Long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation as first transplant for high-risk Hodgkin lymphoma: a retrospective analysis from the Lymphoma Working Party-EBMT

We analysed long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation (allo-HSCT) as a first transplant for high-risk Hodgkin lymphoma (HL). One hundred and ninety patients were included in this study, 63% of them had previously received brentuximab vedotin and/or checkpoint inhibitors. Seventy patients (37%) received an unrelated donor allo-HSCT, 99 (51%) had myeloablative conditioning (MAC) and 60% had in vivo T-cell/depleted grafts (TCD). The 100-day cumulative incidence (CI) of grade II-IV acute graft-versus-host disease (GVHD) was 25% and the 3-year CI of chronic GVHD was 38%. The 3-year CI of non-relapse mortality (NRM) and relapse rate were 21% and 38% respectively. After a median follow-up of 58 months, 3-year overall survival (OS) and progression-free survival (PFS) were 58% and 41% respectively. Multivariate analysis showed that, in comparison to reduced-intensity conditioning regimens with or without TCD, MAC using TCD had similar NRM and a lower risk of relapse leading to significantly better OS and PFS. MAC without TCD was associated with higher NRM and worse survival outcomes. These results suggest that in patients with high-risk HL and candidates of allo-HSCT, a MAC strategy with TCD might be the best option.

Postremission Consolidation by Autologous Hematopoietic Cell Transplantation (HCT) for Acute Myeloid Leukemia in First Complete Remission (CR) and Negative Implications for Subsequent Allogeneic HCT in Second CR: A Study by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

After autologous hematopoietic cell transplantation (HCT) in the first complete remission (CR1), patients with acute myeloid leukemia (AML) may relapse and undergo allogeneic HCT in the second complete remission (CR2). The aim of this study was to analyze the outcome of allogeneic HCT performed in CR2 comparing patients with prior consolidation by autologous HCT versus patients with chemotherapy consolidation. Included were 2619 adults with allogeneic HCT in CR2 from 2000 to 2017 with (n = 417) or without (n = 2202) prior autologous HCT. Patient groups were not entirely comparable; patients with prior autologous HCT were younger, had less often a favorable cytogenetic profile, had more commonly donors other than matched siblings, and more often received reduced-intensity conditioning. In multivariate analysis, nonrelapse mortality risks in patients with prior autologous HCT were 1.34 (1.07 to 1.67; P = .01) after adjustment for age, cytogenetic risk, transplant year, donor, conditioning intensity, sex matching, interval diagnosis-relapse, and relapse-allogeneic HCT as compared with chemotherapy consolidation. Similarly, risks of events in leukemia-free survival and graft-versus-host disease, relapse-free survival were higher with prior autologous HCT, 1.17 (1.01 to 1.35), P = .03 and 1.18 (1.03 to 1.35), P = .02, respectively. Risk of death was also higher, 1.13 (0.97 to 1.32), P = .1, but this was not significant. Postremission consolidation with autologous HCT for AML in CR1 increases toxicity of subsequent allogeneic HCT in CR2.

Provision of cellular blood components to CMV-seronegative patients undergoing allogeneic stem cell transplantation in the UK: survey of UK transplant centres

OBJECTIVES

To identify current UK practice with regards to provision of blood components for cytomegalovirus (CMV)-seronegative, potential, allogeneic stem cell recipients of seronegative grafts.

BACKGROUND

Infection with CMV remains a major cause of morbidity and mortality after allogeneic stem cell transplantation (aSCT). CMV transmission has been a risk associated with the transfusion of blood components from previously exposed donors, but leucocyte reduction has been demonstrated to minimise this risk. In 2012, the UK Advisory Committee for the Safety of Tissues and Organs (SaBTO) recommended that CMV-unselected components could be safely transfused without increased risk of CMV transmission.

METHODS

We surveyed UK aSCT centres to establish current practice.

RESULTS

Fifteen adult and seven paediatric centres (75%) responded; 22·7% continue to provide components from CMV-seronegative donors. Reasons cited include the continued perceived risk of CMV transmission by blood transfusion, its associated morbidity and concerns regarding potential for ambiguous CMV serostatus in seronegative potential transplant recipients due to passive antibody transfer from CMV-seropositive blood donors, leading to erroneous donor/recipient CMV matching at transplant.

CONCLUSIONS

The survey demonstrated a surprisingly high rate (22.7%) of centres continuing to provide blood components from CMV-seronegative donors despite SaBTO guidance.

Impact of ABO blood group mismatch in alemtuzumab-based reduced-intensity conditioned haematopoietic SCT

The impact of ABO incompatibility on clinical outcomes following haematopoietic SCT (HSCT) remains controversial. This retrospective study assessed the effect of ABO mismatch on transplant outcomes and transfusion requirements in 594 patients undergoing reduced-intensity conditioned (RIC) HSCT with alemtuzumab in three UK transplant centres. We found no significant effects of minor, major or bidirectional ABO mismatch on overall survival, relapse-free survival, nonrelapse mortality or relapse incidence. Although the rate of acute GVHD was unaffected by ABO mismatch, the incidence of extensive chronic GVHD was higher in patients with minor and major mismatch compared with those who were ABO matched (hazard ratio (HR) 1.74, P=0.032 for minor, HR 1.69 P=0.0036 for major mismatch). Red cell and platelet transfusion requirements in the first 100 days post transplant did not differ by ABO mismatch. In this large UK series, ABO mismatch in RIC HSCT has no clinically significant effect on survival outcomes but appears to modify susceptibility to extensive chronic GVHD.

Extracorporeal photopheresis for treatment of adults and children with acute GVHD: UK consensus statement and review of published literature

Extracorporeal photopheresis (ECP) has been used for over 20 years to treat acute GVHD (aGVHD) and chronic GVHD. Evidence on the efficacy of response in aGVHD has continued to accrue and data suggest that there is a good response and prolonged survival in both children and adults with grade II-IV aGVHD. Unlike chronic GVHD where treatment schedules are typically one or two times monthly for 12-18 months, patients with aGVHD respond rapidly to an intense weekly treatment schedule for 8 weeks, typically allowing steroids to be discontinued without flare-ups of aGVHD. Maintenance ECP therapy is generally not required. Many centres across Europe and United States treat aGVHD with ECP as second-line therapy and responses are excellent in a subset of patients. Unlike other second-line therapies, ECP is not immunosuppressive and has no reported drug interactions. Importantly, ECP does not have a negative impact on the graft-versus-malignancy effect of the transplant. This statement aims to select those patients most likely to respond to treatment and summarises treatment and monitoring schedules for the management of aGVHD in adult and paediatric patients to ensure the correct patients are treated with the optimal protocol for efficacy.

Post-transplant T cell chimerism predicts graft versus host disease but not disease relapse in patients undergoing an alemtuzumab based reduced intensity conditioned allogeneic transplant

In this multicentre retrospective study we have studied the impact of T cell chimerism on the outcome of 133 patients undergoing an alemtuzumab based reduced intensity conditioning allograft (RIC). The median age of the patients was 50 years (range 42-55 years). 77 patients were transplanted using an HLA identical sibling donor while 56 patients received a fully matched volunteer unrelated donor graft. 64 patients had a lymphoid malignancy and 69 were transplanted for a myeloid malignancy. 38 patients (29%) relapsed with no significant difference in risk of relapse between patients developing full donor and mixed donor chimerism in the T-cell compartment on D+90 and D+180 post transplant. Day 90 full donor T cell chimerism correlated with an increased incidence of acute GVHD according to NIH criteria (p=0.0004) and the subsequent development of chronic GVHD. Consistent with previous observations, our results confirmed a correlation between the establishment of T cell full donor chimerism and acute GVHD in T deplete RIC allografts. However our study failed to identify any correlation between T cell chimerism and relapse risk and challenge the use of pre-emptive donor lymphocyte infusions (DLI) in patients with mixed T cell chimerism transplanted using an alemtuzumab based RIC regimen.

Automatic segmentation of histological structures in mammary gland tissue sections

Real-time three-dimensional (3-D) reconstruction of epithelial structures in human mammary gland tissue blocks mapped with selected markers would be an extremely helpful tool for diagnosing breast cancer and planning treatment. Besides its clear clinical application, this tool could also shed a great deal of light on the molecular basis of the initiation and progression of breast cancer. We present a framework for real-time segmentation of epithelial structures in two-dimensional (2-D) images of sections of normal and neoplastic mammary gland tissue blocks. Complete 3-D rendering of the tissue can then be done by surface rendering of the structures detected in consecutive sections of the blocks. Paraffin-embedded or frozen tissue blocks are first sliced and sections are stained with hematoxylin and eosin. The sections are then imaged using conventional bright-field microscopy and their background corrected using a phantom image. We then use the fast-marching algorithm to roughly extract the contours of the different morphological structures in the images. The result is then refined with the level-set method, which converges to an accurate (subpixel) solution for the segmentation problem. Finally, our system stacks together the 2-D results obtained in order to reconstruct a 3-D representation of the entire tissue block under study. Our method is illustrated with results from the segmentation of human and mouse mammary gland tissue samples.

Correlation-based methods of automatic particle detection in electron microscopy images with smoothing by anisotropic diffusion

Two methods of correlation-based automatic particle detection in electron microscopy images are compared - computing a cross-correlation function or a local correlation coefficient vs. azimuthally averaged reference projections (either from a model or from experimental particle images). The ability of smoothing images by anisotropic diffusion to improve the performance of particle detection is also considered. Anisotropic diffusion is an effective method of preprocessing that enhances the edges and overall shape of particles while reducing noise. It is found that anisotropic diffusion improves particle detection by a local correlation coefficient when projections from a high-resolution reconstruction are used as references. When references from experimental particle images are used, a cross-correlation function shows a more marked improvement in particle detection in images smoothed by anisotropic diffusion.

Segmentation of nuclei and cells using membrane related protein markers

Segmenting individual cell nuclei from microscope images normally involves volume labelling of the nuclei with a DNA stain. However, this method often fails when the nuclei are tightly clustered in the tissue, because there is little evidence from the images on where the borders of the nuclei are. In this paper we present a method which solves this limitation and furthermore enables segmentation of whole cells. Instead of using volume stains, we used stains that specifically label the surface of nuclei or cells: lamins for the nuclear envelope and alpha-6 or beta-1 integrins for the cellular surface. The segmentation is performed by identifying unique seeds for each nucleus/cell and expanding the boundaries of the seeds until they reach the limits of the nucleus/cell, as delimited by the lamin or integrin staining, using gradient-curvature flow techniques. We tested the algorithm using computer-generated objects to evaluate its robustness against noise and applied it to cells in culture and to tissue specimens. In all the cases that we present the algorithm gave accurate results.

A geometric model for 3-D confocal image analysis

In this paper, we use partial-differential-equation-based filtering as a preprocessing and post processing strategy for computer-aided cytology. We wish to accurately extract and classify the shapes of nuclei from confocal microscopy images, which is a prerequisite to an accurate quantitative intranuclear (genotypic and phenotypic) and internuclear (tissue structure) analysis of tissue and cultured specimens. First, we study the use of a geometry-driven edge-preserving image smoothing mechanism before nuclear segmentation. We show how this filter outperforms other widely-used filters in that it provides higher edge fidelity. Then we apply the same filter, with a different initial condition, to smooth nuclear surfaces and obtain sub-pixel accuracy. Finally we use another instance of the geometrical filter to correct for misinterpretations of the nuclear surface by the segmentation algorithm. Our prefiltering and post filtering nicely complements our initial segmentation strategy, in that it provides substantial and measurable improvement in the definition of the nuclear surfaces.

Subjective surfaces: a method for completing missing boundaries

We present a model and algorithm for segmentation of images with missing boundaries. In many situations, the human visual system fills in missing gaps in edges and boundaries, building and completing information that is not present. This presents a considerable challenge in computer vision, since most algorithms attempt to exploit existing data. Completion models, which postulate how to construct missing data, are popular but are often trained and specific to particular images. In this paper, we take the following perspective: We consider a reference point within an image as given and then develop an algorithm that tries to build missing information on the basis of the given point of view and the available information as boundary data to the algorithm. We test the algorithm on some standard images, including the classical triangle of Kanizsa and low signal/noise ratio medical images.

A general framework for low level vision

We introduce a new geometrical framework based on which natural flows for image scale space and enhancement are presented. We consider intensity images as surfaces in the (x, I) space. The image is, thereby, a two-dimensional (2-D) surface in three-dimensional (3-D) space for gray-level images, and 2-D surfaces in five dimensions for color images. The new formulation unifies many classical schemes and algorithms via a simple scaling of the intensity contrast, and results in new and efficient schemes. Extensions to multidimensional signals become natural and lead to powerful denoising and scale space algorithms.

An O(N log N) algorithm for shape modeling

We present a shape-recovery technique in two dimensions and three dimensions with specific applications in modeling anatomical shapes from medical images. This algorithm models extremely corrugated structures like the brain, is topologically adaptable, and runs in O(N log N) time, where N is the total number of points in the domain. Our technique is based on a level set shape-recovery scheme recently introduced by the authors and the fast marching method for computing solutions to static Hamilton-Jacobi equations.

A unified approach to noise removal, image enhancement, and shape recovery

We present a unified approach to noise removal, image enhancement, and shape recovery in images. The underlying approach relies on the level set formulation of the curve and surface motion, which leads to a class of PDE-based algorithms. Beginning with an image, the first stage of this approach removes noise and enhances the image by evolving the image under flow controlled by min/max curvature and by the mean curvature. This stage is applicable to both salt-and-pepper grey-scale noise and full-image continuous noise present in black and white images, grey-scale images, texture images, and color images. The noise removal/enhancement schemes applied in this stage contain only one enhancement parameter, which in most cases is automatically chosen. The other key advantage of our approach is that a stopping criteria is automatically picked from the image; continued application of the scheme produces no further change. The second stage of our approach is the shape recovery of a desired object; we again exploit the level set approach to evolve an initial curve/surface toward the desired boundary, driven by an image-dependent speed function that automatically stops at the desired boundary.

Image processing via level set curvature flow

We present a controlled image smoothing and enhancement method based on a curvature flow interpretation of the geometric heat equation. Compared to existing techniques, the model has several distinct advantages. (i) It contains just one enhancement parameter. (ii) The scheme naturally inherits a stopping criterion from the image; continued application of the scheme produces no further change. (iii) The method is one of the fastest possible schemes based on a curvature-controlled approach.