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Leserer S, Graf T, Franke M, Bogdanov R, Arrieta-Bolaños E, Buttkereit U, Leimkühler N, Fleischhauer K, Reinhardt HC, Beelen DW, Turki AT. Time series clustering of T cell subsets dissects heterogeneity in immune reconstitution and clinical outcomes among MUD-HCT patients receiving ATG or PTCy. Front Immunol 2023; 14:1082727. [PMID: 37020562 PMCID: PMC10067907 DOI: 10.3389/fimmu.2023.1082727] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/02/2023] [Indexed: 03/22/2023] Open
Abstract
IntroductionAnti-T-lymphocyte globulin (ATG) or post-transplant cyclophosphamide (PTCy) prevent graft-versus-host disease (GVHD) after hematopoietic cell transplantation (HCT), yet individual patients benefit differentially.MethodsGiven the sparse comparative data on the impact of cellular immune reconstitution in this setting, we studied flow cytometry and clinical outcomes in 339 recipients of 10/10 matched-unrelated donor (MUD) HCT using either ATG (n=304) or PTCy (n=35) for in vivo T cell manipulation along with a haploidentical PTCy control cohort (n=45). Longitudinal cellular immune reconstitution data were analyzed conventionally and with a data science approach using clustering with dynamic time warping to determine the similarity between time-series of T cell subsets.ResultsConsistent with published studies, no significant differences in clinical outcomes were observed at the cohort level between MUD-ATG and MUD-PTCy. However, cellular reconstitution revealed preferences for distinct T cell subpopulations associating with GVHD protection in each setting. Starting early after HCT, MUD-PTCy patients had higher regulatory T cell levels after HCT (p <0.0001), while MUD-ATG patients presented with higher levels of γδ T- or NKT cells (both p <0.0001). Time-series clustering further dissected the patient population’s heterogeneity revealing distinct immune reconstitution clusters. Importantly, it identified phenotypes that reproducibly associated with impaired clinical outcomes within the same in vivo T cell manipulation platform. Exemplarily, patients with lower activated- and αβ T cell counts had significantly higher NRM (p=0.032) and relapse rates (p =0.01).DiscussionThe improved understanding of the heterogeneity of cellular reconstitution in MUD patients with T cell manipulation both at the cohort and individual level may support clinicians in managing HCT complications.
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Affiliation(s)
- Saskia Leserer
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Computational Hematology Lab, Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Institute for Experimental Cellular Therapy, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Theresa Graf
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Computational Hematology Lab, Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martina Franke
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Rashit Bogdanov
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Computational Hematology Lab, Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Esteban Arrieta-Bolaños
- Institute for Experimental Cellular Therapy, West-German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner site Essen/Düsseldorf, Essen, Germany
| | - Ulrike Buttkereit
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Nils Leimkühler
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Katharina Fleischhauer
- Institute for Experimental Cellular Therapy, West-German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner site Essen/Düsseldorf, Essen, Germany
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Research Center Cologne Essen (CCCE), Essen, Germany
| | - Dietrich W. Beelen
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Amin T. Turki
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Computational Hematology Lab, Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Institute for Experimental Cellular Therapy, West-German Cancer Center, University Hospital Essen, Essen, Germany
- *Correspondence: Amin T. Turki,
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Eisenberg L, Brossette C, Rauch J, Grandjean A, Ottinger H, Rissland J, Schwarz U, Graf N, Beelen DW, Kiefer S, Pfeifer N, Turki AT, Bittenbring J, Kaddu‐Mulindwa D, Götz K, Och K, Lehr T, Brossette C, Theobald S, Braun Y, Graf N, Kadir A, Schwarz U, Grandjean A, Ihle M, Riede C, Fix S, Turki AT, Beelen DW, Ottinger H, Tsachakis‐Mück N, Bogdanov R, Koldehoff M, Steckel N, Yi J, Fokaite A, Klisanin V, Kordelas L, Garay D, Gavilanes X, Lams RF, Pillibeit A, Leserer S, Graf T, Hilbig S, Weiß J, Brossette C, Rauch J, Grandjean A, Ottinger H, Rissland J, Schwarz U, Graf N, Beelen DW, Kiefer S, Pfeifer N, Turki AT. Time-dependent prediction of mortality and cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation using machine learning. Am J Hematol 2022; 97:1309-1323. [PMID: 36071578 DOI: 10.1002/ajh.26671] [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: 06/22/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 01/24/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) effectively treats high-risk hematologic diseases but can entail HCT-specific complications, which may be minimized by appropriate patient management, supported by accurate, individual risk estimation. However, almost all HCT risk scores are limited to a single risk assessment before HCT without incorporation of additional data. We developed machine learning models that integrate both baseline patient data and time-dependent laboratory measurements to individually predict mortality and cytomegalovirus (CMV) reactivation after HCT at multiple time points per patient. These gradient boosting machine models provide well-calibrated, time-dependent risk predictions and achieved areas under the receiver-operating characteristic of 0.92 and 0.83 and areas under the precision-recall curve of 0.58 and 0.62 for prediction of mortality and CMV reactivation, respectively, in a 21-day time window. Both models were successfully validated in a prospective, non-interventional study and performed on par with expert hematologists in a pilot comparison.
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Affiliation(s)
- Lisa Eisenberg
- Department of Computer Science, University of Tübingen, Tübingen, Germany.,Institute of Bioinformatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
| | | | - Christian Brossette
- Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| | - Jochen Rauch
- Department of Biomedical Data & Bioethics, Fraunhofer Institute for Biomedical Engineering (IBMT), Sulzbach, Germany
| | | | - Hellmut Ottinger
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Jürgen Rissland
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Ulf Schwarz
- Institute for Formal Ontology and Medical Information Science (IFOMIS), Saarland University, Saarbrücken, Germany
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| | - Dietrich W Beelen
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Stephan Kiefer
- Department of Biomedical Data & Bioethics, Fraunhofer Institute for Biomedical Engineering (IBMT), Sulzbach, Germany
| | - Nico Pfeifer
- Department of Computer Science, University of Tübingen, Tübingen, Germany.,Institute of Bioinformatics and Medical Informatics (IBMI), University of Tübingen, Tübingen, Germany
| | - Amin T Turki
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Christian Brossette
- Department of Pediatric Oncology and Hematology Saarland University Homburg Germany
| | - Jochen Rauch
- Fraunhofer Institute for Biomedical Engineering (IBMT) Sulzbach Germany
| | | | - Hellmut Ottinger
- Department of Hematology and Stem Cell Transplantation University Hospital Essen Essen Germany
| | - Jürgen Rissland
- Institute of Virology Saarland University Medical Center Homburg Germany
| | - Ulf Schwarz
- Institute for Formal Ontology and Medical Information Science (IFOMIS) Saarland University Saarbrücken Germany
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology Saarland University Homburg Germany
| | - Dietrich W. Beelen
- Department of Hematology and Stem Cell Transplantation University Hospital Essen Essen Germany
| | - Stephan Kiefer
- Fraunhofer Institute for Biomedical Engineering (IBMT) Sulzbach Germany
| | - Nico Pfeifer
- Department of Computer Science University of Tübingen Tübingen Germany
- Institute of Bioinformatics and Medical Informatics (IBMI) University of Tübingen Tübingen Germany
| | - Amin T. Turki
- Department of Hematology and Stem Cell Transplantation University Hospital Essen Essen Germany
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Leserer S, Bayraktar E, Trilling M, Bogdanov R, Arrieta‐Bolaños E, Tsachakis‐Mück N, Crivello P, Koldehoff M, Maaßen F, Ross RS, Fleischhauer K, Beelen DW, Turki AT. Cytomegalovirus kinetics after hematopoietic cell transplantation reveal peak titers with differential impact on mortality, relapse and immune reconstitution. Am J Hematol 2021; 96:436-445. [PMID: 33439488 DOI: 10.1002/ajh.26094] [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: 10/14/2020] [Revised: 12/23/2020] [Accepted: 01/08/2021] [Indexed: 12/16/2022]
Abstract
Even in the era of PCR-based monitoring, prophylaxis, and preemptive therapy, Cytomegalovirus (CMV) viremia remains a relevant cause of non-relapse mortality (NRM) after allogeneic hematopoietic cell transplantation (HCT). However, studies using binary analysis (presence/absence of CMV) reported contradicting data for NRM, overall survival and leukemia relapse. Here, we analyzed CMV replication kinetics in 11 508 whole blood PCR samples of 705 patients with HCT between 2012 and 2017. Using two independent models based on CMV peak titers and on the time point of first CMV reactivation, we stratified patients into risk cohorts. Each cohort had distinct cellular immune reconstitution profiles and differentiated for relevant clinical outcomes. Patients with high CMV peak titers had significantly reduced overall survival (HR 2.13, 95% CI 1.53-2.96; p < .0001), due to high NRM. Early impaired T cell reconstitution was a risk factor for high CMV peak titers, however relevant CMV viremia also related to boosted T cell reconstitution. Importantly, intermediate CMV peak titers associated with a significantly reduced relapse probability (HR 0.53, 95% CI 0.31-0.91; p = .022). In short, CMV kinetics models distinguished relevant clinical outcome cohorts beyond the R+ serostatus with distinct immune reconstitution patterns and resolve in part contradicting results of previous studies exclusively focused on the presence or absence of CMV.
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Affiliation(s)
- Saskia Leserer
- Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
- Computational Hematology Workgroup, Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
- Institute for Experimental Cellular Therapy, West‐German Cancer Center University Hospital Essen Essen Germany
| | - Evren Bayraktar
- Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
- Computational Hematology Workgroup, Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
- Chair of Applied Mathematics and Numerics III TU Dortmund University Dortmund Germany
| | - Mirko Trilling
- Institute for Virology University Hospital Essen, University Duisburg‐Essen Essen Germany
| | - Rashit Bogdanov
- Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
- Computational Hematology Workgroup, Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
| | - Esteban Arrieta‐Bolaños
- Institute for Experimental Cellular Therapy, West‐German Cancer Center University Hospital Essen Essen Germany
- German Cancer Consortium (DKTK) Heidelberg Germany
| | - Nikolaos Tsachakis‐Mück
- Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
| | - Pietro Crivello
- Institute for Experimental Cellular Therapy, West‐German Cancer Center University Hospital Essen Essen Germany
| | - Michael Koldehoff
- Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
| | - Fabienne Maaßen
- Institute for Experimental Cellular Therapy, West‐German Cancer Center University Hospital Essen Essen Germany
- Institute for Virology University Hospital Essen, University Duisburg‐Essen Essen Germany
| | - Rudolf Stefan Ross
- Institute for Virology University Hospital Essen, University Duisburg‐Essen Essen Germany
| | - Katharina Fleischhauer
- Institute for Experimental Cellular Therapy, West‐German Cancer Center University Hospital Essen Essen Germany
- German Cancer Consortium (DKTK) Heidelberg Germany
| | - Dietrich W. Beelen
- Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
| | - Amin T. Turki
- Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
- Computational Hematology Workgroup, Department of Hematology and Stem Cell Transplantation, West‐German Cancer Center University Hospital Essen Essen Germany
- Institute for Experimental Cellular Therapy, West‐German Cancer Center University Hospital Essen Essen Germany
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Gagelmann N, Badbaran A, Beelen DW, Salit RB, Stölzel F, Rautenberg C, Becker H, Radujkovic A, Panagiota V, Bogdanov R, Christopeit M, Park Y, Nibourel O, Luft T, Koldehoff M, Corsten M, Heuser M, Finke J, Kobbe G, Platzbecker U, Robin M, Scott BL, Kröger N. A prognostic score including mutation profile and clinical features for patients with CMML undergoing stem cell transplantation. Blood Adv 2021; 5:1760-1769. [PMID: 33755092 PMCID: PMC7993107 DOI: 10.1182/bloodadvances.2020003600] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/26/2021] [Indexed: 11/20/2022] Open
Abstract
The inclusion of mutation status improved risk stratification for newly diagnosed patients with chronic myelomonocytic leukemia (CMML). Stem cell transplantation is a potentially curative treatment option, and patient selection is critical because of relevant transplant-related morbidity and mortality. We aimed to evaluate the impact of mutation status together with clinical presentations on posttransplant outcome. Our study included 240 patients with a median follow-up of 5.5 years. A significant association with worse survival was identified for the presence of mutations in ASXL1 and/or NRAS. In multivariable analysis, ASXL1- and/or NRAS-mutated genotype (hazard ratio [HR], 1.63), marrow blasts >2% (HR, 1.70), and increasing comorbidity index (continuous HR, 1.16) were independently associated with worse survival. A prognostic score (CMML transplant score) was developed, and the following points were assigned: 4 points for an ASXL1- and/or NRAS-mutated genotype or blasts >2% and 1 point each for an increase of 1 in the comorbidity index. The CMML transplant score (range, 0-20) was predictive of survival and nonrelapse mortality (P < .001 for both). Up to 5 risk groups were identified, showing 5-year survival of 81% for a score of 0 to 1, 49% for a score of 2 to 4, 43% for a score of 5 to 7, 31% for a score of 8 to 10, and 19% for a score >10. The score retained performance after validation (concordance index, 0.68) and good accuracy after calibration. Predictions were superior compared with existing scores designed for the nontransplant setting, which resulted in significant risk reclassification. This CMML transplant score, which incorporated mutation and clinical information, was prognostic in patients specifically undergoing transplantation and may facilitate personalized counseling.
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Affiliation(s)
- Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anita Badbaran
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dietrich W Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | | | - Friedrich Stölzel
- Medical Clinic I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christina Rautenberg
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty Heinrich-Heine University of Duesseldorf, Duesseldorf, Germany
| | - Heiko Becker
- Department of Medicine I, Medical Center-University of Freiburg, Freiburg, Germany
| | - Aleksandar Radujkovic
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Victoria Panagiota
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Rashit Bogdanov
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yong Park
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Thomas Luft
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | - Maarten Corsten
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Jürgen Finke
- Department of Medicine I, Medical Center-University of Freiburg, Freiburg, Germany
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty Heinrich-Heine University of Duesseldorf, Duesseldorf, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig, Germany; and
| | - Marie Robin
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris, Paris, France
| | - Bart L Scott
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Radujkovic A, Kordelas L, Bogdanov R, Müller-Tidow C, Beelen DW, Dreger P, Luft T. Interleukin-18 and Hematopoietic Recovery after Allogeneic Stem Cell Transplantation. Cancers (Basel) 2020; 12:cancers12102789. [PMID: 32998441 PMCID: PMC7601738 DOI: 10.3390/cancers12102789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/16/2022] Open
Abstract
Simple Summary We have previously shown that high pre-conditioning levels of Interleukin-18 were associated with worse survival after allogeneic stem cell transplantation due to increased non-relapse mortality. While no correlations with acute graft-versus-host disease were observed, interleukin-18-related excess mortality was mainly driven by fatal infectious complications. In multiple studies, delayed hematopoietic recovery and poor graft function following allogeneic stem cell transplantation has been demonstrated as a powerful predictor of non-relapse mortality. The present study links high interleukin-18 to delayed platelet recovery in allografted patients. Given the functions of interleukin-18 in regulating the quiescence of hematopoietic stem/progenitor cells, our findings may be explained by Interferon gamma-independent inhibitory effects of interleukin-18 on stem cell proliferation and hematopoietic reconstitution in allografted patients. Importantly, considering recent successful interleukin-18-neutralizing approaches in autoimmune disorders, our results provide a rationale to explore modulation of interleukin-18 for improving hematopoietic recovery and outcomes in allogeneic stem cell transplantation recipients. Abstract Interleukin-18 (IL-18) is an immunoregulatory cytokine and a context-dependent regulator of hematopoietic stem/progenitor cell (HSPC) quiescence in murine models. In a previous study, high pre-conditioning levels of IL-18 were associated with increased non-relapse mortality (NRM) after allogeneic stem cell transplantation (alloSCT). To investigate the clinical impact of IL-18 status on hematopoietic function, the associations of pre-conditioning and day 0–3 cytokine levels with platelet and neutrophil recovery were analyzed in a training cohort of 714 allografted patients. In adjusted logistic regression analyses, both increasing pre-conditioning and day 0–3 IL-18 levels had a significantly higher adjusted odds ratio (aOR) of delayed platelet and neutrophil recovery on day +28 post-transplant (aOR per two-fold increase: 1.6–2.0). The adverse impact of high pre-conditioning IL-18 on day +28 platelet recovery was verified in an independent cohort of 673 allografted patients (aOR per two-fold increase: 1.8 and 1.7 for total and free IL-18, respectively). In both cohorts, a platelet count ≤20/nL on day +28 was associated with a significantly increased hazard of NRM (hazard ratio 2.13 and 2.94, respectively). Our findings support the hypothesis that elevated peritransplant IL-18 levels affect post-transplant HSPC function and may provide a rationale to explore modulation of IL-18 for improving alloSCT outcomes.
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Affiliation(s)
- Aleksandar Radujkovic
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany; (C.M.-T.); (P.D.); (T.L.)
- Correspondence:
| | - Lambros Kordelas
- Department of Bone Marrow Transplantation, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.K.); (R.B.); (D.W.B.)
| | - Rashit Bogdanov
- Department of Bone Marrow Transplantation, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.K.); (R.B.); (D.W.B.)
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany; (C.M.-T.); (P.D.); (T.L.)
| | - Dietrich W. Beelen
- Department of Bone Marrow Transplantation, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.K.); (R.B.); (D.W.B.)
| | - Peter Dreger
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany; (C.M.-T.); (P.D.); (T.L.)
| | - Thomas Luft
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany; (C.M.-T.); (P.D.); (T.L.)
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Mannina D, Gagelmann N, Badbaran A, Ditschkowski M, Bogdanov R, Robin M, Cassinat B, Heuser M, Shahswar R, Thol F, Beelen D, Kröger N. Allogeneic stem cell transplantation in patients with myelofibrosis harboring the MPL mutation. Eur J Haematol 2019; 103:552-557. [PMID: 31446640 DOI: 10.1111/ejh.13318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/20/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Primary and post-ET/PV myelofibrosis are myeloproliferative neoplasms harboring in most cases driving mutations in JAK2, CALR or MPL, and a variable number of additional mutations in other genes. Molecular analysis represents a powerful tool to guide prognosis and clinical management. Only about 10% of patients with myelofibrosis harbor alterations in MPL gene. No data are available about the transplantation outcome in the specific MPL-mutated group. PATIENTS We collected the data of 18 myelofibrosis patients(primary: 14; post-ET: 4) transplanted in 4 EBMT centers (Hamburg, Paris, Essen, and Hannover) between 2005 and 2016. RESULTS Before the transplant, we explored the molecular profile by NGS and reported the frequency of mutations occurring in a panel of genes including JAK2, MPL, CALR, U2AF1, SRSF2, SF3B1, ASXL1, IDH1, IDH2, CBL, DNMT3A, TET2, EZH2, TP53, IKZF1, NRAS, KRAS, FLT3, SH2B3, and RUNX1. The 1-year transplant-related mortality was 16.5%, 5-years overall survival and 5-y relapse-free survival 83.5%. The only relapse occurred in a patient who harbored mutations in both ASXL1 and EZH2 genes. CONCLUSION These retrospective data suggest that MPL-mutated myelofibrosis patients have a favorable outcome after allogeneic transplantation with very low rate of disease relapse (5.5%) in comparison with the available historical controls regarding myelofibrosis in all.
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Affiliation(s)
- Daniele Mannina
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Hematology and Bone Marrow Transplantation, San Raffaele Hospital, Milan, Italy
| | - Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anita Badbaran
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Ditschkowski
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | - Rashit Bogdanov
- Department of Hematology, Saint-Louis Hospital, APHP. Paris, Paris, France
| | - Marie Robin
- Department of Hematology, Saint-Louis Hospital, APHP. Paris, Paris, France
| | - Bruno Cassinat
- Department of Hematology, Saint-Louis Hospital, APHP. Paris, Paris, France
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Rabia Shahswar
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Felicitas Thol
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gagelmann N, Ditschkowski M, Bogdanov R, Cassinat B, Robin M, Heuser M, Thol F, Shahswar R, Beelen D, Badbaran A, Kröger N. Comprehensive Clinical-Molecular Transplant Risk Model for Myelofibrosis Undergoing Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.381] [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: 10/27/2022]
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Bogdanov R, Manannikova E, Kotov S, Abramenko A, Maratkanova T. Analysis parameters of cerebral morphometry in cerebrovascular and Parkinson's Diseases. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bogdanov R, Bogdanov A, Kotov S, Kaganov B. 1.006 FEATURES OF THE BASAL METABOLISM IN PATIENTS WITH PARKINSON'S DISEASE. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70120-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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