of inhibitors. CONCLUSION The SMI microtissues appear to be a useful pre-clinical tool for predicting drug bioavailability of orally administered drugs.
Collapse
Affiliation(s)
- Seyoum Ayehunie
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts, USA.
| | - Tim Landry
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts, USA
| | - Zachary Stevens
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts, USA
| | - Alex Armento
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts, USA
| | - Patrick Hayden
- MatTek Corporation, 200 Homer Avenue, Ashland, Massachusetts, USA
| | | |
Collapse
|
41
|
Bachelor M, Seeley E, Walsh C, Armento A, Klausner M, Hayden P, Goodman H. Use of mass spectrometry imaging and a full thickness 3D skin equivalent for evaluation of percutaneous absorption. Toxicol Lett 2017. [DOI: 10.1016/j.toxlet.2017.07.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Jackson GR, Maione A, Coughlin S, Klausner M, Hayden P. Detection of reactive chemicals and oxidants using an organotypic human airway model with Nrf2 reporter activity: Application to tobacco products. Toxicol Lett 2017. [DOI: 10.1016/j.toxlet.2017.07.955] [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]
|
43
|
Smolicek I, Kinuthia M, Truong T, Hayden P, Klausner M, Kaluzhny Y. In vitro reconstructed human corneal tissue model: Applications to corneal oxidative stress, dry eye, and ophthalmic drug delivery. Toxicol Lett 2017. [DOI: 10.1016/j.toxlet.2017.07.980] [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]
|
44
|
Douglas KW, Gilleece M, Hayden P, Hunter H, Johnson PRE, Kallmeyer C, Malladi RK, Paneesha S, Pawson R, Quinn M, Raj K, Richardson D, Robinson S, Russell N, Snowden J, Sureda A, Tholouli E, Thomson K, Watts M, Wilson KM. UK consensus statement on the use of plerixafor to facilitate autologous peripheral blood stem cell collection to support high-dose chemoradiotherapy for patients with malignancy. J Clin Apher 2017. [PMID: 28631842 DOI: 10.1002/jca.21563] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Plerixafor is a CXC chemokine receptor (CXCR4) antagonist that mobilizes stem cells in the peripheral blood. It is indicated (in combination with granulocyte-colony stimulating factor [G-CSF]) to enhance the harvest of adequate quantities of cluster differentiation (CD) 34+ cells for autologous transplantation in patients with lymphoma or multiple myeloma whose cells mobilize poorly. Strategies for use include delayed re-mobilization after a failed mobilization attempt with G-CSF, and rescue or pre-emptive mobilization in patients in whom mobilization with G-CSF is likely to fail. Pre-emptive use has the advantage that it avoids the need to re-schedule the transplant procedure, with its attendant inconvenience, quality-of-life issues for the patient and cost of additional admissions to the transplant unit. UK experience from 2 major centers suggests that pre-emptive plerixafor is associated with an incremental drug cost of less than £2000 when averaged over all patients undergoing peripheral blood stem cell (PBSC) transplant. A CD34+ cell count of <15 µl-1 at the time of recovery after chemomobilization or after four days of G-CSF treatment, or an apheresis yield of <1 × 106 CD34+ cells/kg on the first day of apheresis, could be used to predict the need for pre-emptive plerixafor.
Collapse
Affiliation(s)
- Kenneth W Douglas
- Clinical Apheresis Unit, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Maria Gilleece
- Yorkshire Blood and Marrow Transplant Programme, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Patrick Hayden
- Haematology Department, St James's Hospital, Dublin, Ireland
| | - Hannah Hunter
- Haematology Department, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Peter R E Johnson
- Department of Haematology, Western General Hospital, Edinburgh, United Kingdom
| | - Charlotte Kallmeyer
- Department of Haematology, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
| | - Ram K Malladi
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Shankara Paneesha
- Department of Haematology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Rachel Pawson
- Tissue Services and Cell Banking, NHS Blood and Transplant, Bristol, United Kingdom
| | - Michael Quinn
- Department of Haematology, Belfast NHS Trust, Belfast, United Kingdom
| | - Kavita Raj
- Haematological Cancer Services, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Deborah Richardson
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | - Stephen Robinson
- Bristol Haematology Unit, University Hospitals Bristol, Bristol, United Kingdom
| | - Nigel Russell
- Clinical Haematology, Nottingham University Hospital, Nottingham, United Kingdom
| | - John Snowden
- Department of Haematology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Anna Sureda
- Department of Haematology, Institut Catalá d'Oncologia, Barcelona, Spain
| | - Eleni Tholouli
- HSC Transplant Services, Department of Haematology, Central Manchester University Hospitals, Manchester, United Kingdom
| | - Kirsty Thomson
- Department of Clinical Haematology, University College Hospitals, London, United Kingdom
| | - Mike Watts
- Wolfson Cellular Therapies Unit, University College Hospitals, London, United Kingdom
| | - Keith M Wilson
- Department of Haematology, Cardiff & Vale University Health Board, Cardiff, United Kingdom
| |
Collapse
|
45
|
Su MG, Min Q, Cao SQ, Sun DX, Hayden P, O'Sullivan G, Dong CZ. Evolution analysis of EUV radiation from laser-produced tin plasmas based on a radiation hydrodynamics model. Sci Rep 2017; 7:45212. [PMID: 28332621 PMCID: PMC5362918 DOI: 10.1038/srep45212] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/20/2017] [Indexed: 01/06/2023] Open
Abstract
One of fundamental aims of extreme ultraviolet (EUV) lithography is to maximize brightness or conversion efficiency of laser energy to radiation at specific wavelengths from laser produced plasmas (LPPs) of specific elements for matching to available multilayer optical systems. Tin LPPs have been chosen for operation at a wavelength of 13.5 nm. For an investigation of EUV radiation of laser-produced tin plasmas, it is crucial to study the related atomic processes and their evolution so as to reliably predict the optimum plasma and experimental conditions. Here, we present a simplified radiation hydrodynamic model based on the fluid dynamic equations and the radiative transfer equation to rapidly investigate the evolution of radiation properties and dynamics in laser-produced tin plasmas. The self-absorption features of EUV spectra measured at an angle of 45° to the direction of plasma expansion have been successfully simulated and explained, and the evolution of some parameters, such as the plasma temperature, ion distribution and density, expansion size and velocity, have also been evaluated. Our results should be useful for further understanding of current research on extreme ultraviolet and soft X-ray source development for applications such as lithography, metrology and biological imaging.
Collapse
Affiliation(s)
- M G Su
- Key Laboratory of Atomic and Molecular Physics &Functional Material of Gansu Province, College of Physics and Electronic Engineering, Northwest Normal University, Lanzhou 730070, China
| | - Q Min
- Key Laboratory of Atomic and Molecular Physics &Functional Material of Gansu Province, College of Physics and Electronic Engineering, Northwest Normal University, Lanzhou 730070, China
| | - S Q Cao
- Key Laboratory of Atomic and Molecular Physics &Functional Material of Gansu Province, College of Physics and Electronic Engineering, Northwest Normal University, Lanzhou 730070, China
| | - D X Sun
- Key Laboratory of Atomic and Molecular Physics &Functional Material of Gansu Province, College of Physics and Electronic Engineering, Northwest Normal University, Lanzhou 730070, China
| | - P Hayden
- School of Physical Sciences and National Centre for Plasma Science and Technology, Dublin City University, Glasnevin, Ireland
| | - G O'Sullivan
- School of Physics, University College Dublin, Belfield, Dublin 4, Ireland
| | - C Z Dong
- Key Laboratory of Atomic and Molecular Physics &Functional Material of Gansu Province, College of Physics and Electronic Engineering, Northwest Normal University, Lanzhou 730070, China
| |
Collapse
|
46
|
Elhassadi E, Flavin R, Browne P, Conneally E, Hayden P, Quinn F, Higgins E, Vandenberghe E. Transformed follicular lymphoma (tFL): consolidation therapy may improve survival. Ir J Med Sci 2017; 186:589-595. [PMID: 28321641 DOI: 10.1007/s11845-017-1594-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 03/02/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Retrospective study to evaluate the outcome of patients with transformed follicular lymphoma (tFL) treated with rituximab-containing chemotherapy and consolidation. PATIENTS AND METHODS Patients diagnosed with tFL from 2003 to 2013 treated with consolidation therapy with last follow-up in December 2015 were identified from the institutional lymphoma database and included in this study. Data collected included age, gender, stage, interval to tFL diagnosis, R-IPI score, histological diagnosis and therapy. The treatment algorithm used was stratified for age, performance status (PS) and sibling donor availability using R-chemotherapy induction followed by consolidation with allogeneic stem cell transplant (SCT), autologous SCT, Zevalin or rituximab maintenance (RM). Patients with B-cell lymphoma with features intermediate between diffuse large B-cell lymphoma and Burkitt's lymphoma (BCL-U), with FISH-proven t(14;18) and t(8;14) and their variants were excluded. RESULTS Four hundred patients were diagnosed with FL of whom 26 (7%) developed histologically proven tFL. The group was predominantly male (73%) with a median age at transformation of 53 (range 27-72) years and 85% presented with stage III/IV disease. Thirteen (50%) patients presented with de novo tFL and the remainder had previously diagnosed FL, with a median time to transformation of 5.7 (range 1-15) years. The median follow-up time from tFL diagnosis to December 2015 is 8 (range 4-14) years. All patients received immuno-chemotherapy achieving an overall response rate (ORR) of 100%. Fourteen (54%), patients were transplant eligible and based on donor availability, six had an auto-SCT only, five had an allo-SCT only and three had a matched unrelated allo-SCT for a post-auto-SCT relapse. The 12 patients (46%) who were not transplant eligible were consolidated with rituximab maintenance (RM) in nine (35%) and Zevalin in three (11%) cases. The overall survival (OS) and progression-free survival (PFS) for the series at 5 years were, 92 and 73%, respectively. CONCLUSION This consecutively treated series of 26 patients with tFL have had a better outcome than expected which may be due to the use of rituximab-chemotherapy and a consolidation strategy based on age, PS and availability of a sibling donor.
Collapse
Affiliation(s)
- E Elhassadi
- Haematology Department, St James Hospital, Dublin, Ireland.
- Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland.
| | - R Flavin
- Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland
- Histopathology Department, St. James's Hospital, Dublin, Ireland
| | - P Browne
- Haematology Department, St James Hospital, Dublin, Ireland
- Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland
| | - E Conneally
- Haematology Department, St James Hospital, Dublin, Ireland
- Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland
| | - P Hayden
- Haematology Department, St James Hospital, Dublin, Ireland
- Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland
| | - F Quinn
- Cancer Molecular Diagnostic Department, St. James's Hospital, Dublin, Ireland
| | - E Higgins
- Haematology Department, St James Hospital, Dublin, Ireland
| | - E Vandenberghe
- Haematology Department, St James Hospital, Dublin, Ireland
- Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
47
|
Gallacher DJ, Robins AG, Burt A, Chadwick S, Hayden P, Williams M. Dispersion of positron emitting radioactive gases in a complex urban building array: a comparison of dose modelling approaches. J Radiol Prot 2016; 36:746-784. [PMID: 27655037 DOI: 10.1088/0952-4746/36/4/746] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A radiological assessment was carried out on the release of positron-emitting radioactive gases from a roof-level stack at a central London site. Different modelling approaches were performed to investigate the range of radiation doses to representative persons. Contributions from plume inhalation, gamma shine and immersion to effective dose were taken into account. Dry and wet surface deposition on the roof, and exposure from contamination on the skin of roof-workers, added only a mean 4.7% to effective dose and were neglected. A 1:200 scale model, consisting of the stack and surrounding buildings, was tested in a wind tunnel to simulate pollutant dispersion in the near-field region i.e. rooftop. Concentration field measurements in the wind tunnel were converted into effective dose, including for roof-workers installing glass cladding to the stack building. Changes in the building shape, from addition of the cladding layer, were investigated in terms of the near-field flow pattern and significant differences found between the two cases. Pollutant concentrations were also modelled using Air Dispersion Modelling System (ADMS) and the results used to calculate the effective dose using the same meteorological data set and source release terms. Sector averaged wind tunnel dose estimates were greater than the ADMS figure by approximately a factor of two to three. Different stack release heights were investigated in the wind tunnel and ADMS simulations in order to determine the best height for the replacement flue stack for the building. Other techniques were investigated: building wake models, modified Gaussian plume methods and uniform dilution into a hemispherical volume to show the wide variation in predicted dose possible with different approaches. Large differences found between simpler analytic approaches indicated that more robust radiological assessments, based on more complex modelling approaches, were required to achieve satisfactory estimates of radiation dose to representative groups in adjacent buildings and on the building rooftop.
Collapse
Affiliation(s)
- D J Gallacher
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | | |
Collapse
|
48
|
Gallacher DJ, Robins AG, Hayden P. Conversion of simulated radioactive pollutant gas concentrations for a complex building array into radiation dose. J Radiol Prot 2016; 36:785-818. [PMID: 27655064 DOI: 10.1088/0952-4746/36/4/785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Methods used to convert wind tunnel and ADMS concentration field data for a complex building array into effective radiation dose were developed based on simulations of a site in central London. Pollutant source terms were from positron emitting gases released from a cyclotron and clinical PET radiotracer facility. Five years of meteorological data were analysed to determine the probability distribution of wind direction and speed. A hemispherical plume cloud model (both static and moving) was developed which enabled an expression of gamma-ray dose, taking into account build-up factors in air, in terms of analytic functions in this geometry. The standard building wake model is presented, but this is extended and developed in a new model to cover the concentration field in the vicinity of a roof top structure recirculation zone, which is then related to the concentration in the main building wake zone. For all models presented the effective dose was determined from inhalation, positron cloud immersion and gamma ray plume contributions. Results of applying these models for determination of radiation dose for a particular site are presented elsewhere.
Collapse
Affiliation(s)
- D J Gallacher
- Medical Physics Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | | |
Collapse
|
49
|
Moses E, Wang T, Corbett S, Jackson GR, Drizik E, Perdomo C, Perdomo C, Kleerup E, Brooks D, O'Connor G, Dubinett S, Hayden P, Lenburg ME, Spira A. Molecular Impact of Electronic Cigarette Aerosol Exposure in Human Bronchial Epithelium. Toxicol Sci 2016; 155:248-257. [PMID: 27701119 DOI: 10.1093/toxsci/kfw198] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Little evidence is available regarding the physiological effects of exposure to electronic cigarette (ECIG) aerosol. We sought to determine the molecular impact of ECIG aerosol exposure in human bronchial epithelial cells (HBECs). Gene-expression profiling was conducted in primary grown at air liquid interface and exposed to 1 of 4 different ECIG aerosols, traditional tobacco cigarette (TCIG) smoke, or clean air. Findings were validated experimentally with quantitative polymerase chain reaction and a reactive oxygen species immunoassay. Using gene set enrichment analysis, signatures of in vitro ECIG exposure were compared with those generated from bronchial epithelial brushings of current TCIG smokers and former TCIG smokers currently using ECIGs. We found 546 genes differentially expressed across the ECIG, TCIG, and air-exposed groups of HBECs (ANOVA; FDR q < .05; fold change > 1.5). A subset of these changes were shared between TCIG- and ECIG-exposed HBECs. ECIG exposure induced genes involved in oxidative and xenobiotic stress pathways and increased a marker of reactive oxygen species production in a dose-dependent manner. ECIG exposure decreased expression of genes involved in cilia assembly and movement. Furthermore, gene-expression differences observed in vitro were concordant with differences observed in airway epithelium collected from ECIG users (q < .01). In summary, our data suggest that ECIG aerosol can induce gene-expression changes in bronchial airway epithelium in vitro, some of which are shared with TCIG smoke. These changes were generally less pronounced than the effects of TCIG exposure and were more pronounced in ECIG products containing nicotine than those without nicotine. Our data further suggest that the gene-expression alterations seen with the in vitro exposure system reflects the physiological effects experienced in vivo by ECIG users.
Collapse
Affiliation(s)
- Elizabeth Moses
- Section of Computational Biomedicine, Department of Medicine Boston University School of Medicine, Boston, Massachusetts 02118
| | - Teresa Wang
- Section of Computational Biomedicine, Department of Medicine Boston University School of Medicine, Boston, Massachusetts 02118
| | - Sean Corbett
- Section of Computational Biomedicine, Department of Medicine Boston University School of Medicine, Boston, Massachusetts 02118
| | | | - Eduard Drizik
- Section of Computational Biomedicine, Department of Medicine Boston University School of Medicine, Boston, Massachusetts 02118
| | - Catalina Perdomo
- Section of Computational Biomedicine, Department of Medicine Boston University School of Medicine, Boston, Massachusetts 02118
| | - Claudia Perdomo
- University of California Los Angeles, Los Angeles, California 90095
| | - Eric Kleerup
- University of California Los Angeles, Los Angeles, California 90095
| | - Daniel Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts 02118
| | - George O'Connor
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts 02118
| | - Steven Dubinett
- University of California Los Angeles, Los Angeles, California 90095
| | | | - Marc E Lenburg
- Section of Computational Biomedicine, Department of Medicine Boston University School of Medicine, Boston, Massachusetts 02118;
| | - Avrum Spira
- Section of Computational Biomedicine, Department of Medicine Boston University School of Medicine, Boston, Massachusetts 02118.,Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts 02118
| |
Collapse
|
50
|
Behrsing H, Raabe H, Manuppello J, Bombick B, Curren R, Sullivan K, Sethi S, Phipps R, Tesfaigzi Y, Yan S, D'Ruiz C, Tarran R, Constant S, Phillips G, Gaça M, Hayden P, Cao X, Mathis C, Hoeng J, Braun A, Hill E. Assessment of in vitro COPD models for tobacco regulatory science: Workshop proceedings, conclusions and paths forward for in vitro model use. Altern Lab Anim 2016; 44:129-66. [PMID: 27256455 DOI: 10.1177/026119291604400206] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Family Smoking Prevention and Tobacco Control Act of 2009 established the Food and Drug Administration Center for Tobacco Products (FDA-CTP), and gave it regulatory authority over the marketing, manufacture and distribution of tobacco products, including those termed 'modified risk'. On 8-10 December 2014, IIVS organised a workshop conference, entitled Assessment of In Vitro COPD Models for Tobacco Regulatory Science, to bring together stakeholders representing regulatory agencies, academia, industry and animal protection, to address the research priorities articulated by the FDA-CTP. Specific topics were covered to assess the status of current in vitro technologies as they are applied to understanding the adverse pulmonary events resulting from tobacco product exposure, and in particular, the progression of chronic obstructive pulmonary disease (COPD). The four topics covered were: a) Inflammation and Oxidative Stress; b) Ciliary Dysfunction and Ion Transport; c) Goblet Cell Hyperplasia and Mucus Production; and d) Parenchymal/Bronchial Tissue Destruction and Remodelling. The 2.5 day workshop included 18 expert speakers, plus poster sessions, networking and breakout sessions, which identified key findings and provided recommendations to advance the in vitro technologies and assays used to evaluate tobacco-induced disease etiologies. The workshop summary was reported at the 2015 Society of Toxicology Annual Meeting, and the recommendations led to an IIVS-organised technical workshop in June 2015, entitled Goblet Cell Hyperplasia, Mucus Production, and Ciliary Beating Assays, to assess these assays and to conduct a proof-of-principle multi-laboratory exercise to determine their suitability for standardisation. Here, we report on the proceedings, recommendations and outcomes of the December 2014 workshop, including paths forward to continue the development of non-animal methods to evaluate tissue responses that model the disease processes that may lead to COPD, a major cause of mortality worldwide.
Collapse
Affiliation(s)
- Holger Behrsing
- Institute for In Vitro Sciences, Inc., Gaithersburg, MD, USA
| | - Hans Raabe
- Institute for In Vitro Sciences, Inc., Gaithersburg, MD, USA
| | | | - Betsy Bombick
- R.J. Reynolds Tobacco Company, Winston-Salem, NC, USA
| | - Rodger Curren
- Institute for In Vitro Sciences, Inc., Gaithersburg, MD, USA
| | - Kristie Sullivan
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Sanjay Sethi
- University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | | | - Sherwin Yan
- Lorillard Tobacco Company, Greensboro, NC, USA
| | - Carl D'Ruiz
- Lorillard Tobacco Company, Greensboro, NC, USA
| | | | | | - Gary Phillips
- British American Tobacco (Investments) Ltd, Southampton, UK
| | - Marianna Gaça
- British American Tobacco (Investments) Ltd, Southampton, UK
| | | | - Xuefei Cao
- FDA-National Center for Toxicological Research, Jefferson, AR, USA
| | | | - Julia Hoeng
- Philip Morris Product SA, Neuchâtel, Switzerland
| | - Armin Braun
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Erin Hill
- Institute for In Vitro Sciences, Inc., Gaithersburg, MD, USA
| |
Collapse
|