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Aerts R, Mehra V, Groll AH, Martino R, Lagrou K, Robin C, Perruccio K, Blijlevens N, Nucci M, Slavin M, Bretagne S, Cordonnier C. Guidelines for the management of Toxoplasma gondii infection and disease in patients with haematological malignancies and after haematopoietic stem-cell transplantation: guidelines from the 9th European Conference on Infections in Leukaemia, 2022. Lancet Infect Dis 2024; 24:e291-e306. [PMID: 38134949 DOI: 10.1016/s1473-3099(23)00495-4] [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] [Received: 12/30/2022] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 12/24/2023]
Abstract
Patients with haematological malignancies might develop life-threatening toxoplasmosis, especially after allogeneic haematopoietic stem-cell transplantation (HSCT). Reactivation of latent cysts is the primary mechanism of toxoplasmosis following HSCT; hence, patients at high risk are those who were seropositive before transplantation. The lack of trimethoprim-sulfamethoxazole prophylaxis and various immune status parameters of the patient are other associated risk factors. The mortality of toxoplasma disease-eg, with organ involvement-can be particularly high in this setting. We have developed guidelines for managing toxoplasmosis in haematology patients, through a literature review and consultation with experts. In allogeneic HSCT recipients seropositive for Toxoplasma gondii before transplant, because T gondii infection mostly precedes toxoplasma disease, we propose weekly blood screening by use of quantitative PCR (qPCR) to identify infection early as a pre-emptive strategy. As trimethoprim-sulfamethoxazole prophylaxis might fail, prophylaxis and qPCR screening should be combined. However, PCR in blood can be negative even in toxoplasma disease. The duration of prophylaxis should be a least 6 months and extended during treatment-induced immunosuppression or severe CD4 lymphopenia. If a positive qPCR test occurs, treatment with trimethoprim-sulfamethoxazole, pyrimethamine-sulfadiazine, or pyrimethamine-clindamycin should be started, and a new sample taken. If the second qPCR test is negative, clinical judgement is recommended to either continue or stop therapy and restart prophylaxis. Therapy must be continued until a minimum of two negative PCRs for infection, or for at least 6 weeks for disease. The pre-emptive approach is not indicated in seronegative HSCT recipients, after autologous transplantation, or in non-transplant haematology patients, but PCR should be performed with a high level of clinical suspicion.
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Affiliation(s)
- Robina Aerts
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Varun Mehra
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Rodrigo Martino
- Servei d'Hematologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Katrien Lagrou
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Christine Robin
- Department of Haematology, Assistance Publique des Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Katia Perruccio
- Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Nicole Blijlevens
- Department of Haematology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Marcio Nucci
- Department of Internal Medicine, University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monica Slavin
- Department of Infectious Diseases and Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stéphane Bretagne
- Université Paris Cité, and Parasitology and Mycology laboratory, Assistance Publique des Hôpitaux de Paris, Saint Louis Hospital, Paris, France
| | - Catherine Cordonnier
- Department of Haematology, Assistance Publique des Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France; University Paris-Est-Créteil, Créteil, France.
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Drozd-Sokolowska J, Gras L, Koster L, Martino R, Salas MQ, Salmenniemi U, Zudaire T, Yañez L, Bellido M, Collin M, Kaufmann M, Kozlowski P, Poiré X, Ferra C, Sampol A, Wilson KMO, Cairoli A, Gedde-Dahl T, Deconinck E, Mirabile M, Suarez F, Raj K, Van Gelder M, Yakoub-Agha I, Tournilhac O, McLornan DP. Autologous hematopoietic cell transplantation for T-cell prolymphocytic leukemia: a retrospective study on behalf of the Chronic Malignancies Working Party of the EBMT. Haematologica 2024; 109:1608-1613. [PMID: 38205539 PMCID: PMC11063836 DOI: 10.3324/haematol.2023.284359] [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: 09/24/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024] Open
Abstract
Not available.
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Affiliation(s)
| | - Luuk Gras
- EBMT Statistical Unit, Leiden, the Netherlands;.
| | - Linda Koster
- EBMT Leiden Study Unit, Leiden, the Netherlands;.
| | | | - María Queralt Salas
- Hematology Department (ICHMO). Hospital Clinic de Barcelona, Barcelona, Spain;.
| | - Urpu Salmenniemi
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland;.
| | - Teresa Zudaire
- Unidad de Ensayos Clínicos de Hematología Pabellón A, bajo., Pamplona, Spain;.
| | | | - Mar Bellido
- University Medical Center Groningen (UMCG), Groningen, Netherlands;.
| | | | | | | | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium;.
| | - Christelle Ferra
- ICO-Hospital Universitari Germans Trias i Pujol, Badalona, Spain;.
| | - Antònia Sampol
- Hospital Son Espases, IDISBA, Palma de Mallorca, Balearic Islands, Spain.
| | | | - Anne Cairoli
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;.
| | | | - Eric Deconinck
- Université de Franche-Comté, CHU Besançon, EFS, INSERM, UMR RIGHT, F-25000 Besançon, France;.
| | | | - Felipe Suarez
- Adult hematology, Hôpital Necker-Enfants Malades, AP-HP.Centre Université Paris Cité, Paris, France;.
| | - Kavita Raj
- University College London Hospitals NHS Trust, London, United Kingdom;.
| | | | | | - Olivier Tournilhac
- CHU Estaing, Clermont-Ferrand University Hospital, Clermont-Ferrand, France;.
| | - Donal P McLornan
- University College London Hospitals NHS Trust, London, United Kingdom;.
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Piñana JL, Tridello G, Xhaard A, Wendel L, Montoro J, Vazquez L, Heras I, Ljungman P, Mikulska M, Salmenniemi U, Perez A, Kröger N, Cornelissen J, Sala E, Martino R, Geurten C, Byrne J, Maertens J, Kerre T, Martin M, Pascual MJ, Yeshurun M, Finke J, Groll AH, Shaw PJ, Blijlevens N, Arcese W, Ganser A, Suarez-Lledo M, Alzahrani M, Choi G, Forcade E, Paviglianiti A, Solano C, Wachowiak J, Zuckerman T, Bader P, Clausen J, Mayer J, Schroyens W, Metafuni E, Knelange N, Averbuch D, de la Camara R. Upper and/or Lower Respiratory Tract Infection Caused by Human Metapneumovirus After Allogeneic Hematopoietic Stem Cell Transplantation. J Infect Dis 2024; 229:83-94. [PMID: 37440459 DOI: 10.1093/infdis/jiad268] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Human metapneumovirus (hMPV) epidemiology, clinical characteristics and risk factors for poor outcome after allogeneic stem cell transplantation (allo-HCT) remain a poorly investigated area. METHODS This retrospective multicenter cohort study examined the epidemiology, clinical characteristics, and risk factors for poor outcomes associated with human metapneumovirus (hMPV) infections in recipients of allo-HCT. RESULTS We included 428 allo-HCT recipients who developed 438 hMPV infection episodes between January 2012 and January 2019. Most recipients were adults (93%). hMPV infections were diagnosed at a median of 373 days after allo-HCT. The infections were categorized as upper respiratory tract disease (URTD) or lower respiratory tract disease (LRTD), with 60% and 40% of cases, respectively. Patients with hMPV LRTD experienced the infection earlier in the transplant course and had higher rates of lymphopenia, neutropenia, corticosteroid use, and ribavirin therapy. Multivariate analysis identified lymphopenia and corticosteroid use (>30 mg/d) as independent risk factors for LRTD occurrence. The overall mortality at day 30 after hMPV detection was 2% for URTD, 12% for possible LRTD, and 21% for proven LRTD. Lymphopenia was the only independent risk factor associated with day 30 mortality in LRTD cases. CONCLUSIONS These findings highlight the significance of lymphopenia and corticosteroid use in the development and severity of hMPV infections after allo-HCT, with lymphopenia being a predictor of higher mortality in LRTD cases.
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Affiliation(s)
- Jose Luis Piñana
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
| | - Gloria Tridello
- Azienda Ospedaliera, Universitaria Integrata Verona, Verona, Italy
| | - Aliénor Xhaard
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, Université Paris-Diderot, Paris, France
| | - Lotus Wendel
- Leiden Study Unit, EBMT, Leiden, The Netherlands
| | - Juan Montoro
- Hematology División, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lourdes Vazquez
- Hematology Department, Hospital Clinico Universitario de Salamanca, Salamanca, Spain
| | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Dipartimento di scienze della salute, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Urpu Salmenniemi
- Hematology Department, Comprehensive Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Ariadna Perez
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
| | - Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Cornelissen
- Hematology Department, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Elisa Sala
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Claire Geurten
- Hematology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
- Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - Jenny Byrne
- Hematology Department, Nottingham University, Nottingham, United Kingdom
| | - Johan Maertens
- Hematology Department, University Hospital Gasthuisberg, Leuven, Belgium
| | - Tessa Kerre
- Hematology Department, Ghent University Hospital, Gent, Belgium
| | - Murray Martin
- Hematology Department, Leicester Royal Infirmary, Leicester, United Kingdom
| | | | - Moshe Yeshurun
- Institution of Hematology, Rabin Medical Center, Petach-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jürgen Finke
- Hematology Department, University of Freiburg, Freiburg, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Department of Pediatric Hemtology and Oncology and Center for Bone Marrow Transplantation, University Children's Hospital, Muenster, Germany
| | - Peter J Shaw
- The Children`s Hospital at Westmead, Sydney, Australia
| | | | - William Arcese
- Hematology Department, Tor Vergata University of Rome, Rome, Italy
| | | | | | - Mohsen Alzahrani
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Goda Choi
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | | | - Carlos Solano
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology, and Hematopoietic Cell Transplantation, University of Medical Sciences, Poznan, Poland
| | | | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Pediatrics and Adolescent Medicine, University Hospital, Goethe University, Frankfurt, Germany
| | - Johannes Clausen
- Department of Internal Medicine I, Ordensklinikum Linz-Elisabethinen, Johannes Kepler University, Linz, Austria
| | - Jiri Mayer
- Masaryk University Hospital Brno, Brno, Czech Republic
| | | | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e EmatologiaGemelli Research Institute, Fondazione Policlinico Universitario Agostino Gemelli Research Institute, Roma, Italy
| | | | - Dina Averbuch
- Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Rafael de la Camara
- Hematology Department, Hospital de la Princesa, Madrid, Spain
- Hematology Department, Hospital Universitario Sanitas La Zarzuela, Madrid, Spain
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Esquirol A, Cadenas IG, Novelli S, Garrido A, Caballero AC, Oñate G, Lopez J, Redondo S, Argüello M, Saavedra S, Moreno C, Briones J, Sierra J, Martino R. Outcome improvement over time in reduced intensity conditioning hematopoietic transplantation: a 20-year experience. Ann Hematol 2024; 103:321-334. [PMID: 37971549 DOI: 10.1007/s00277-023-05530-w] [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: 05/26/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
The current study includes all consecutive patients (N = 484) who received a reduced-intensity conditioning regimen (RIC) allogeneic hematopoietic stem cell transplantation in our center from 1999 to 2020. Conditioning regimens were based on fludarabine with melphalan or busulfan, with low-dose thiotepa and pharmacological GVHD prophylaxis consisted of cyclosporine A (CsA)-methotrexate (MTX)/mofetil (MMF) (n = 271), tacrolimus-sirolimus (n = 145), and post-transplantation cyclophosphamide (PTCy)-tacrolimus (n = 68). The median time of overall follow-up in survivors was 8 years (1-22 years) and was at least 3 years in all three GVHD prophylaxis groups. Thirty-three percent had a high or very high disease risk index, 56% ≥ 4 European bone marrow transplantation risk, and 65% ≥ 3 hematopoietic stem cell transplantation comorbidity index score-age score. Neutrophil and platelet engraftment was longer for PTCy-tacro (p 0.0001). Cumulative incidence of grade III-IV aGVHD was 17% at 200 days, and that of moderate-severe cGvHD was 36% at 8 years. GVHD prophylaxis was the only prognostic factor in the multivariable analyses for the development of aGVHD and moderate-severe cGVHD (p 0.0001). NRM and relapse incidences were 29% and 30% at 8 years, while OS and PFS rates were 43% and 39% at 8 years. At 3 years, OS was highest in the PTCy-tacro group (68%) than in the tacro-siro (61%) and CsA-MTX/MMF (49%) cohorts (p < 0.01). In the three groups, respectively, the 200-day incidence of grade III-IV aGvHD (6% vs. 12% vs. 23%) and 3-year moderate-severe cGVHD (8% vs. 40% vs. 38%) were lower in the PTCy cohort. These better outcomes were confirmed in multivariable analyses. Based on our recent results, the PTCy could be considered as a real GvHD prophylaxis in the RIC setting due to improve best 3-year GvHD and survival outcomes.
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Affiliation(s)
- Albert Esquirol
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain.
| | - Irene Garcia Cadenas
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Ana Garrido
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Ana Carolina Caballero
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Guadalupe Oñate
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Jordi Lopez
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Sara Redondo
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Miguel Argüello
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Silvana Saavedra
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Carolina Moreno
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
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Penack O, Tridello G, Salmenniemi U, Martino R, Khanna N, Perruccio K, Fagioli F, Richert-Przygonska M, Labussière-Wallet H, Maertens J, Jubert C, Aljurf M, Pichler H, Kriván G, Kunadt D, Popova M, Gabriel M, Calore E, Blau IW, Benedetti F, Itäla-Remes M, de Kort E, Russo D, Faraci M, Ménard AL, Borne PVD, Poiré X, Yesilipek A, Gozdzik J, Yeğin ZA, Yañez L, Facchini L, Van Gorkom G, Thurner L, Kocak U, Sampol A, Zuckerman T, Bierings M, Mielke S, Ciceri F, Wendel L, Knelange N, Mikulska M, Averbuch D, Styczynski J, Camara RDL, Cesaro S. Influence of invasive aspergillosis during acute leukaemia treatment on survival after allogeneic stem cell transplantation: a prospective study of the EBMT Infectious Diseases Working Party. EClinicalMedicine 2024; 67:102393. [PMID: 38152413 PMCID: PMC10751840 DOI: 10.1016/j.eclinm.2023.102393] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023] Open
Abstract
Background Infections are the main reason for mortality during acute leukaemia treatment and invasive aspergillosis (IA) is a major concern. Allogeneic stem cell transplantation (alloSCT) is a standard therapy and often is the only live-saving procedure in leukaemia patients. The profound immunodeficiency occurring after alloSCT led to high IA-associated mortality in the past. Therefore, patients with IA were historically considered transplant-ineligible. Recently, there has been improvement of anti-fungal management including novel anti-fungal agents. As a result, more leukaemia patients with IA are undergoing alloSCT. Outcome has not been prospectively assessed. Methods We performed a prospective study in acute leukaemia patients undergoing alloSCT to analyse the impact of a prior history of probable or proven IA (pre-SCT IA). The primary endpoint was 1-year non-relapse mortality (NRM). Relapse free survival and overall survival were analysed as secondary endpoints. Findings 1439 patients were included between 2016 and 2021. The incidence of probable or proven pre-SCT IA was 6.0% (n = 87). The cumulative incidence of 1-year NRM was 17.3% (95% CI 10.2-26.0) and 11.2% (9.6-13.0) for patients with and without pre-SCT IA. In multivariate analyses the hazard ratio (HR) for 1-year NRM was 2.1 (1.2-3.6; p = 0.009) for patients with pre-SCT IA. One-year relapse-free survival was inferior in patients with pre-SCT IA (59.4% [48.3-68.9] vs. 70.4 [67.9-72.8]; multivariate HR 1.5 [1.1-2.1]; p = 0.02). Consequently, 1-year overall survival was lower in patients with pre-SCT IA: (68.8% [57.8-77.4] vs. 79.0% [76.7-81.1]; multivariate HR 1.7 [1.1-2.5]; p = 0.01). Interpretation Pre-SCT IA remains to be significantly associated with impaired alloSCT outcome. On the other hand, more than two thirds of patients with pre-SCT IA were alive at one year after alloSCT. IA is not anymore an absolute contraindication for alloSCT because the majority of patients with IA who undergo alloSCT benefit from this procedure. Funding There was no external funding source for this study.
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Affiliation(s)
- Olaf Penack
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Berlin, Germany
| | | | | | | | - Nina Khanna
- Division of Infectious Diseases, University Hospital, Basel, Switzerland
| | - Katia Perruccio
- Pediatric Oncology Hematology and Stem Cell Transplantation Program, Santa Maria Della Misericordia Hospital, Perugia
| | | | - Monika Richert-Przygonska
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | | | | | - Charlotte Jubert
- CHU Bordeaux Groupe Hospitalier Pellegrin-Enfants, Bordeaux, France
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Herbert Pichler
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | | | | | - Marina Popova
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian Federation
| | - Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Elisabetta Calore
- Pediatric Hematology Oncology and Stem Cell Transplant Division, Department of Women's and Children's Health, Azienda Ospedale-UniversitàPadova, Italy
| | - Igor Wolfgang Blau
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Berlin, Germany
| | | | | | - Elizabeth de Kort
- Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Domenico Russo
- Unit of Blood Diseases and Bone Marrow Transplantation, Brescia University, Italy
| | - Maura Faraci
- HSCT Unit, Department of Hematology-Oncology, IRCCS Istituto G. Gaslini, Genova, Italy
| | | | | | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | | | - Jolanta Gozdzik
- Department of Clinical Immunology and Transplantation, Jagiellonian University Medical Collage, University Children's Hospital in Krakow, Poland
| | | | - Lucrecia Yañez
- Hospital U. Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | | | - Lorenz Thurner
- Lorenz Thurner, University of Saarland, Homburg, Germany
| | - Ulker Kocak
- Gazi University School of Medicine, Ankara, Turkey
| | - Antònia Sampol
- Hospital Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Tsila Zuckerman
- Rambam Medical Center, Technion –Faculty of Medicine. Haifa, Israel
| | - Marc Bierings
- Princess Maxima Center/ University Hospital for Children (WKZ), Utrecht, the Netherlands
| | | | - Fabio Ciceri
- Università Vita Salute San Raffaele, Milan, Italy
| | | | | | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Dina Averbuch
- Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Israel
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | | | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Murthy HS, Zhang MJ, Chen K, Ahmed S, Deotare U, Ganguly S, Kansagra A, Michelis FV, Nishihori T, Patnaik M, Abid MB, Aljurf M, Arai Y, Bacher U, Badar T, Badawy SM, Ballen K, Battiwalla M, Beitinjaneh A, Bejanyan N, Bhatt VR, Brown VI, Martino R, Cahn JY, Castillo P, Cerny J, Chhabra S, Copelan E, Daly A, Dholaria B, Diaz Perez MA, Freytes CO, Grunwald MR, Hashmi S, Hildebrandt GC, Jamy O, Joseph J, Kanakry CG, Khera N, Krem MM, Kuwatsuka Y, Lazarus HM, Lekakis LJ, Liu H, Modi D, Munshi PN, Mussetti A, Palmisiano N, Patel SS, Rizzieri DA, Seo S, Shah MV, Sharma A, Sohl M, Solomon SR, Ulrickson M, Ustun C, van der Poel M, Verdonck LF, Wagner JL, Wang T, Wirk B, Zeidan A, Litzow M, Kebriaei P, Hourigan CS, Weisdorf DJ, Saber W, Kharfan-Dabaja MA. Allogeneic hematopoietic cell transplantation for blastic plasmacytoid dendritic cell neoplasm: a CIBMTR analysis. Blood Adv 2023; 7:7007-7016. [PMID: 37792849 PMCID: PMC10690553 DOI: 10.1182/bloodadvances.2023011308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy with a poor prognosis and considered incurable with conventional chemotherapy. Small observational studies reported allogeneic hematopoietic cell transplantation (allo-HCT) offers durable remissions in patients with BPDCN. We report an analysis of patients with BPDCN who received an allo-HCT, using data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). We identified 164 patients with BPDCN from 78 centers who underwent allo-HCT between 2007 and 2018. The 5-year overall survival (OS), disease-free survival (DFS), relapse, and nonrelapse mortality (NRM) rates were 51.2% (95% confidence interval [CI], 42.5-59.8), 44.4% (95% CI, 36.2-52.8), 32.2% (95% CI, 24.7-40.3), and 23.3% (95% CI, 16.9-30.4), respectively. Disease relapse was the most common cause of death. On multivariate analyses, age of ≥60 years was predictive for inferior OS (hazard ratio [HR], 2.16; 95% CI, 1.35-3.46; P = .001), and higher NRM (HR, 2.19; 95% CI, 1.13-4.22; P = .02). Remission status at time of allo-HCT (CR2/primary induction failure/relapse vs CR1) was predictive of inferior OS (HR, 1.87; 95% CI, 1.14-3.06; P = .01) and DFS (HR, 1.75; 95% CI, 1.11-2.76; P = .02). Use of myeloablative conditioning with total body irradiation (MAC-TBI) was predictive of improved DFS and reduced relapse risk. Allo-HCT is effective in providing durable remissions and long-term survival in BPDCN. Younger age and allo-HCT in CR1 predicted for improved survival, whereas MAC-TBI predicted for less relapse and improved DFS. Novel strategies incorporating allo-HCT are needed to further improve outcomes.
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Affiliation(s)
- Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Mei-Jie Zhang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Karen Chen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sairah Ahmed
- Department of Lymphoma/Myeloma and Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Uday Deotare
- London Health Sciences Centre, Toronto, ON, Canada
| | | | - Ankit Kansagra
- Blood and Marrow Transplant Program, UT Southwestern Medical Center, Dallas, TX
| | - Fotios V Michelis
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Muhammad Bilal Abid
- Divisions of Hematology/Oncology & Infectious Diseases, Bone and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Yasuyuki Arai
- Kyoto University Hospital, Kyoto University, Kyoto, Japan
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Talha Badar
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Karen Ballen
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | | | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Valerie I Brown
- Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children's Hospital and College of Medicine, Hershey, PA
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Paul Castillo
- UF Health Shands Children's Hospital, Gainesville, FL
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA
| | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, AB, Canada
| | | | - Miguel Angel Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - César O Freytes
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jacinth Joseph
- Methodist Healthcare Blood and Marrow Transplant Center, Memphis, TN
| | - Christopher G Kanakry
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Lazaros J Lekakis
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Hongtao Liu
- Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL
| | - Dipenkumar Modi
- Division of Oncology, Karmanos Cancer Center/Wayne State University, Detroit, MI
| | - Pashna N Munshi
- Stem Cell Transplant and Cellular Immunotherapy Program, MedStar Georgetown University Hospital, Washington, DC
| | - Alberto Mussetti
- Clinical Hematology Department, Catalan Institute of Oncology, Hospitalet, Barcelona, Spain
- Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Neil Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Sagar S Patel
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | | | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | | | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN
| | - Melhm Sohl
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA
| | - Scott R Solomon
- Blood and Marrow Transplant Program, Northside Hospital Cancer Institute, Atlanta, GA
| | | | - Celalettin Ustun
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, IL
| | - Marjolein van der Poel
- Division of Hematology, Department of Internal Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - John L Wagner
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Trent Wang
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | - Amer Zeidan
- Bridgeport Hospital, Yale University School of Medicine, New Haven, CT
| | | | - Partow Kebriaei
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Daniel J Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
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7
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Piñana JL, Pérez A, Chorão P, Guerreiro M, García-Cadenas I, Solano C, Martino R, Navarro D. Respiratory virus infections after allogeneic stem cell transplantation: Current understanding, knowledge gaps, and recent advances. Transpl Infect Dis 2023; 25 Suppl 1:e14117. [PMID: 37585370 DOI: 10.1111/tid.14117] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
Before the COVID-19 pandemic, common community-acquired seasonal respiratory viruses (CARVs) were a significant threat to the health and well-being of allogeneic hematopoietic cell transplant (allo-HCT) recipients, often resulting in severe illness and even death. The pandemic has further highlighted the significant risk that immunosuppressed patients, including allo-HCT recipients, face when infected with SARS-CoV-2. As preventive transmission measures are relaxed and CARVs circulate again among the community, including in allo-HSCT recipients, it is crucial to understand the current state of knowledge, gaps, and recent advances regarding CARV infection in allo-HCT recipients. Urgent research is needed to identify seasonal respiratory viruses as potential drivers for future pandemics.
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Affiliation(s)
- Jose L Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | | | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Navarro
- Microbiology department, Hospital Clinico Universitario de Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
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8
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Piñana JL, Heras I, Aiello TF, García-Cadenas I, Vazquez L, Lopez-Jimenez J, Chorão P, Aroca C, García-Vidal C, Arroyo I, Soler-Espejo E, López-Corral L, Avendaño-Pita A, Arrufat A, Garcia-Gutierrez V, Arellano E, Hernández-Medina L, González-Santillana C, Morell J, Hernández-Rivas JÁ, Rodriguez-Galvez P, Mico-Cerdá M, Guerreiro M, Campos D, Navarro D, Cedillo Á, Martino R, Solano C. Remdesivir or Nirmatrelvir/Ritonavir Therapy for Omicron SARS-CoV-2 Infection in Hematological Patients and Cell Therapy Recipients. Viruses 2023; 15:2066. [PMID: 37896843 PMCID: PMC10612015 DOI: 10.3390/v15102066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Scarce data exist that analyze the outcomes of hematological patients with SARS-CoV-2 infection during the Omicron variant period who received treatment with remdesivir or nirmatrelvir/ritonavir. METHODS This study aims to address this issue by using a retrospective observational registry, created by the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group, spanning from 27 December 2021 to 30 April 2023. RESULTS This study included 466 patients, 243 (52%) who were treated with remdesivir and 223 (48%) with nirmatrelvir/ritonavir. Nirmatrelvir/ritonavir was primarily used for mild cases, resulting in a lower COVID-19-related mortality rate (1.3%), while remdesivir was preferred for moderate to severe cases (40%), exhibiting a higher mortality rate (9%). A multivariate analysis in the remdesivir cohort showed that male gender (odds ratio (OR) 0.35, p = 0.042) correlated with a lower mortality risk, while corticosteroid use (OR 9.4, p < 0.001) and co-infection (OR 2.8, p = 0.047) were linked to a higher mortality risk. Prolonged virus shedding was common, with 52% of patients shedding the virus for more than 25 days. In patients treated with remdesivir, factors associated with prolonged shedding included B-cell malignancy as well as underlying disease, severe disease, a later onset of and shorter duration of remdesivir treatment and a higher baseline viral load. Nirmatrelvir/ritonavir demonstrated a comparable safety profile to remdesivir, despite a higher risk of drug interactions. CONCLUSIONS Nirmatrelvir/ritonavir proved to be a safe and effective option for treating mild cases in the outpatient setting, while remdesivir was preferred for severe cases, where corticosteroids and co-infection significantly predicted worse outcomes. Despite antiviral therapy, prolonged shedding remains a matter of concern.
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Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | - Inmaculada Heras
- Hematology Division, Hospital Morales Meseguer, 30100 Murcia, Spain; (I.H.); (C.A.); (E.S.-E.)
| | | | - Irene García-Cadenas
- Hematology Division, Hospital de la Santa Creu i Sant Pau, 08193 Barcelona, Spain; (I.G.-C.); (A.A.); (R.M.)
| | - Lourdes Vazquez
- Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (L.V.); (L.L.-C.); (A.A.-P.); (L.H.-M.)
| | - Javier Lopez-Jimenez
- Hematology Division, Hospital Ramon y Cajal, 28029 Madrid, Spain; (J.L.-J.); (V.G.-G.)
| | - Pedro Chorão
- Hematology Division, Hospital Universitario y Politécnico La Fe, 46017 Valencia, Spain; (P.C.); (M.G.)
| | - Cristina Aroca
- Hematology Division, Hospital Morales Meseguer, 30100 Murcia, Spain; (I.H.); (C.A.); (E.S.-E.)
| | - Carolina García-Vidal
- Infectious Disease Division, Hospital Clinic, 08193 Barcelona, Spain; (T.F.A.); (C.G.-V.)
| | - Ignacio Arroyo
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | - Eva Soler-Espejo
- Hematology Division, Hospital Morales Meseguer, 30100 Murcia, Spain; (I.H.); (C.A.); (E.S.-E.)
| | - Lucia López-Corral
- Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (L.V.); (L.L.-C.); (A.A.-P.); (L.H.-M.)
| | - Alejandro Avendaño-Pita
- Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (L.V.); (L.L.-C.); (A.A.-P.); (L.H.-M.)
| | - Anna Arrufat
- Hematology Division, Hospital de la Santa Creu i Sant Pau, 08193 Barcelona, Spain; (I.G.-C.); (A.A.); (R.M.)
| | | | - Elena Arellano
- Hematology Division, Hospital Universitario Virgen Macarena, 41092 Sevilla, Spain;
| | - Lorena Hernández-Medina
- Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (L.V.); (L.L.-C.); (A.A.-P.); (L.H.-M.)
| | | | - Julia Morell
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | | | - Paula Rodriguez-Galvez
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | - Mireia Mico-Cerdá
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital Universitario y Politécnico La Fe, 46017 Valencia, Spain; (P.C.); (M.G.)
| | - Diana Campos
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
- Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Brain, Behavior and Metabolism (CBBM), University of Lübeck, 23562 Lübeck, Germany
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
- Department of Medicine, School of Medicine. University of Valencia, 46010 Valencia, Spain
| | - Ángel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH-TC) Office, 28029 Madrid, Spain;
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, 08193 Barcelona, Spain; (I.G.-C.); (A.A.); (R.M.)
| | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario, 46017 Valencia, Spain; (I.A.); (J.M.); (P.R.-G.); (M.M.-C.); (D.C.); (C.S.)
- INCLIVA, Biomedical Research Institute, 46017 Valencia, Spain
- Department of Medicine, School of Medicine. University of Valencia, 46010 Valencia, Spain
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9
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Arguello-Tomas M, Albiol N, Jara P, Garcia-Cadenas I, Redondo S, Esquirol A, Novelli S, Saavedra S, Martino R, Nomdedeu J, Sierra J, Mora A, Moreno C. Evolution in the frontline treatment of patients with chronic lymphocytic leukemia: experience from one European center. Leuk Lymphoma 2023; 64:1655-1661. [PMID: 37452739 DOI: 10.1080/10428194.2023.2232489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
Treatment of chronic lymphocytic leukemia (CLL) has dramatically evolved over the last decades thanks to the introduction of targeted therapies. We aimed to describe retrospectively the evolution in the frontline prescription in the CLL patients from our institution. As a secondary objective, the impact of frontline therapy on the time-to-next-treatment (TTNT) and overall survival (OS). After a median of 6.4 years (0.1-36.4) of follow-up from diagnosis, 323 of 780 CLL patients (41.4%) required therapy. Alkylating agents in monotherapy (chlorambucil) were the most used until 2012, and from then, chemoimmunotherapy. Since 2018, targeted therapies were the most common therapeutic strategy (74.1%). Patients who received targeted therapies had significantly longer TTNT compared to other regimens. In the multivariable analyses, mutated IGHV genes targeted therapies and chemoimmunotherapy regimens were related to longer TTNT, and sex female, age younger than 65, and mutated IGHV genes were associated with better OS.
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Affiliation(s)
- Miguel Arguello-Tomas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Nil Albiol
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Hematology Department, Catalan Institute of Oncology (ICO), Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Paola Jara
- Josep Carreras Leukemia Research Institute, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Irene Garcia-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Sara Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Silvana Saavedra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Josep Nomdedeu
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Jordi Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Alba Mora
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Carol Moreno
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
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10
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Albiol N, Lynton-Pons E, Aso O, Moga E, Vidal S, Gómez-Pérez L, Santiago JA, Triquell M, Roch N, Lázaro E, González I, López-Contreras J, Esquirol A, Sierra J, Martino R, García-Cadenas I. mRNA-1273 SARS-CoV-2 vaccine in recently transplanted allogeneic hematopoietic cell transplant recipients: Dynamics of cellular and humoral immune responses and booster effect. Leuk Res 2023; 132:107347. [PMID: 37356281 PMCID: PMC10284722 DOI: 10.1016/j.leukres.2023.107347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
Allogeneic hematopoietic stem cell transplant (HCT) recipients are at high risk of severe COVID-19 despite vaccination. Little is known about cellular response to SARS-CoV-2 vaccine in this population, especially in recently transplanted patients (RTP). In this single-center study we examined cellular and humoral response to the mRNA-1273 (Spikevax®) vaccine in recently transplanted patients (RTP, n = 49), and compared them to long-term transplanted patients (LTTP, n = 19) and healthy controls (n = 20) at three different timepoints: one and three months after the second dose (T1 and T2, respectively, 28 days apart), and one month after the third dose (T3). Controls did not receive a third dose. RTPs showed lower IgG anti-S1 titers than healthy controls at both T1 (mean 0.50 vs 0.94 arbitrary units -AU-, p < 0.0001) and T2 (0.37 vs 0.79 AU, p < 0.0001). They also presented lower titers than LTTPs at T1 (0.50 vs 0.66, p = 0.01), but no differences at T2 (0.37 vs 0.40 AU, p = 0.55). The rate of positive T-cell responses was lower in RTPs than in controls at both T1 and T2 (61.2 % vs 95 %, p = 0.007; 59.2 % vs 100 %, p = 0.001, respectively), but without statistically significant differences between transplanted groups. At T3 no differences were seen between RTPs and LTTPs as well, neither in IgG antibodies (p = 0.82) nor in cellular responses (p = 0.15), although a third dose increased the rate of positive cellular and humoral responses in approximately 50 % of recently transplanted patients. However, active immunosuppressive treatment severely diminished their chances to produce an adequate response.
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Affiliation(s)
- Nil Albiol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Catalan Institute of Oncology (ICO), Hospital Universitari Doctor Josep Trueta, 17007 Girona, Spain.
| | - Elionor Lynton-Pons
- Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Olga Aso
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Esther Moga
- Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Silvia Vidal
- Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Lucía Gómez-Pérez
- Hematology Department, Hospital del Mar - Parc de Salut Mar, Passeig Marítim de la Barceloneta 25-29, 08003 Barcelona, Spain
| | - Jose Alejandre Santiago
- Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Mercè Triquell
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Nerea Roch
- Division of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Elisabeth Lázaro
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Iria González
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Joaquín López-Contreras
- Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Division of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain.
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11
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Regalado-Artamendi I, García-Fasanella M, Medina L, Fernandez-Sojo J, Esquirol A, García-Cadenas I, Martino R, Briones J, Sierra J, Novelli S. Age, CD34+ cell dose, conditioning and pre-transplant cytopenias can help predict transfusion support in lymphoma patients undergoing autologous stem cell transplantation. Vox Sang 2023; 118:681-689. [PMID: 37356813 DOI: 10.1111/vox.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Autologous stem cell transplant (ASCT) is a widely used therapy for lymphoma patients and can nowadays be performed on an outpatient basis. This study aimed to describe transfusion support in lymphoma patients undergoing ASCT and identify increased or prolonged transfusion requirement predictors. MATERIALS AND METHODS A retrospective study of all consecutive lymphoma patients undergoing ASCT between 2010 and 2020. RESULTS Out of 226 patients, 145 (64%) received red blood cell (RBC) transfusions, whereas all 226 (100%) required platelet transfusion (PT). Transfusions between Day +1 and +30 were higher in patients over 60 (2 [1-4] vs. 2 [0-2] RBC; p = 0.001 and 4 [2-8] vs. 3 [2-4] PT; p < 0.001); patients with pre-transplant anaemia (4 [2.5-6] vs. 2 [0-2] RBC; p < 0.001 and 5 [3-9] vs. 3 [2-4] PT; p = 0.001); pre-transplant thrombocytopenia (2 [1-4] vs. 2 [0-2] RBC; p < 0.001 and 4 [3-8.5] vs. 2 [1-3] PT; p < 0.001) or CD34+ cell dose <4 × 106 /kg (2 [0-4] vs. 2 [0-2] RBC; p = 0.024 and 4 [2-6] vs. 2 [1-3.5] PT; p < 0.001). RBC transfusion independence was reached later in patients receiving carmustine, cytarabine, etoposide and melphalan (BEAM) (hazard ratio [HR] 1.6; confidence interval [CI] 1.1-2.3) and those requiring RBC before infusion and/or with pre-transplant anaemia (HR 2.2; CI 1.4-3.4). Age above 60 (HR 1.4; CI 1.0-1.9), BEAM conditioning (HR 1.4; CI 1.0-2.0) and pre-transplant thrombocytopenia and/or requiring PT before infusion (HR 1.8; CI 1.4-2.5) entailed longer time until PT independence. CONCLUSION These four factors (age ≥60 years; BEAM conditioning, CD34+ dose <4 × 106 /kg and pre-transplant cytopenia and/or Day -10 to 0 transfusion) allowed dividing patients into three groups with significant differences between them regarding the time until transfusion independence.
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Affiliation(s)
- Isabel Regalado-Artamendi
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Laura Medina
- Banc de Sang i Teixits de Catalunya, Barcelona, Spain
| | | | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
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12
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Rossi M, Tritapepe L, Conigliaro R, Fanti L, Monzani R, De Robertis E, Martino R, Pietrini L, Sbaraglia F, Pasquale L, Petrini F. Rethink analgo-sedation in digestive endoscopy: the role of scientific societies in tracing training path. Eur Rev Med Pharmacol Sci 2023; 27:4670-4677. [PMID: 37259750 DOI: 10.26355/eurrev_202305_32478] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Care Medicine (SIAARTI) and the Italian Society of Digestive Endoscopy (SIED) worked together to produce a joint Good Clinical Practice (GCP) on analgo-sedation in digestive endoscopy and launched a survey to support the document. The aim was to identify and describe the actual clinical practice of sedation in Italian digestive endoscopy units and offer material for a wider and more widespread discussion among anesthetists and endoscopists. SUBJECTS AND METHODS A national survey was planned, in order to support the statements of the GCP. Twelve thousand and five hundred questionnaires were sent to the members of SIAARTI and SIED in June 2020. RESULTS A total of 662 forms (5.3%) returned completed. Highly complex procedures are performed according to 70% of respondents; daily anesthesiologist's assistance is guaranteed in 26%, for scheduled sessions in 14.5% and as needed in 8%. 69% of respondents declared not to have a dedicated team of anesthesiologists, while just 5% reported an anesthesiologist in charge. A complete monitoring system was assured by 70% of respondents. Dedicated pathways for COVID-19-positive patients were confirmed in <40% of the answers. With regard to moderate/deep sedation, 90% of respondents stated that an anesthetist decides timing and doses. Propofol was exclusively administered by anesthetists according to 94% of answers, and for 6% of respondents the endoscopist is allowed to administer propofol in presence of a dedicated nurse, but with a readily available anesthetist. Only 32.8% of respondents reported institutional training courses on procedural analgo-sedation. CONCLUSIONS The need to provide patients scheduled for endoscopy procedures with an adequate analgo-sedation is becoming an increasing concern, well-known in almost all countries, but many factors compromise the quality of patient care. Results of a national survey would give strength to the need for a shared GCP in gastrointestinal endoscopy. Training and certification of non-anesthetist professionals should be one of the main ways to center the objective.
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Affiliation(s)
- M Rossi
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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13
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Berengua C, Miró E, Gutiérrez C, Sánchez M, Mulero A, Ramos P, Del Cuerpo M, Torrego A, García-Cadenas I, Pajares V, Navarro F, Martino R, Rabella N. Detection of cytomegalovirus in bronchoalveolar lavage fluid from immunocompromised patients with pneumonitis by viral culture and DNA quantification. J Virol Methods 2023; 317:114743. [PMID: 37116585 DOI: 10.1016/j.jviromet.2023.114743] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To compare the detection of human cytomegalovirus (HCMV) in bronchoalveolar lavage (BAL) fluid by viral culture and quantitative polymerase chain reaction (qPCR), and to establish a viral load threshold that can identify cases of HCMV replication indicative of pneumonitis. There is currently no universal viral load cut-off to differentiate between patients with and without pneumonitis, and the interpretation of qPCR results is challenging. METHODS 176 consecutive BAL samples from immunosuppressed hosts with signs and/or symptoms of respiratory infection were prospectively studied by viral culture and qPCR. RESULTS Concordant results were obtained in 81.25% of the BAL samples. The rest were discordant, as only 34% of the qPCR-positive BAL samples were positive by culture. The median HCMV load was significantly higher in culture-positive than in culture-negative BAL samples (5,038 vs 178 IU/mL). Using a cut-off value of 1,258 IU/mL of HCMV in BAL, pneumonia was diagnosed with a sensitivity of 76%, a specificity of 100%, a VPP of 100% and VPN of 98%, and HCMV was isolated in 100% of the BAL cultures. CONCLUSION We found that a qPCR-negative was a quick and reliable way of ruling out HCMV pneumonitis, but a positive result did not always indicate clinically significant replication in the lung. However, an HCMV load in BAL fluid of ≥1,258 IU/mL was always associated with disease, whereas <200 IU/mL rarely so.
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Affiliation(s)
- C Berengua
- Genetics and Microbiology Department. Universitat Autònoma de Barcelona. Spain; Microbiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain; Sant Pau Institute of Biomedical Research (IIb Sant Pau) Barcelona. Spain.
| | - E Miró
- Genetics and Microbiology Department. Universitat Autònoma de Barcelona. Spain; Microbiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain; Sant Pau Institute of Biomedical Research (IIb Sant Pau) Barcelona. Spain
| | - C Gutiérrez
- Microbiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - M Sánchez
- Microbiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - A Mulero
- Microbiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - P Ramos
- Microbiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - M Del Cuerpo
- Microbiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - A Torrego
- Pneumology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain; Sant Pau Institute of Biomedical Research (IIb Sant Pau) Barcelona. Spain
| | - I García-Cadenas
- Pneumology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain; Sant Pau Institute of Biomedical Research (IIb Sant Pau) Barcelona. Spain
| | - V Pajares
- Pneumology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain; Sant Pau Institute of Biomedical Research (IIb Sant Pau) Barcelona. Spain
| | - F Navarro
- Genetics and Microbiology Department. Universitat Autònoma de Barcelona. Spain; Microbiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain; Sant Pau Institute of Biomedical Research (IIb Sant Pau) Barcelona. Spain
| | - R Martino
- Hematology Department. Hospital de la Santa Creu I Sant Pau. Barcelona. Spain; Sant Pau Institute of Biomedical Research (IIb Sant Pau) Barcelona. Spain
| | - N Rabella
- Genetics and Microbiology Department. Universitat Autònoma de Barcelona. Spain; Microbiology Department. Hospital de la Santa Creu i Sant Pau. Barcelona. Spain; Sant Pau Institute of Biomedical Research (IIb Sant Pau) Barcelona. Spain
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14
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García-Cadenas I, Redondo S, Esquirol A, Portos JM, Novelli S, Saavedra S, Moreno C, Garrido A, Oñate G, López J, Ana-Carolina C, Miqueleiz S, Arguello-Tomas M, Briones J, Sierra J, Martino R. Successful Outcome in Patients with Myelofibrosis Undergoing Allogeneic Donor Hematopoietic Cell Transplantation Using Reduced-Doses of Post-Transplant Cyclophosphamide: challenges and review of the literature. Transplant Cell Ther 2023:S2666-6367(23)01239-3. [PMID: 37086849 DOI: 10.1016/j.jtct.2023.04.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Engraftment and non-relapse mortality (NRM) greatly depend upon the transplant platform in patients with Myelofibrosis (MF). OBJECTIVE We report outcomes of 14 consecutive MF patients who received reduced doses of post-transplant Cyclophosphamide (PTCy) (60 mg/kg total dose) and tacrolimus as graft versus host disease (GVHD) prophylaxis as part of a new standardized allogeneic hematopoietic-cell transplantation (allo-HCT) protocol. STUDY DESIGN Median age at HCT was 59 years (range: 41-67), and median interval from diagnosis to HCT was 19 months (range: 2-114). All cases received ruxolitinib before HCT and 71% had no response. Most patients (78%) had symptomatic splenomegaly at HCT. Eighty-six percent received reduced-intensity conditioning (RIC) and most of them (64%) from an unrelated donor. RESULTS There were not graft failures and neutrophil and platelet recovery occurred at a median of 21 and 31 days. The cumulative incidence of grade II-IV and III-IV acute GVHD was 28.6% and 7%. The 2-year incidence of overall and moderate-severe chronic GVHD was 36% and 14%. Only 1 patient relapsed after transplant, and NRM at 100 days and 2-years was 7% and 14%. GVHD-free/relapse-free and immunosuppression free incidence at 1 year was 41%. With a median follow-up for survivors of 28 months (range:8-55), the 2-year overall survival and progression-free survival are 86% and 69%. CONCLUSION Reduced doses of PTCy as GVHD prophylaxis for high risk MF patients shows promising results by reducing GVHD incidence without cases of graft failure.
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Affiliation(s)
- Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Sara Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain..
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - J M Portos
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Silvana Saavedra
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Carol Moreno
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Ana Garrido
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Guadalupe Oñate
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Jordi López
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Caballero Ana-Carolina
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Sara Miqueleiz
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Miguel Arguello-Tomas
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
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15
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Redondo S, García-Cadenas I, Vila A, Esquirol A, Portos JM, Novelli S, Saavedra S, Moreno C, Garrido A, Arguello-Tomas M, Oñate G, López-Pardo J, Caballero AC, Miqueleiz S, Briones J, Sierra J, Sancho G, Martino R. Sequence matters: Total body irradiation (TBI)-based myeloablative conditioning with post-transplant cyclophosphamide may reduce the early nonrelapse mortality compared with pretransplant cyclophosphamide plus TBI. Eur J Haematol 2023. [PMID: 37058419 DOI: 10.1111/ejh.13978] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES High-dose total body irradiation (TBI) is considered a cornerstone of myeloablative conditioning for allogeneic stem cell transplantation (allo-SCT). We retrospectively compared the main outcomes of an HLA matched or 1-allele mismatched related or unrelated allo-SCT in adult patients affected by acute leukemia (AL) or myelodysplastic syndromes (MDS). METHODS Fifty-nine patients received cyclophosphamide (Cy)-TBI (13.5 Gy) and graft-versus-host disease (GVHD) prophylaxis with a calcineurin-inhibitor plus methrotrexate (CyTBI group) and 28 patients received fludarabine-TBI (8.8-13.5 Gy) and GVHD prophylaxis with PTCy and tacrolimus (FluTBI-PTCy group). RESULTS Median follow-up for survivors was 82 and 22 months. The 12-month probability of overall survival and progression-free survival were similar (p = .18, p = .7). The incidence of Grades 2-4 and 3-4 acute GVHD, and the incidence of moderate-to-severe chronic GVHD were higher in the CyTBI group (p = .02, p < .01and p = .03). Nonrelapse mortality (NRM) at 12 months posttransplant was higher in the CyTBI group (p = 0.05), while the incidence of relapse was similar in both groups (p = 0.7). The number of GVHD-free and relapse-free patients without systemic immunosuppression (GRFS) at 1-year posttransplant was higher in the FluTBI-PTCy group (p = 0.01). CONCLUSIONS The study confirms the safety and efficacy of a novel FluTBI-PTCy platform with reduced incidence of severe acute and chronic GVHD, and early improvement of NRM.
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Affiliation(s)
- Sara Redondo
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonio Vila
- Radiotherapy Oncology Department, Hospital de la Sant Creu i Sant Pau, Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J M Portos
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Silvana Saavedra
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Carol Moreno
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ana Garrido
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Miguel Arguello-Tomas
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Guadalupe Oñate
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jordi López-Pardo
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ana-Carolina Caballero
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Sara Miqueleiz
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Gemma Sancho
- Radiotherapy Oncology Department, Hospital de la Sant Creu i Sant Pau, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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16
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Redondo S, De Dios A, Gomis-Pastor M, Esquirol A, Aso O, Triquell M, Moreno ME, Riba M, Ruiz J, Blasco A, Tobajas E, González I, Sierra J, Martino R, García-Cadenas I. Feasibility of a new model of care for allogeneic stem cell transplantation recipients facilitated by eHealth: The MY-Medula pilot study. Transplant Cell Ther 2023:S2666-6367(23)01175-2. [PMID: 36948273 DOI: 10.1016/j.jtct.2023.03.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The use of allogeneic stem cell transplantation (allo-SCT) for the treatment of hematologic diseases is steadily increasing. However, allo-SCT has the downside of causing considerable treatment-related morbidity and mortality. Mobile technology applied to healthcare (mHealth) has proven to be a cost-effective strategy to improve care and offer new services to people with multimorbidity, but there are few data on its usefulness in allo-SCT recipients. OBJECTIVE The aim of this report was to describe a new integrated healthcare model facilitated by an mHealth platform, named EMMASalud-MY-Medula, and to report the results of a le. STUDY DESIGN The MY-Medula platform development approach consisted of 4 phases. Firstly, patient and healthcare professional needs were identified and technological development and pre-testing tests were conducted (phases 1-3, January 2016-March 2021). Then, a non-randomized, prospective, observational, single-center pilot study was conducted (October 2021-January 2022) at the adult Stem Cell Transplant Unit of a tertiary university hospital. RESULTS Twenty-eight volunteer allo-SCT recipients were included in the pilot study. Fifty percent were outpatients in the first-year post-SCT and the remaining 50% were affected by steroid-dependent graft-versus-host disease (SR-GVHD). All patients used MY-Medula application during the two-month follow-up period with a median number of visits to the application of 143 (range 6-477). A total of 2067 self-monitoring records were made, and 205 text messages were received, most of them related to symptoms description (47%) and doubts about medication (21%). In 3.4% of the cases drug dose adjustments were performed by the pharmacist because of dosing errors or interactions. At the end of the study, a 6-question Likert-type questionnaire for patients and a 22-question test for healthcare professionals showed a high degree of satisfaction (95% and 100% respectively) with the new healthcare pathway. CONCLUSIONS Re-engineering allo-SCT recipients follow-up into an integrated, multidisciplinary model of care facilitated by mHealth tools is feasible and has been associated with a high usability and degree of satisfaction by patients and healthcare professionals. A randomized trial aiming to determine the cost-effectiveness of MY-Medula-based follow-up post-SCT is currently enrolling participants.
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Affiliation(s)
- S Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain.
| | - A De Dios
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau.; Digital Health Department, Hospital de la Santa Creu i Sant Pau
| | - M Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau.; Digital Health Department, Hospital de la Santa Creu i Sant Pau
| | - A Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - O Aso
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - M Triquell
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - M E Moreno
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau
| | - M Riba
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau
| | - J Ruiz
- Nutrition and Dietetics Department, Hospital de la Santa Creu i Sant Pau
| | - A Blasco
- Nutrition and Dietetics Department, Hospital de la Santa Creu i Sant Pau
| | - E Tobajas
- Psycho-Oncology Department, Hospital de la Santa Creu i Sant Pau
| | - I González
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - J Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - R Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - I García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
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17
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Piñana JL, Martino R, Vazquez L, López-Corral L, Pérez A, Chorão P, Avendaño-Pita A, Pascual MJ, Sánchez-Salinas A, Sanz-Linares G, Olave MT, Arroyo I, Tormo M, Villalon L, Conesa-Garcia V, Gago B, Terol MJ, Villalba M, Garcia-Gutierrez V, Cabero A, Hernández-Rivas JÁ, Ferrer E, García-Cadenas I, Teruel A, Navarro D, Cedillo Á, Sureda A, Solano C. SARS-CoV-2-reactive antibody waning, booster effect and breakthrough SARS-CoV-2 infection in hematopoietic stem cell transplant and cell therapy recipients at one year after vaccination. Bone Marrow Transplant 2023; 58:567-580. [PMID: 36854892 PMCID: PMC9974060 DOI: 10.1038/s41409-023-01946-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
The kinetics of SARS-CoV-2 reactive IgG antibodies after full vaccination and booster in allogeneic and autologous stem cell transplantation (allo-HSCT, ASCT) and chimeric antigen receptor T-cell therapy (CAR-T) are of utmost importance for estimating risk of infection. A prospective multicenter registry-based cohort study, conducted from December 2020 to July 2022 was used to analyze antibody waning over time, booster effect and the relationship of antibody response and breakthrough infection in 572 recipients (429 allo-HSCT, 121 ASCT and 22 CAR-T cell therapy). A significant decline in antibody titers was observed at 3 and 6 months after full vaccination in recipients without pre-vaccine SARS-CoV-2 infection, whereas recipients infected prior to vaccination showed higher and stable antibody titers over time. In poor responders, a booster dose was able to increase antibody titers in 83% of allo-HSCT and 58% of ASCT recipients but not in CART-T cell recipients [0%] (p < 0.01). One-year cumulative incidence of breakthrough infection was 15%, similar among cell therapy procedures. Immunosuppressive drugs at the time of vaccination [hazard ratio (HR) 1.81, p = 0.0028] and reduced intensity conditioning (HR 0.49, p = 0.011) were identified as the only conditions associated with different risk of breakthrough infection in allo-HSCT recipients. Antibody titers were associated with breakthrough infection and disease severity. No death was observed among the 72 breakthrough infections. Antibody level decay after the first two vaccine doses was common except in recipients with pre-vaccination SARS-CoV-2 infection. Poorly responding allo-HSCT recipients showed a response advantage with the booster as compared to ASCT and, especially, the null response found in CAR-T cell recipients. Antibody titers were positively correlated with the risk of breakthrough SARS-CoV-2 infection which was mainly driven by the immunosuppression status.
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Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain. .,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - Rodrigo Martino
- grid.413396.a0000 0004 1768 8905Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lourdes Vazquez
- grid.411258.bHematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Lucia López-Corral
- grid.411258.bHematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Ariadna Pérez
- grid.411308.fHematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain ,grid.411308.fFundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Pedro Chorão
- grid.84393.350000 0001 0360 9602Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
| | - Alejandro Avendaño-Pita
- grid.411258.bHematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - María-Jesús Pascual
- grid.411457.2Hematology Division, Hospital Regional Universitario Carlos Haya, Malaga, Spain
| | - Andrés Sánchez-Salinas
- grid.411372.20000 0001 0534 3000Hematology Division, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Gabriela Sanz-Linares
- grid.414660.1Hematology Division, Institut Català Oncologia-Hospital Duran i reynals, Barcelona, Spain
| | - María T. Olave
- grid.411050.10000 0004 1767 4212Hematology Division, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain
| | - Ignacio Arroyo
- grid.411308.fHematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Mar Tormo
- grid.411308.fFundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Lucia Villalon
- grid.411316.00000 0004 1767 1089Hematology Division, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Venancio Conesa-Garcia
- grid.411093.e0000 0004 0399 7977Hematology Division, Hospital General universitari d’Elx, Elche, Spain
| | - Beatriz Gago
- grid.411457.2Hematology Division, Hospital Regional Universitario Carlos Haya, Malaga, Spain
| | - María-José Terol
- grid.411308.fHematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain ,grid.411308.fFundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marta Villalba
- grid.84393.350000 0001 0360 9602Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
| | | | - Almudena Cabero
- grid.411258.bHematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - José Ángel Hernández-Rivas
- grid.414761.1Hematology Division, Hospital Universitario Infanta Leonor. Department of Medicine. Complutense University, Madrid, Spain
| | - Elena Ferrer
- grid.411308.fHematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain ,grid.411308.fFundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Irene García-Cadenas
- grid.413396.a0000 0004 1768 8905Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anabel Teruel
- grid.411308.fHematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain ,grid.411308.fFundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - David Navarro
- grid.411308.fFundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain ,grid.411308.fMicrobiology department, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Ángel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH), Valencia, Spain
| | - Anna Sureda
- grid.414660.1Hematology Division, Institut Català Oncologia-Hospital Duran i reynals, Barcelona, Spain
| | - Carlos Solano
- grid.411308.fHematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain ,grid.411308.fFundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain ,grid.5338.d0000 0001 2173 938XDepartment of Medicine, School of Medicine. University of Valencia, Valencia, Spain
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Velao SR, Garcia Cadenas I, Cuesta MA, Sanchez-Ortega I, Fernández-Avilés F, Roldan E, Torrent A, Viguria MC, Villar S, Bento L, Yáñez L, Martino R, Piñana JL. Low rate of infectious enterocolitis in allogeneic stem cell transplant recipients with acute diarrhea: A prospective study by the GETH-TC. Acta Haematol 2022; 146:161-165. [PMID: 36446336 DOI: 10.1159/000528242] [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: 06/29/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
Acute diarrhea is a common and debilitating complication in recipients of an allogeneic hematopoietic stem cell transplantation (HCT). In this prospective, observational, and multi-center study we examined all episodes occurring in the first 6 months of 142 consecutive adult patients who underwent a reduced-intensity conditioning (RIC) HCT in 10 Spanish tertiary University Hospitals. Fifty-four patients (38%) developed a total of 75 acute diarrhea episodes. The median time from HCT to the first episode was 38 days (4-157). The main cause of enterocolitis was lower GI-aGVHD (38%), followed by infections (21%) and drug-related toxicity (8%). Causative infectious causes were identified in only 16/75 episodes (21%). C. difficile-related infection (CDI) was the most common infectious agent with an incidence and recurrence of 13% and 2%, respectively. With a median follow-up for survivors of 32 months, the NRM and the overall survival (OS) at 1 year, were 20% (95% C.I.: 14-28%) and 69% (95% C.I.: 61-77%), respectively. Development of enterocolitis was not associated with higher NRM (p = 0.37) or worse OS (p = 0.9). This real-life study confirms that the diagnosis and management of acute diarrhea in the early stages after HCT is challenging. Nosocomial infections, seem to be relatively uncommon, probably due to more rational use of antibiotics.
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Affiliation(s)
- Sara Redondo Velao
- Department of Hematology and Hemotherapy. Hospital de La Santa Creu I Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Irene Garcia Cadenas
- Department of Hematology and Hemotherapy. Hospital de La Santa Creu I Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Mª Angeles Cuesta
- Department of Hematology and Hemotherapy, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | - Elisa Roldan
- Department of Hematology and Hemotherapy, Hospital Vall D'Hebron, Barcelona, Spain
| | - Anna Torrent
- Department of Hematology and Hemotherapy, Institut Català d'Oncologia Badalona, Barcelona, Spain
| | - M Cruz Viguria
- Department of Hematology and Hemotherapy, Hospital Universitario de Navarra, Pamplona, Spain
| | - Sara Villar
- Department of Hematology and Hemotherapy, Clínica Universidad de Navarra, Pamplona, Spain
| | - Leyre Bento
- Department of Hematology and Hemotherapy, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Lucrecia Yáñez
- Department of Hematology and Hemotherapy, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rodrigo Martino
- Department of Hematology and Hemotherapy. Hospital de La Santa Creu I Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jose Luis Piñana
- Department of Hematology and Hemotherapy, Hospital Universitario Clinico de Valencia, Valencia, Spain
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19
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Albiol N, Aso O, Gómez-Pérez L, Triquell M, Roch N, Lázaro E, Esquirol A, González I, López-Contreras J, Sierra J, Martino R, García-Cadenas I. Correction to: mRNA-1273 SARS-CoV-2 vaccine safety and COVID-19 risk perception in recently transplanted allogeneic hematopoietic stem cell transplant recipients. Support Care Cancer 2022; 30:9691. [DOI: 10.1007/s00520-022-07452-1] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Saliba RM, Alousi AM, Pidala J, Arora M, Spellman SR, Hemmer MT, Wang T, Abboud C, Ahmed S, Antin JH, Beitinjaneh A, Buchbinder D, Byrne M, Cahn JY, Choe H, Hanna R, Hematti P, Kamble RT, Kitko CL, Laughlin M, Lekakis L, MacMillan ML, Martino R, Mehta PA, Nishihori T, Patel SS, Perales MA, Rangarajan HG, Ringdén O, Rosenthal J, Savani BN, Schultz KR, Seo S, Teshima T, van der Poel M, Verdonck LF, Weisdorf D, Wirk B, Yared JA, Schriber J, Champlin RE, Ciurea SO. Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis. Transplant Cell Ther 2022; 28:681-693. [PMID: 35853610 PMCID: PMC10141544 DOI: 10.1016/j.jtct.2022.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/23/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGvHD rate after Haplo/PTCY was also lower (hazard ratio [HR] = .4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR = .6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR = .6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) during, but not after (HR = .9, P = .6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate.
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Affiliation(s)
- Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Amin M Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph Pidala
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Mukta Arora
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be the Match, Minneapolis, Minnesota; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Stephen R Spellman
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Michael T Hemmer
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tao Wang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Divsion of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Camille Abboud
- Washington University in St. Louis School of Medicine, Division of Oncology, Section of BMT and Leukemia, St. Louis, Missouri
| | - Sairah Ahmed
- Department of Lymphoma-Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Joseph H Antin
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, California
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Hannah Choe
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio
| | | | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Carrie L Kitko
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Laughlin
- Medical Director, Cleveland Cord Blood Center, Cleveland, Ohio
| | - Lazaros Lekakis
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Parinda A Mehta
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, Florida
| | - Sagar S Patel
- Blood and Marrow Transplant Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hemalatha G Rangarajan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio
| | - Olov Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm, Sweden
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Marjolein van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minnesota
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Jean A Yared
- Transplantation & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Jeffrey Schriber
- Cancer Treatment Centers of America Comprehensive Care and Research Center, Phoenix, Arizona
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stefan O Ciurea
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, University of California, Irvine, Orange, California
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21
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Khan MM, Manduchi B, Rodriguez V, Fitch MI, Barbon CEA, McMillan H, Hutcheson KA, Martino R. Exploring patient experiences with a telehealth approach for the PRO-ACTIVE trial intervention in head and neck cancer patients. BMC Health Serv Res 2022; 22:1218. [PMID: 36180905 PMCID: PMC9523628 DOI: 10.1186/s12913-022-08554-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/11/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Following the COVID-19 directive to cease non-essential services, a rapid shift was made in the delivery of Speech Language Pathology (SLP) dysphagia management in the 3-arm, randomized PRO-ACTIVE trial. To inform future programs, this study explored patients' experiences with telehealth when the planned in-person SLP intervention was moved to a telehealth modality. METHODS A theory-guided qualitative descriptive approach was used. Willing participants who had received at least one telehealth swallowing therapy session participated in a one-time semi-structured interview. Interview transcripts were subjected to a standard qualitative content/theme analysis. Researchers reviewed all transcripts and used a multi-step analysis process to build a coding framework through consensus discussion. Summaries and key messages were generated for each code. RESULTS Eleven participants recounted their telehealth experiences and reported feeling satisfied, comfortable and confident with the session(s). They identified that previous experience with teleconferencing, access to optimal technical equipment, clinician skill, and caregiver assistance facilitated their telehealth participation. Participants highlighted that telehealth was beneficial as it reduced commuting time, COVID-19 exposure and fatigue from travel; and also allowed caregiver participation particularly during COVID. In comparing their in-person SLP sessions to telehealth sessions, limitations were also identified, including: lack of previous experience with and/or poor access to technology, and less opportunity for personalization. Participants indicated that use of phone alone was less preferred than an audio/video platform. DISCUSSION Patients reported that overall, telehealth sessions did not compromise their learning experience when compared to in-person sessions. Patients benefited from use of telehealth in several ways despite some limitations of the use of technology. Patient feedback about telehealth provides an important perspective that may be critical to inform best practices for care delivery.
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Affiliation(s)
- M M Khan
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - B Manduchi
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - V Rodriguez
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - M I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - C E A Barbon
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave., Houston, TX, 77030, USA
| | - H McMillan
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave., Houston, TX, 77030, USA
| | - K A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave., Houston, TX, 77030, USA.
- Department of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA.
| | - R Martino
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
- Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
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22
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Albiol N, Barata A, Aso O, Gómez-Pérez L, Triquell M, Roch N, Lázaro E, Esquirol A, González I, López-Contreras J, Sierra J, Martino R, García-Cadenas I. mRNA-1273 SARS-CoV-2 vaccine safety and COVID-19 risk perception in recently transplanted allogeneic hematopoietic stem cell transplant recipients. Support Care Cancer 2022; 30:9687-9690. [PMID: 36169731 PMCID: PMC9517991 DOI: 10.1007/s00520-022-07376-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2022]
Abstract
Purpose This study aims to describe the incidence and severity of adverse events (AEs) following the mRNA-1273 SARS-CoV-2 vaccine and explore the risk perception of COVID-19 in allogeneic hematopoietic stem cell transplant (HCT) recipients. Methods We performed a single-center prospective study including recently transplanted (< 2 years post-infusion) allogeneic HCT recipients. AEs were assessed through phone calls and graded from 0 to 4, while COVID-19 risk perception was measured using the Brief Illness Perception Questionnaire (BIP-Q5). Results Fifty-four HCT recipients were evaluated. Incidence and grades of AE (94.4% and 85.2% after the first and second dose, respectively) were similar to those described in the general population. The most common AE was pain at the site of injection. Three patients (5.6%) developed a grade ≥ 3 AE. Vaccine-related cytopenias and graft-versus-host disease flares were not observed. Female sex (OR 3.94, 95% CI 1.14–13.58, p = 0.03) and time since HCT (per month since HCT: OR 1.09, 95% CI 1.01–1.18, p = 0.04) were associated with the occurrence of any AE. The patients’ risk perception level of COVID-19 decreased over time (p < 0.05). Conclusion Our study confirms that the mRNA-1273 SARS-CoV-2 vaccine is safe in recent HCT recipients and suggests that the perceived risk of COVID-19 decreases over time.
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Affiliation(s)
- Nil Albiol
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain. .,Autonomous University of Barcelona, Barcelona, Spain. .,Josep Carreras Leukaemia Research Institute, Barcelona, Spain.
| | - Anna Barata
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Olga Aso
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Lucía Gómez-Pérez
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Mercè Triquell
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Nerea Roch
- Infectious Diseases Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Elisabeth Lázaro
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Iria González
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Joaquín López-Contreras
- Autonomous University of Barcelona, Barcelona, Spain.,Infectious Diseases Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain. .,Autonomous University of Barcelona, Barcelona, Spain. .,Josep Carreras Leukaemia Research Institute, Barcelona, Spain.
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23
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Fernandez-Sojo J, Horton R, Cid J, Azqueta C, Garcia-Buendia A, Valdivia E, Martorell L, Rubio-Lopez N, Codinach M, Aran G, Marsal J, Mussetti A, Martino R, Diaz-de-Heredia C, Ferra C, Valcarcel D, Linares M, Ancochea A, García-Rey E, García-Muñoz N, Medina L, Carreras E, Villa J, Lozano M, Gibson D, Querol S. Leukocytapheresis variables and transit time for allogeneic cryopreserved hpc: better safe than sorry. Bone Marrow Transplant 2022; 57:1531-1538. [PMID: 35804055 PMCID: PMC9264299 DOI: 10.1038/s41409-022-01750-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022]
Abstract
Cryopreservation was recommended to ensure continuity in allogeneic hematopoietic progenitor cells (HPC) transplantation during the COVID-19 pandemic. Several groups have shown no impact on clinical outcomes for patients who underwent HPC transplantation with cryopreserved products during the first months of this pandemic. However, concerns about quality control attributes after cryopreservation have been raised. We investigated, in 155 allogeneic peripheral blood cryopreserved HPC, leukocytapheresis characteristics influencing viable CD34+ and CD3+ cells, and CFU-GM recoveries after thawing. Collection characteristics such as volume, nucleated cells (NC)/mL and hematocrit correlated with viable CD34+ and CD3+ cells recoveries after thawing in univariate analysis but only CD3+ cells remained statistically significant in multivariate analysis (r2 = 0.376; P = < 0.001). Additionally, transit time also showed correlation with viable CD34+ (r2 = 0.186), CD3+ (r2 = 0.376) and CFU-GM recoveries (r2 = 0.212) in multivariate analysis. Thus, diluting leukocytapheresis below 200 × 106 NC/mL, avoiding red cells contamination above 2%, cryopreserving below 250 × 106 NC/mL and minimizing transit time below 36 h, prevented poor viable CD34+ and CD3+ cells, and CFU-GM recoveries. In summary, optimizing leukocytapheresis practices and minimizing transportation time may better preserve the quality attributes of HPC when cryopreservation is indicated.
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Affiliation(s)
- Jesus Fernandez-Sojo
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain.
| | - Roger Horton
- Anthony Nolan Cell Therapy Centre, Nottingham Trent University, Nottingham, UK
| | - Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carmen Azqueta
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Ana Garcia-Buendia
- Data manager and statisticians, cell therapy department, Banc de Sang I Teixits, Barcelona, Spain
| | - Elena Valdivia
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Lluis Martorell
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Nuria Rubio-Lopez
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | | | - Gemma Aran
- Cell Laboratory, Banc de Sang i Teixits, Barcelona, Spain
| | - Julia Marsal
- Pediatric Hematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Alberto Mussetti
- Adult Hematology Department, Institut Catala d'Oncologia-Hospitalet, Barcelona, Spain
| | - Rodrigo Martino
- Adult Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Cristina Diaz-de-Heredia
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Christelle Ferra
- Adult Hematology Department, Institut Català d'Oncologia-Badalona, Barcelona, Spain
| | - David Valcarcel
- Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mónica Linares
- Banc de Sang i Teixits, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Agueda Ancochea
- Banc de Sang i Teixits, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Enric García-Rey
- Banc de Sang i Teixits, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Nadia García-Muñoz
- Banc de Sang i Teixits, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Medina
- Banc de Sang i Teixits, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Enric Carreras
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukemia Research Institute, Barcelona, Catalonia, Spain
| | - Juliana Villa
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukemia Research Institute, Barcelona, Catalonia, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Daniel Gibson
- Anthony Nolan Cell Therapy Centre, Nottingham Trent University, Nottingham, UK
| | - Sergio Querol
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
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24
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Piñana JL, López-Corral L, Martino R, Vazquez L, Pérez A, Martin-Martin G, Gago B, Sanz-Linares G, Sanchez-Salinas A, Villalon L, Conesa-Garcia V, Olave MT, Corona M, Marcos-Corrales S, Tormo M, Hernández-Rivas JÁ, Montoro J, Rodriguez-Fernandez A, Risco-Gálvez I, Rodríguez-Belenguer P, Hernandez-Boluda JC, García-Cadenas I, Ruiz-García M, Muñoz-Bellido JL, Solano C, Cedillo Á, Sureda A, Navarro D. SARS-CoV-2 vaccine response and rate of breakthrough infection in patients with hematological disorders. J Hematol Oncol 2022; 15:54. [PMID: 35526045 PMCID: PMC9077637 DOI: 10.1186/s13045-022-01275-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background The clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has not yet been established. Patients and methods A prospective multicenter registry-based cohort study conducted from December 2020 to December 2021 by the Spanish transplant and cell therapy group was used to analyze the relationship of antibody response at 3–6 weeks after full vaccination (2 doses) with breakthrough SARS-CoV-2 infection in 1394 patients with hematological disorders. Results At a median follow-up of 165 days after complete immunization, 37 out of 1394 (2.6%) developed breakthrough SARS-CoV-2 infection at median of 77 days (range 7–195) after full vaccination. The incidence rate was 6.39 per 100 persons-year. Most patients were asymptomatic (19/37, 51.4%), whereas only 19% developed pneumonia. The mortality rate was 8%. Lack of detectable antibodies at 3–6 weeks after full vaccination was the only variable associated with breakthrough infection in multivariate logistic regression analysis (Odds Ratio 2.35, 95% confidence interval 1.2–4.6, p = 0.012). Median antibody titers were lower in cases than in non-cases [1.83 binding antibody units (BAU)/mL (range 0–4854.93) vs 730.81 BAU/mL (range 0–56,800), respectively (p = 0.007)]. We identified 250 BAU/mL as a cutoff above which incidence and severity of the infection were significantly lower. Conclusions Our study highlights the benefit of developing an antibody response in these highly immunosuppressed patients. Level of antibody titers at 3 to 6 weeks after 2-dose vaccination links with protection against both breakthrough infection and severe disease for non-Omicron SARS-CoV-2 variants. Supplementary Information The online version contains supplementary material available at 10.1186/s13045-022-01275-7.
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Affiliation(s)
- José Luis Piñana
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain. .,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - Lucia López-Corral
- Hematology Division, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lourdes Vazquez
- Hematology Division, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ariadna Pérez
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Beatriz Gago
- Hematology Division, Hospital Regional Universitario Carlos Haya, Malaga, Spain
| | - Gabriela Sanz-Linares
- Hematology Division, Institut Català Oncologia-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Andrés Sanchez-Salinas
- Hematology Division, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Lucia Villalon
- Hematology Division, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - María T Olave
- Hematology Division, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Saragossa, Spain
| | | | | | - Mar Tormo
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Juan Montoro
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
| | | | | | - Pablo Rodríguez-Belenguer
- Research Program on Biomedical Informatics (GRIB), Department of Experimental and Health Sciences, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Juan Carlos Hernandez-Boluda
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | | | | | | | - Carlos Solano
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Ángel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH) Office, Madrid, Spain
| | - Anna Sureda
- Hematology Division, Institut Català Oncologia-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - David Navarro
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.,Hospital Clinico Universitario de Valencia, Valencia, Spain
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25
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Piñana JL, López‐Corral L, Martino R, Montoro J, Vazquez L, Pérez A, Martin‐Martin G, Facal‐Malvar A, Ferrer E, Pascual M, Sanz‐Linares G, Gago B, Sanchez‐Salinas A, Villalon L, Conesa‐Garcia V, Olave MT, López‐Jimenez J, Marcos‐Corrales S, García‐Blázquez M, Garcia‐Gutiérrez V, Hernández‐Rivas JÁ, Saus A, Espigado I, Alonso C, Hernani R, Solano C, Ferrer‐Lores B, Guerreiro M, Ruiz‐García M, Muñoz‐Bellido JL, Navarro D, Cedillo A, Sureda A. SARS-CoV-2-reactive antibody detection after SARS-CoV-2 vaccination in hematopoietic stem cell transplant recipients: Prospective survey from the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group. Am J Hematol 2022; 97:30-42. [PMID: 34695229 PMCID: PMC8646900 DOI: 10.1002/ajh.26385] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023]
Abstract
This is a multicenter prospective observational study that included a large cohort (n = 397) of allogeneic (allo‐HSCT; (n = 311) and autologous (ASCT) hematopoietic stem cell transplant (n = 86) recipients who were monitored for antibody detection within 3–6 weeks after complete severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination from February 1, 2021, to July 20, 2021. Most patients (n = 387, 97.4%) received mRNA‐based vaccines. Most of the recipients (93%) were vaccinated more than 1 year after transplant. Detectable SARS‐CoV‐2‐reactive antibodies were observed in 242 (78%) of allo‐HSCT and in 73 (85%) of ASCT recipients. Multivariate analysis in allo‐HSCT recipients identified lymphopenia < 1 × 109/ml (odds ratio [OR] 0.33, 95% confidence interval [95% CI] 0.16–0.69, p = .003), active graft versus host disease (GvHD; OR 0.51, 95% CI 0.27–0.98, p = .04) and vaccination within the first year of transplant (OR 0.3, 95% CI 0.15–0.9, p = .04) associated with lower antibody detection whereas. In ASCT, non‐Hodgkin's lymphoma (NHL; OR 0.09, 95% CI 0.02–0.44, p = .003) and active corticosteroid therapy (OR 0.2, 95% CI 0.02–0.87, p = .03) were associated with lower detection rate. We report an encouraging rate of SARS‐CoV‐2‐reactive antibodies detection in these severe immunocompromised patients. Lymphopenia, GvHD, the timing of vaccine, and NHL and corticosteroids therapy should be considered in allo‐HSCT and ASCT, respectively, to identify candidates for SARS‐CoV‐2 antibodies monitoring.
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Affiliation(s)
- José Luis Piñana
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | | | - Rodrigo Martino
- Hematology Division Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Juan Montoro
- Hematology Division Hospital universitario y politécnico La Fe Valencia Spain
| | - Lourdes Vazquez
- Hematology Division Hospital Universitario de Salamanca Salamanca Spain
| | - Ariadna Pérez
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | | | - Ana Facal‐Malvar
- Hematology Division Hospital universitario y politécnico La Fe Valencia Spain
| | - Elena Ferrer
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
| | - María‐Jesús Pascual
- Hematology Division Hospital Regional Universitario Carlos Haya Malaga Spain
| | - Gabriela Sanz‐Linares
- Hematology Division Institut Català Oncologia‐Hospital Duran i reynals Barcelona Spain
| | - Beatriz Gago
- Hematology Division Hospital Regional Universitario Carlos Haya Malaga Spain
| | | | - Lucia Villalon
- Hematology Division Hospital Universitario Fundación Alcorcón Madrid Spain
| | | | - Maria T. Olave
- Hematology Division Hospital Clínico Universitario Lozano Blesa IIS Aragon, Zaragoza Spain
| | | | | | | | | | | | - Ana Saus
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | - Ildefonso Espigado
- Hematology Division Universidad de Sevilla, Hospital Universitario Virgen Macarena‐Hospital Universitario Virgen del Rocío, IBiS/CSIC Sevilla Spain
| | - Carmen Alonso
- Hematology Division Hospital Arnau de Vilanova Valencia Spain
| | - Rafael Hernani
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | - Carlos Solano
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
- Department of Medicine, School of Medicine University of Valencia Valencia Spain
| | - Blanca Ferrer‐Lores
- Hematology Department Hospital Clínico Universitario de Valencia Valencia Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
| | - Manuel Guerreiro
- Hematology Division Hospital universitario y politécnico La Fe Valencia Spain
| | | | | | - David Navarro
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia Valencia Spain
- Microbiology department Hospital Clinico Universitario de Valencia Valencia Spain
| | - Angel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH) Madrid Spain
| | - Anna Sureda
- Hematology Division Institut Català Oncologia‐Hospital Duran i reynals Barcelona Spain
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26
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Redondo S, Esquirol A, Novelli S, Caballero AC, Garrido A, Oñate G, López J, Moreno C, Saavedra SD, Granell M, Briones J, Sierra J, Martino R, García-Cadenas I. Efficacy and Safety of Ruxolitinib in Steroid-Refractory/Dependent Chronic Graft-versus-Host Disease: Real-World Data and Challenges. Transplant Cell Ther 2022; 28:43.e1-43.e5. [PMID: 34757054 DOI: 10.1016/j.jtct.2021.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/24/2021] [Accepted: 10/24/2021] [Indexed: 01/31/2023]
Abstract
Steroid-refractory (SR) chronic graft-versus-host disease (cGVHD) is a major obstacle in recipients of allogeneic stem cell transplantation (HCT). Ruxolitinib is the first agent to demonstrate superior efficacy to the best available therapy, but real-life data are still lacking. Here we describe the results of ruxolitinib compassionate use for the treatment of SR/steroid-dependent cGVHD in a tertiary care university hospital. In this retrospective single-center study, we evaluated the outcomes of 48 patients diagnosed with SR-cGVHD who were treated with ruxolitinib. Forty-seven (98%) had moderate-severe disease, and 27 (56%) had received ≥2 lines of prior therapy (excluding steroids). Results were analyzed using SPSS version 26.0.01 and R version 3.4.3. The overall response rate was 77% (37 of 48), with 15% (7 of 37) in complete remission. The median time to response was 2 months (range, 0.5 to 8 months). Steroid tapering was achieved in 26 patients (54%) and definitive discontinuation was achieved in 10 patients (21%) after a median of 20 months (range, 1.5 to 60 months). Toxicity was predominantly hematologic, including a 33% rate of anemia and a 17% rate of thrombocytopenia. Overall survival at 2 years was significantly higher in responders compared with nonresponders (88% [95% confidence interval (CI), 65% to 96%] versus 49% [95% CI, 12% to 78%]; P = .01). At last follow-up, tapering of ruxolitinib had been started in 8 of 37 responders (22%). Our experience supports the efficacy of ruxolitinib in the treatment of SR-cGVHD, along with its steroid-sparing effect and manageable toxicity. Gradual tapering of ruxolitinib seems feasible without cases of GVHD flare. More studies and longer follow-up are needed to confirm these data, as well as to identify the ideal dose adjustments in cases of toxicity.
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Affiliation(s)
- Sara Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ana Carolina Caballero
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ana Garrido
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Guadalupe Oñate
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jordi López
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Carol Moreno
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Silvanna-Daniela Saavedra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Miquel Granell
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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Piñana JL, Vázquez L, Martino R, de la Cámara R, Sureda A, Rodríguez-Veiga R, Garrido A, Sierra J, Ribera JM, Torrent A, Mateos MV, de la Rubia J, Tormo M, Díez-Campelo M, García-Gutiérrez V, Álvarez-Larrán A, Sancho JM, MartínGarcía-Sancho A, Yañez L, Pérez Simón JA, Barba P, Abrisqueta P, Álvarez-Twose I, Bonanad S, Lecumberri R, Ruiz-Camps I, Navarro D, Hernández-Rivas JÁ, Cedillo Á, García-Sanz R, Bosch F. Spanish Society of Hematology and Hemotherapy expert consensus opinion for SARS-CoV-2 vaccination in onco-hematological patients. Leuk Lymphoma 2021; 63:538-550. [PMID: 34668835 PMCID: PMC8544670 DOI: 10.1080/10428194.2021.1992619] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the midst of the COVID-19 pandemic, different vaccines in front of SARS-CoV-2 have been approved and administered in different vulnerable populations. As patients with cancer were excluded from pivotal trials of vaccination, little is known on their immunogenic response to these vaccines, particularly in patients with severely impaired immune system. In response to that uncertainty, the Spanish Society of Hematology and Hemotherapy launched an initiative aimed to provide recommendations for vaccination of the main hematological conditions. This document is based on the available information on COVID-19 outcomes, prior knowledge on vaccination in hematological patients, recent published data on serological response in oncohematological patients and expert opinions. New information about SARS-CoV-2 vaccination will be gathered in the near future, providing new scientific grounds to delineate the most adequate management of vaccination in patients with hematological diseases. The current limited data on SARS-CoV-2 vaccines in hematological patients represents a major limitation of this expert consensus opinion. In fact, the speed in which this field evolves may reduce their validity in the near future.
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Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Lourdes Vázquez
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Rodrigo Martino
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Anna Sureda
- Hematology Department, Hematology Department, Institut Català d'Oncologia-Hospitalret, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Ana Garrido
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José-María Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Research Institute, Badalona, Spain
| | - Anna Torrent
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Research Institute, Badalona, Spain
| | | | - Javier de la Rubia
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María Díez-Campelo
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Juan-Manuel Sancho
- Hematology Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
| | | | - Lucrecia Yañez
- Hematology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Pere Barba
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Pau Abrisqueta
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Iván Álvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast) and CIBERONC, Hospital Virgen del Valle, Toledo, Spain
| | - Santiago Bonanad
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ramón Lecumberri
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Ruiz-Camps
- Infectious disease department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - David Navarro
- Department of Medicine, School of Medicine, Microbiology Service, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | | | - Ángel Cedillo
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ramón García-Sanz
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Francesc Bosch
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
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Martino R, Fitch MI, Fuller CD, Hope A, Krisciunas G, Langmore SE, Lazarus C, Macdonald CL, McCulloch T, Mills G, Palma DA, Pytynia K, Ringash J, Sultanem K, Theurer J, Thorpe KE, Hutcheson K. The PRO-ACTIVE trial protocol: a randomized study comparing the effectiveness of PROphylACTic swallow InterVEntion for patients receiving radiotherapy for head and neck cancer. BMC Cancer 2021; 21:1100. [PMID: 34645411 PMCID: PMC8513207 DOI: 10.1186/s12885-021-08826-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/21/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Swallowing therapy is commonly provided as a treatment to lessen the risk or severity of dysphagia secondary to radiotherapy (RT) for head and neck cancer (HNC); however, best practice is not yet established. This trial will compare the effectiveness of prophylactic (high and low intensity) versus reactive interventions for swallowing in patients with HNC undergoing RT. METHODS This multi-site, international randomized clinical trial (RCT) will include 952 adult patients receiving radiotherapy for HNC and who are at high risk for post-RT dysphagia. Participants will be randomized to receive one of three interventions for swallowing during RT: RE-ACTIVE, started promptly if/when dysphagia is identified; PRO-ACTIVE EAT, low intensity prophylactic intervention started before RT commences; or, PRO-ACTIVE EAT+EXERCISE, high intensity prophylactic intervention also started before RT commences. We hypothesize that the PRO-ACTIVE therapies are more effective than late RE-ACTIVE therapy; and, that the more intensive PRO-ACTIVE (EAT + EXERCISE) is superior to the low intensive PRO-ACTIVE (EAT). The primary endpoint of effectiveness is duration of feeding tube dependency one year post radiation therapy, selected as a pragmatic outcome valued equally by diverse stakeholders (e.g., patients, caregivers and clinicians). Secondary outcomes will include objective measures of swallow physiology and function, pneumonia and weight loss, along with various patient-reported swallowing-related outcomes, such as quality of life, symptom burden, and self-efficacy. DISCUSSION Dysphagia is a common and potentially life-threatening chronic toxicity of radiotherapy, and a priority issue for HNC survivors. Yet, the optimal timing and intensity of swallowing therapy provided by a speech-language pathologist is not known. With no clearly preferred strategy, current practice is fraught with substantial variation. The pragmatic PRO-ACTIVE trial aims to specifically address the decisional dilemma of when swallowing therapy should begin (i.e., before or after a swallowing problem develops). The critical impact of this dilemma is heightened by the growing number of young HNC patients in healthcare systems that need to allocate resources most effectively. The results of the PRO-ACTIVE trial will address the global uncertainty regarding best practice for dysphagia management in HNC patients receiving radiotherapy. TRIAL REGISTRATION The protocol is registered with the US Patient Centered Outcomes Research Institute, and the PRO-ACTIVE trial was prospectively registered at ClinicalTrials.gov , under the identifier NCT03455608 ; First posted: Mar 6, 2018; Last verified: Jun 17, 2021. Protocol Version: 1.3 (January 27, 2020).
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Affiliation(s)
- R Martino
- Department of Speech Language Pathology, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- Rehabilitation Science Institute, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
- Department of Otolaryngology, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
| | - M I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - C D Fuller
- Division of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA
| | - A Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
| | - G Krisciunas
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, USA
| | - S E Langmore
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, USA
| | - C Lazarus
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA
| | - C L Macdonald
- Qualitative Health Research Consultants, Madison, WI, USA
| | - T McCulloch
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, WI, U.S.A
| | - G Mills
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - D A Palma
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - K Pytynia
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA
| | - J Ringash
- Department of Otolaryngology, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
| | - K Sultanem
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - J Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - K E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Canada
| | - K Hutcheson
- Division of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA.
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA.
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29
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Granell M, Senín A, Barata A, Cibeira MT, Gironella M, López-Pardo J, Motlló C, Garcia-Guiñón A, Ben-Azaiz R, Abella E, Soler A, Canet M, Martí JM, Martino R, Sierra J, de Larrea CF, Oriol A, Rosiñol L. Predictors of return to work after autologous stem cell transplantation in patients with multiple myeloma. Bone Marrow Transplant 2021; 56:2904-2910. [PMID: 34404917 DOI: 10.1038/s41409-021-01429-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/16/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022]
Abstract
Return to work (RTW) is a marker of functional recovery in cancer patients, with quality of life, financial and social implications. We investigated frequency and factors associated with RTW in a cohort of patients younger than 66 years, with newly diagnosed multiple myeloma (MM), uniformly treated with a bortezomib-based induction followed by autologous stem cell transplantation (ASCT). Socio-economic and working status data were collected by a self-administered questionnaire. One hundred and eighty-six patients entered the study. Of whom, 145 (78%) where employed at diagnosis, which was more frequent in younger (median 55 vs. 60 years, p < 0.001), men (59.3% vs. 34.2%, p = 0.004), and with college studies (44.8% vs. 24.4%, p = 0.008). Forty-three (30%) of the 145 patients who had a job at diagnosis, RTW after ASCT in a median of 5 (range 1-27) months. Factors independently associated with RTW were having three or more children (HR 2.87, 95% CI 1.33-6.18), college studies (HR 2.78, 95% CI 1.21-6.41), and a family income >40 × 103€/year (HR 2.31, 95% CI 1.12-4.78). In conclusion, the frequency of RTW herein reported in MM patients seems lower than reported in other malignancies. The risk factors observed may guide the design RTW programs.
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Affiliation(s)
- Miquel Granell
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Alicia Senín
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - Anna Barata
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Health Outcomes and Behavior Department, Moffitt Cancer Center, Tampa, FL, US.
| | - Maria-Teresa Cibeira
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mercedes Gironella
- Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi López-Pardo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Motlló
- Hematology Department, Hospital Sant Joan de Déu Manresa, Barcelona, Spain
| | | | - Randa Ben-Azaiz
- Hematology Department, Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eugènia Abella
- Hematology Department, Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alfons Soler
- Hematology Department, Hospital Universitari Parc Taulí Sabadell, Barcelona, Spain
| | - Marta Canet
- Hematology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Josep Ma Martí
- Hematology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Albert Oriol
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - Laura Rosiñol
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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Albiol N, Novelli S, Mozos A, Pratcorona M, Martino R, Sierra J. Venetoclax in relapsed/refractory blastic plasmacytoid dendritic cell neoplasm with central nervous system involvement: a case report and review of the literature. J Med Case Rep 2021; 15:326. [PMID: 34172079 PMCID: PMC8235836 DOI: 10.1186/s13256-021-02939-7] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/01/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND We describe a patient with blastic plasmacytoid dendritic cell neoplasm with central nervous system involvement and the outcome of venetoclax use in this setting. CASE PRESENTATION A 54-year-old Caucasian male was referred to the Haematology Unit with an enlarged inguinal lymph node which was diagnostic of a blastic plasmacytoid dendritic cell neoplasm. The staging revealed disseminated disease (skin, visceral, lymph nodes, and bone marrow). He received chemotherapy with an acute myeloid leukaemia-like regime. Afterwards, he underwent allogeneic haematopoietic stem cell transplantation, though it was not successful, showing a relapse 14 months later with hepatic and central nervous system dissemination. Intrathecal chemotherapy was administered, and venetoclax (anti-bcl2 agent) was started in an off-label indication based on most recent literature. The disease halted its course for 3 months. In the end, the patient's disease progressed and so he succumbed due to infectious complications. CONCLUSIONS Venetoclax monotherapy seems not enough to control the disease progression under CNS involvement and other treatments should be investigated.
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Affiliation(s)
- Nil Albiol
- Haematology Department. Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, Barcelona, Spain.
| | - Silvana Novelli
- Haematology Department. Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute (Hospital Sant Pau Campus), Barcelona, Spain
| | - Anna Mozos
- Pathology Department. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Pratcorona
- Haematology Department. Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute (Hospital Sant Pau Campus), Barcelona, Spain
| | - Rodrigo Martino
- Haematology Department. Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute (Hospital Sant Pau Campus), Barcelona, Spain
| | - Jorge Sierra
- Haematology Department. Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute (Hospital Sant Pau Campus), Barcelona, Spain
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Esquirol A, Pascual MJ, Kwon M, Pérez A, Parody R, Ferra C, Garcia Cadenas I, Herruzo B, Dorado N, Hernani R, Sanchez-Ortega I, Torrent A, Sierra J, Martino R. Severe infections and infection-related mortality in a large series of haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant 2021; 56:2432-2444. [PMID: 34059802 PMCID: PMC8165955 DOI: 10.1038/s41409-021-01328-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/10/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
Severe infections and their attributable mortality are major complications in recipients of allogeneic hematopoietic stem cell transplantation (alloSCT). We herein report 236 adult patients who received haploSCT with PTCy. The median follow-up for survivors was 37 months. The overall incidence of bloodstream infections by gram-positive and gram-negative bacteria at 37 months was 51% and 46%, respectively. The incidence of cytomegalovirus infection was 69%, while Epstein Barr virus infections occurred in 10% of patients and hemorrhagic cystitis in 35% of cases. Invasive fungal infections occurred in 11% at 17 months. The 3-year incidence of infection-related mortality was 19%. The median interval from transplant to IRM was 3 months (range 1–30), 53% of IRM occurred >100 days post-haploSCT. Risk factors for IRM included age >50 years, lymphoid malignancy, and developing grade III-IV acute GvHD. Bacterial infections were the most common causes of IRM (51%), mainly due to gram-negative bacilli BSI. In conclusion, severe infections are the most common causes of NRM after haploSCT with PTCy, with a reemergence of gram-negative bacilli as the most lethal pathogens. More studies focusing on the severe infections after haploSCT with PTCy and differences with other types of alloSCT in adults are clearly warranted.
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Affiliation(s)
- Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain.
| | | | - Mi Kwon
- Hematology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Rocio Parody
- Hematology Department, Hospital de Bellvitge, Barcelona, Spain
| | - Christelle Ferra
- Hematology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Irene Garcia Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Beatriz Herruzo
- Hematology Department, Hospital Regional Universitario, Malaga, Spain
| | - Nieves Dorado
- Hematology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Rafael Hernani
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | - Anna Torrent
- Hematology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
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Esquirol A, Pascual MJ, Garcia-Cadenas I, Herruzo B, Ferrà C, Pérez A, Torio A, Torrent A, Cuesta M, Martino R, Sierra J. Combining Three Different Pretransplantation Scores Improves Predictive Value in Patients after Haploidentical Stem Cell Transplantation with Thiotepa, Busulfan, and Fludarabine Conditioning and Post-Transplantation Cyclophosphamide. Transplant Cell Ther 2021; 27:614.e1-614.e8. [PMID: 33775908 DOI: 10.1016/j.jtct.2021.03.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
One hundred and sixty-one patients underwent haploidentical stem cell transplantation (haploSCT) with thiotepa, busulfan, and fludarabine conditioning followed by post-transplantation cyclophosphamide (PTCy) (on days +3 and +4) and tacrolimus as graft-versus-host disease prophylaxis. Forty-two percent of patients had a high or very high revised Disease Risk Index (rDRI), 55% had an European Society for Blood and Marrow Transplantation risk score (EBMT-RS) ≥4, and 36% had an age-adjusted Hematopoietic Cell Transplant Comorbidity Index (HCT-CI-age) score ≥3. Each of these was considered an unfavorable score. Using the pretransplantation unfavorable scores that had an independent impact on each transplantation outcome studied in multivariate analysis allowed for better stratification of patient outcomes. Thus, the 3-year overall survival (OS) in patients with 0, 1, 2, and 3 unfavorable scores was 86%, 56%, 36%, and 24%, respectively. Nonrelapse mortality (NRM) was negatively impacted by the EBMT-RS and the HCT-CI-age score (3-year NRM in patients with 0, 1, and 2 unfavorable scores was 12%, 33%, and 43%, respectively), whereas the EBMT-RS and the rDRI had an impact on the 3-year relapse incidence (8%, 18%, and 41% in patients with 0, 1, and 2 unfavorable scores, respectively). In conclusion, our study shows that combining 2 or 3 of these well-defined pretransplantation scores improves the ability to predict transplantation outcomes in the setting of haploSCT with PTCy.
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Affiliation(s)
- Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain.
| | | | - Irene Garcia-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Beatriz Herruzo
- Hematology Department, Hospital Regional Universitario, Malaga, Spain
| | - Christelle Ferrà
- Hematology Department, Institut Català d'Oncologia Hospital Germans Trias i Pujol, Badalona, Spain and Universitat de Vic-Universitat Central de Catalunya, Catalonia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Alberto Torio
- Immunology Department, Hospital Regional Universitario, Malaga, Spain
| | - Anna Torrent
- Hematology Department, Institut Català d'Oncologia Hospital Germans Trias i Pujol, Badalona, Spain and Universitat de Vic-Universitat Central de Catalunya, Catalonia, Spain
| | - Marian Cuesta
- Hematology Department, Hospital Regional Universitario, Malaga, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
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Novelli S, Bento L, Garcia I, Prieto L, López L, Gutierrez G, Hernani R, Pérez A, Esquirol A, Solano C, Bastos M, Dorado N, Rodríguez N, Rodríguez G, Piñana JL, Montoro J, Herrera P, Luna A, Parody R, Martín C, García E, López O, Heras I, Zanabili J, Moraleda JM, Yañez L, Gutierrez A, Zudaire T, Córdoba R, Varela R, Ferra C, Martínez J, Martínez C, Gonzalez-Barca E, Martino R, Caballero D. Allogeneic Stem Cell Transplantation in Mature T Cell and Natural Killer/T Neoplasias: A Registry Study from Spanish GETH/GELTAMO Centers. Transplant Cell Ther 2021; 27:493.e1-493.e8. [PMID: 33857447 DOI: 10.1016/j.jtct.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/27/2020] [Revised: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Despite advances in understanding the biology of mature T and natural killer (NK)/T cell neoplasia, current therapies, even the most innovative ones, are still far from ensuring its cure. The only treatment to date that has been shown to control aggressive T cell neoplasms in the long term is allogeneic stem cell transplantation (alloSCT). We aim to report the results of alloSCT for advanced mature T and NK/T neoplasias performed in centers from our national GELTAMO/GETH (Grupo Español de Linfoma y Trasplante de Médula Ósea/Grupo Español de Trasplante Hematopoyético y Terapia Celular) over the past 25 years. As a secondary objective, we analyzed the results of alloSCT from haploidentical donors. We performed a retrospective analysis of all patients who received an alloSCT in Spanish centers (n = 201) from September 1995 to August 2018. The 2-year overall survival (OS) and disease-free survival (DFS) were 65.5% and 58.2%, respectively. The univariate for OS and DFS showed statistically different hazard ratios for conditioning intensity, response pre-alloSCT, comorbidity index, donor/receptor cytomegalovirus status and Eastern Cooperative Oncology Group (ECOG) pre-alloSCT, but only a better ECOG pre-alloSCT remained significant in the multivariate analysis. There was an increased incidence of relapse in those patients who did not develop chronic graft-versus-host disease (GVHD) and an increased risk of death in those developing moderate to severe acute GVHD. The 1-year nonrelapse mortality was 21.9% and was mainly due to GVHD (30%) and bacterial infections (17%). When comparing unrelated donors with haploidentical donors, we found similar results in terms of OS and DFS. There was, however, a reduction of acute GVHD in the haploidentical group (P = .04) and trend to a reduction of chronic GVHD. In conclusion, alloSCT is the only curative option for most aggressive T cell neoplasias. Haploidentical donors offer similar results to related donors in terms of survival with a reduction of acute GVHD.
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Affiliation(s)
- Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain.
| | - Leyre Bento
- Hematology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Irene Garcia
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain
| | - Laura Prieto
- Hematology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Lucía López
- Hematology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Rafael Hernani
- Hematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain
| | - Carlos Solano
- Hematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | - Mariana Bastos
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nieves Dorado
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nancy Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Guillermo Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Jose L Piñana
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Herrera
- Hematology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alejandro Luna
- Hematology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rocío Parody
- Hematology Department, Institut Catala d'Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | - Carmen Martín
- Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Estefanía García
- Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Oriana López
- Hematology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Inmaculada Heras
- Hematology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Joud Zanabili
- Hematology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jose M Moraleda
- Hematology Department, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Lucrecia Yañez
- Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Antonio Gutierrez
- Hematology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Teresa Zudaire
- Hematology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Raúl Córdoba
- Hematology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Rosario Varela
- Hematology Department, Hospital Universitario de A Coruña, A Coruña, Spain
| | - Christelle Ferra
- Hematology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Joaquin Martínez
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Martínez
- Hematology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Eva Gonzalez-Barca
- Hematology Department, Institut Catala d'Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain
| | - Dolores Caballero
- Hematology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Ljungman P, Bermudez A, Logan AC, Kharfan-Dabaja MA, Chevallier P, Martino R, Wulf G, Selleslag D, Kakihana K, Langston A, Lee DG, Solano C, Okamoto S, Smith LR, Boeckh M, Wingard JR, Cywin B, Fredericks C, Lademacher C, Wang X, Young J, Maertens J. A randomised, placebo-controlled phase 3 study to evaluate the efficacy and safety of ASP0113, a DNA-based CMV vaccine, in seropositive allogeneic haematopoietic cell transplant recipients. EClinicalMedicine 2021; 33:100787. [PMID: 33842870 PMCID: PMC8020145 DOI: 10.1016/j.eclinm.2021.100787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) is a complication of allogeneic haematopoietic cell transplantation (allo-HCT). ASP0113, a DNA-based vaccine, contains two plasmids encoding human CMV glycoprotein B and phosphoprotein 65 (pp65). We assessed ASP0113 in CMV-seropositive allo-HCT recipients. METHODS In this phase 3, randomised, placebo-controlled study, CMV-seropositive allo-HCT recipients were randomly assigned (1:1) via interactive response technology to receive five injections of 1 mL of 5 mg/mL ASP0113 or placebo. The pharmacist and designated staff were unblinded. Masked syringes maintained the blind for patients and study personnel. Efficacy and safety analyses included patients who received ≥1 dose of ASP0113/placebo. The primary efficacy endpoint was the proportion of allo-HCT recipients with composite all-cause mortality and adjudicated CMV end-organ disease (EOD) by 1 year post-transplant. ClinicalTrials.gov: NCT01877655 (not recruiting). FINDINGS Patients were recruited between Sept 11, 2013 and Sept 21, 2016. Overall, 501 patients received ≥1 dose of ASP0113 (n = 246) or placebo (n = 255). The proportion of patients with composite all-cause mortality and adjudicated CMV EOD by 1 year post-transplant was 35.4% (n = 87) with ASP0113 and 30•2% (n = 77) with placebo (odds ratio 1.27; 95% confidence interval: 0.87 to 1.85; p = 0.205). Incidence of injection site-related treatment-emergent adverse events (TEAEs) was higher with ASP0113 than placebo. Overall incidence and severity of other TEAEs was similar between groups. T-cell response to pp65 increased over time and was greater with placebo than ASP0113 (p = 0.027). INTERPRETATION ASP0113 did not reduce overall mortality or CMV EOD by 1 year post-transplant. Safety findings were similar between groups. FUNDING Astellas Pharma Global Development, Inc .
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Affiliation(s)
- Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, SE-14186, Stockholm, Sweden
- Corresponding author.
| | - Arancha Bermudez
- Department of Hematology, Hospital Universitario Marqués de Valdecilla, Instituto de Formación e Investigación Marqués de Valdecilla, 39008, Santander, Spain
| | - Aaron C. Logan
- Division of Hematology and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, 94143, San Francisco, United States
| | - Mohamed A. Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, 33612, Tampa, United States
| | - Patrice Chevallier
- Service d'Hématologie Clinique, CHU de Nantes, 44093, Nantes, France and CRCINA / INSERM UMR1232 / CNRS ERL6001 IRS UN – 8 Quai Moncousu – BP 70721, 44007 Nantes cedex 1, France
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, 08041, Barcelona, Spain
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, D-37075, Göttingen, Germany
| | - Dominik Selleslag
- Department of Hematology, AZ Sint-Jan Brugge-Oostende, 8000, Brugge, Belgium
| | - Kazuhiko Kakihana
- Hematology Division, Tokyo Metropolitan Komagome Hospital, 113-8677, Tokyo, Japan
| | - Amelia Langston
- Winship Cancer Institute, Emory University, 30322, Atlanta, United States
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Catholic Hematology Hospital and Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 06591, Seoul, Republic of Korea
| | - Carlos Solano
- Hematology Service, Hospital Clínico Universitario, Institute of Research INCLIVA and University of Valencia, 46010, Valencia, Spain
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Kelo University School of Medicine, 160-8582, Tokyo, Japan
| | | | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center and University of Washington, 98109, Seattle, United States
| | - John R. Wingard
- Division of Hematology & Oncology, Department of Medicine, University of Florida, 32610, Gainesville, United States
| | - Beth Cywin
- Astellas Pharma Global Development, Inc., 60062, Northbrook, United States
| | | | | | - Xuegong Wang
- Astellas Pharma Global Development, Inc., 60062, Northbrook, United States
| | - James Young
- Astellas Pharma Global Development, Inc., 60062, Northbrook, United States
| | - Johan Maertens
- Department of Microbiology and Immunology, K.U. Leuven and Department of Hematology, UZ Leuven, Leuven, Belgium
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Averbuch D, Tridello G, Hoek J, Mikulska M, Pabst T, Yaňez San Segundo L, Akan H, Özçelik T, Donnini I, Klyasova G, Botelho de Sousa A, Zuckerman T, Tecchio C, de la Camara R, Aki SZ, Ljungman P, Gülbas Z, Nicolas-Virelizier E, Calore E, Perruccio K, Ram R, Annaloro C, Martino R, Avni B, Shaw PJ, Jungova A, Codeluppi K, O'Brien T, Waszczuk-Gajda A, Batlle M, Pouli A, Lueck C, Gil L, Iacobelli S, Styczynski J, Engelhard D, Cesaro S. Intercontinental study on pre-engraftment and post-engraftment Gram-negative rods bacteremia in hematopoietic stem cell transplantation patients: Risk factors and association with mortality. J Infect 2020; 81:882-894. [PMID: 33186673 DOI: 10.1016/j.jinf.2020.11.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/16/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We present here data on Gram-negative rods bacteremia (GNRB) rates, risk factors and associated mortality. METHODS Data on GNRB episodes were prospectively collected in 65 allo-/67 auto-HSCT centers in 24 countries (Europe, Asia, Australia). In patients with and without GNRB, we compared: demography, underlying disease, HSCT-related data, center` fluoroquinolone prophylaxis (FQP) policy and accreditation status, and involvement of infection control team (ICT). RESULTS The GNRB cumulative incidence among 2818 allo-HSCT was: pre-engraftment (pre-eng-allo-HSCT), 8.4 (95% CI 7-9%), post-engraftment (post-eng-allo-HSCT), 5.8% (95%CI: 5-7%); among 3152 auto-HSCT, pre-eng-auto-HSCT, 6.6% (95%CI: 6-7%), post-eng-auto-HSCT, 0.7% (95%CI: 0.4-1.1%). GNRB, especially MDR, was associated with increased mortality. Multivariate analysis revealed the following GNRB risk factors: (a) pre-eng-allo-HSCT: south-eastern Europe center location, underlying diseases not at complete remission, and cord blood source; (b) post-eng-allo-HSCT: center location not in northwestern Europe; underlying non-malignant disease, not providing FQP and never accredited. (c) pre-eng-auto-HSCT: older age, autoimmune and malignant (vs. plasma cell) disease, and ICT absence. CONCLUSIONS Benefit of FQP should be explored in prospective studies. Increased GNRB risk in auto-HSCT patients transplanted for autoimmune diseases is worrying. Infection control and being accredited are possibly protective against bacteremia. GNRB are associated with increased mortality.
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Affiliation(s)
| | - Gloria Tridello
- Pediatric Hematology Oncology, Mother and Child Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | | | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa and Ospedale Policlinico San Martino, Genova, Italy.
| | - Thomas Pabst
- Department of Medical Oncology, University Hospital Bern, Bern, Switzerland.
| | | | - Hamdi Akan
- Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Tülay Özçelik
- Bilim University, Florence Nightingale Hospital, Istanbul, Turkey.
| | - Irene Donnini
- Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
| | - Galina Klyasova
- National Research Center for Hematology, Moscow, Russian Federation.
| | | | | | - Cristina Tecchio
- Department of Medicine, Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy.
| | | | | | - Per Ljungman
- Karolinska University Hospital, Stockholm, Sweden.
| | - Zafer Gülbas
- Anadolu Medical Center Hospital, Kocaeli, Turkey.
| | | | | | - Katia Perruccio
- Ospedale Santa Maria della Misericordia, Università di Perugia, Perugia, Italy.
| | - Ron Ram
- Tel Aviv Sourasky Medical Center, Sourasky Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - Claudio Annaloro
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
| | | | - Batia Avni
- Hadassah University Hospital, Jerusalem, Israel.
| | - Peter J Shaw
- The Children's Hospital at Westmead, Sydney, Australia.
| | | | - Katia Codeluppi
- Hematology, Azienda Unità Sanitaria Locale -IRCCS di Reggio Emilia, Italy.
| | | | | | | | | | | | - Lidia Gil
- University of Medical Sciences, Poznan, Poland.
| | | | - Jan Styczynski
- Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland.
| | | | - Simone Cesaro
- Pediatric Hematology Oncology, Mother and Child Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
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36
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Bejanyan N, Zhang M, Bo-Subait K, Brunstein C, Wang H, Warlick ED, Giralt S, Nishihori T, Martino R, Passweg J, Dias A, Copelan E, Hale G, Gale RP, Solh M, Kharfan-Dabaja MA, Diaz MA, Ganguly S, Gore S, Verdonck LF, Hossain NM, Kekre N, Savani B, Byrne M, Kanakry C, Cairo MS, Ciurea S, Schouten HC, Bredeson C, Munker R, Lazarus H, Cahn JY, van Der Poel M, Rizzieri D, Yared JA, Freytes C, Cerny J, Aljurf M, Palmisiano ND, Pawarode A, Bacher VU, Grunwald MR, Nathan S, Wirk B, Hildebrandt GC, Seo S, Olsson RF, George B, de Lima M, Hourigan CS, Sandmaier BM, Litzow M, Kebriaei P, Saber W, Weisdorf D. Myeloablative Conditioning for Allogeneic Transplantation Results in Superior Disease-Free Survival for Acute Myelogenous Leukemia and Myelodysplastic Syndromes with Low/Intermediate but not High Disease Risk Index: A Center for International Blood and Marrow Transplant Research Study. Transplant Cell Ther 2020; 27:68.e1-68.e9. [PMID: 33010430 DOI: 10.1016/j.bbmt.2020.09.026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/05/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022]
Abstract
Compared with reduced-intensity conditioning (RIC), myeloablative conditioning (MAC) is generally associated with lower relapse risk after allogeneic hematopoietic cell transplantation (HCT) for acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDS). However, disease-specific risk factors in AML/MDS can further inform when MAC and RIC may yield differential outcomes. We analyzed HCT outcomes stratified by the Disease Risk Index (DRI) in 4387 adults (age 40 to 65 years) to identify the impact of conditioning intensity. In the low/intermediate-risk DRI cohort, RIC was associated with lower nonrelapse mortality (NRM) (hazard ratio [HR], .74; 95% confidence interval [CI], .62 to .88; P < .001) but significantly greater relapse risk (HR, 1.54; 95% CI, 1.35 to 1.76; P < .001) and thus inferior disease-free survival (DFS) (HR, 1.19; 95% CI, 1.07 to 1.33; P = .001). In the high/very high-risk DRI cohort, RIC was associated with marginally lower NRM (HR, .83; 95% CI, .68 to 1.00; P = .051) and significantly higher relapse risk (HR, 1.23; 95% CI, 1.08 to 1.41; P = .002), leading to similar DFS using either RIC or MAC. These data support MAC over RIC as the preferred conditioning intensity for patients with AML/MDS with low/intermediate-risk DRI, but with a similar benefit as RIC in high/very high-risk DRI. Novel MAC regimens with less toxicity could benefit all patients, but more potent antineoplastic approaches are needed for the high/very-high risk DRI group.
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Affiliation(s)
- Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.
| | - Meijie Zhang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Khalid Bo-Subait
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Claudio Brunstein
- Adult Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Hailin Wang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Erica D Warlick
- Adult Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jakob Passweg
- Division of Hematology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Gregory Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Melhem Solh
- Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - Steven Gore
- Section of Medical Oncology, Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherland
| | - Nasheed M Hossain
- Stem Cell Transplant Program, Division of Hematology/Oncology, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Natasha Kekre
- Blood & Marrow Transplant Program, Department of Medicine, Ottawa Hospital Ottawa, Ontario, Canada
| | - Bipin Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Byrne
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher Kanakry
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Stefan Ciurea
- Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, The Netherlands
| | - Christopher Bredeson
- Blood & Marrow Transplant Program, Department of Medicine, Ottawa Hospital Ottawa, Ontario, Canada
| | - Reinhold Munker
- Division of Medical Oncology, Markey Cancer Center, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Hillard Lazarus
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Marjolein van Der Poel
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Cesar Freytes
- Hematopoietic Stem Cell Transplant Program, Texas Transplant Institute, San Antonio, Texas
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Neil D Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Sunita Nathan
- Section of Bone Marrow Transplantation and Cellular Therapy, Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush Medical College, Chicago, Illinois
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Gerhard C Hildebrandt
- Division of Medical Oncology, Markey Cancer Center, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Sweden
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancies, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, Minnesota
| | - Partow Kebriaei
- Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wael Saber
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, 96
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Ortí G, Palacio-Garcia C, García-Cadenas I, Sánchez-Ortega I, Jimenez MJ, Azqueta C, Villacampa G, Ferrà C, Parody R, Martino R, Bosch F, Querol S, Valcárcel D. Analysis of Cell Subsets in Donor Lymphocyte Infusions from HLA Identical Sibling Donors after Allogeneic Hematopoietic Cell Transplant. Transplant Cell Ther 2020; 27:53.e1-53.e8. [PMID: 32987150 DOI: 10.1016/j.bbmt.2020.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/11/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
Donor lymphocytes infusions (DLIs) are a major therapeutic approach to treat relapse and mixed chimerism after allogeneic hematopoietic cell transplant (alloHCT). The impact of the composition regarding different cell subsets in the development of graft-versus-host disease (GVHD) is not fully understood. We performed a cell subsets analysis of 56 DLIs from fully HLA-compatible identical matched sibling donors (MSDs) in 36 alloHCT patients and studied its association with GVHD. A median of one DLI was infused per patient. Fourteen patients (38%) developed GVHD. The cell composition analysis of the first DLI (DLI1) showed that a high dose of B cells (P = .03) and CD27+ B cells (P < .01) was associated with GVHD. We identified DLI dose cutoff points for several cell populations above which GVHD was more frequent (CD8+ TN >3 × 106 cells/kg, CD27+ B cells >2.6 × 106/kg, CD27+ NK >0.35 × 106 cells/kg, and mononuclear cells >0.83 × 108/kg). Noteworthy, the proportion of CD4+ naive T cells (TN) or unselected TN was not linked with GVHD and a DLI1 containing a higher dose of regulatory T cells was not protective for GVHD. We studied several transplant clinical variables and did not find any association with GVHD. Altogether, this study provides a comprehensive analysis of the cell populations in a DLI from MSDs and identifies potential key cell subsets, which provides insight for the understanding of GVHD after DLI.
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Affiliation(s)
- Guillermo Ortí
- Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain; Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Carles Palacio-Garcia
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Sánchez-Ortega
- Hematology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - María José Jimenez
- Hematology Department, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Barcelona, Spain
| | - Carmen Azqueta
- Cellular Therapy Unit, Banc de Sang i Teixits, Barcelona, Spain
| | - Guillermo Villacampa
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Christelle Ferrà
- Hematology Department, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Barcelona, Spain
| | - Rocio Parody
- Hematology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Bosch
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sergi Querol
- Cellular Therapy Unit, Banc de Sang i Teixits, Barcelona, Spain
| | - David Valcárcel
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
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38
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Piñana JL, Martino R, García-García I, Parody R, Morales MD, Benzo G, Gómez-Catalan I, Coll R, De La Fuente I, Luna A, Merchán B, Chinea A, de Miguel D, Serrano A, Pérez C, Diaz C, Lopez JL, Saez AJ, Bailen R, Zudaire T, Martínez D, Jurado M, Calbacho M, Vázquez L, Garcia-Cadenas I, Fox L, Pimentel AI, Bautista G, Nieto A, Fernandez P, Vallejo JC, Solano C, Valero M, Espigado I, Saldaña R, Sisinni L, Ribera JM, Jimenez MJ, Trabazo M, Gonzalez-Vicent M, Fernández N, Talarn C, Montoya MC, Cedillo A, Sureda A. Risk factors and outcome of COVID-19 in patients with hematological malignancies. Exp Hematol Oncol 2020; 9:21. [PMID: 32864192 PMCID: PMC7445734 DOI: 10.1186/s40164-020-00177-z] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023] Open
Abstract
Background Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined. Patients and methods This was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confirmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020. Results We included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n = 58) or allogeneic stem cell transplantation (allo-SCT) (n = 65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1–93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p = 0.02). Prognostic factors identified for day 45 overall mortality (OM) by logistic regression multivariate analysis included age > 70 years [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2–3.8, p = 0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6–5.2, p < 0.0001); ECOG 3–4 (OR, 2.56, 95% CI 1.4–4.7, p = 0.003); neutropenia (< 0.5 × 109/L) (OR 2.8, 95% CI 1.3–6.1, p = 0.01); and a C-reactive protein (CRP) > 20 mg/dL (OR 3.3, 95% CI 1.7–6.4, p < 0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2–0.89 and OR 0.31, 95% CI 0.11–0.87, respectively, p = 0.02) whereas the use of hidroxycloroquine did not show significant improvement in OM (OR 0.64, 95% CI 0.37–1.1, P = 0.1). Conclusions In most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of inflammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19.
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Affiliation(s)
- José Luis Piñana
- Hematology División, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain.,Division of Clinical Hematology, Hospital Universitario la Fe de Valencia, Avda Fernando Abril Martorell, 106 CP 46026 Valencia, Spain
| | - Rodrigo Martino
- Hematology División, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Rocío Parody
- Hematology División, Institut Català Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | | | - Gonzalo Benzo
- Hematology División, Hospital La Princesa, Madrid, Spain
| | | | - Rosa Coll
- Hematology División, Institut Català Oncologia-Hospital Josep Trueta, Girona, Spain
| | | | - Alejandro Luna
- Hematology División, Hospital Ramon y Cajal, Madrid, Spain
| | - Beatriz Merchán
- Hematology División, Hospital de Guadalajara, Guadalajara, Spain
| | | | - Dunia de Miguel
- Hematology División, Hospital de Guadalajara, Guadalajara, Spain
| | - Ana Serrano
- Hematology División, Hospital de Albacete, Albacete, Spain
| | - Carmen Pérez
- Hematology División, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Carola Diaz
- Hematology División, Hospital Carlos Haya, Malaga, Spain
| | - José Luis Lopez
- Hematology División, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - Rebeca Bailen
- Hematology División, Hospital Gregorio Marañon, Madrid, Spain
| | - Teresa Zudaire
- Hematology División, Hospital de Navarra, Navarra, Spain
| | | | - Manuel Jurado
- Hematology División, Hospital Virgen de la Nieves, Granada, Spain
| | - María Calbacho
- Hematology División, Hospital 12 de Octubre, Madrid, Spain
| | - Lourdes Vázquez
- Hematology División, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Laura Fox
- Hematology División, Hospital Vall d`Hebron, Barcelona, Spain
| | - Ana I Pimentel
- Hematology División, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Zaragoza, Spain
| | | | | | | | | | - Carlos Solano
- Hematology División, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marta Valero
- Hematology División, Hospital Arnau de Vilanova, Valencia, Spain
| | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen del Rocío/University of Sevilla, CSIC/Institute of Biomedicine of Sevilla, Sevilla, Spain
| | | | - Luisa Sisinni
- Pediatric Hematology-Oncology División, Hospital la Paz, Madrid, Spain
| | - Josep Maria Ribera
- Hematology División, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Badalona, Spain
| | - Maria Jose Jimenez
- Hematology División, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Badalona, Spain
| | - Maria Trabazo
- Pediatric División, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Noemí Fernández
- Hematology División, Hospital Marqués de Valdecilla, Santander, Spain
| | - Carme Talarn
- Hematology División, Hospital Joan XXIII, Tarragona, Spain
| | | | - Angel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH), Madrid, Spain
| | - Anna Sureda
- Hematology División, Institut Català Oncologia-Hospital Duran i Reynals, Barcelona, Spain
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39
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Fox ML, García-Cadenas I, Pérez AM, Villacampa G, Piñana JL, Ortí G, Montoro J, Roldán E, Bosch Vilaseca A, Martino R, Salamero O, Saavedra S, Hernandez-Boluda JC, Esquirol A, Sierra J, Sanz J, Solano C, Bosch F, Barba P, Valcarcel D. Feasibility of thiotepa addition to the fludarabine-busulfan conditioning with tacrolimus/sirolimus as graft vs host disease prophylaxis. Leuk Lymphoma 2020; 61:1823-1832. [PMID: 32654570 DOI: 10.1080/10428194.2020.1788015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In classical reduced-intensity conditioning (RIC) regimens, including the fludarabine and busulphan (BF) combination, sirolimus and tacrolimus (SIR-TAC) as graft vs host disease (GVHD) prophylaxis has shown acceptable results. The outcomes of SIR-TAC in a more intense RIC regimen as Thiotepa-fludarabine-busulfan (TBF) have been hardly investigated. This retrospective study included all consecutive patients receiving an allogeneic hematopoietic stem cell transplantation for myeloid malignancies (January 2009-2017) conditioned with either TBF or BF and receiving SIR-TAC. Patients receiving TBF presented higher non-relapse mortality (31.6 vs 12.3%, p = .01), along with shorter overall survival (51.8% vs 77.8%, p < .01) at 2 years than patients treated with BF. There were no significant differences in the cumulative incidence of grade II-IV acute GVHD or moderate-severe chronic GVHD or relapse between both groups. These results suggest that TBF does not seem to improve the traditional RIC BF regimen, at least when associated with SIR-TAC prophylaxis.
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Affiliation(s)
- María Laura Fox
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Irene García-Cadenas
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Ariadna Martínez Pérez
- Department of Hematology, Hospital Clínico Universitario- INCLIVA. University of Valencia, Valencia, Spain
| | - Guillermo Villacampa
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - José Luis Piñana
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain - CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Guillermo Ortí
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juan Montoro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain - CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Elisa Roldán
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anna Bosch Vilaseca
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Rodrigo Martino
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Olga Salamero
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Silvana Saavedra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | | | - Albert Esquirol
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Jordi Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Jaime Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain - CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Carlos Solano
- Department of Hematology, Hospital Clínico Universitario- INCLIVA. University of Valencia, Valencia, Spain
| | - Francesc Bosch
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pere Barba
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Valcarcel
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Martino R, Garrido A, Santaliestra M, García-Cadenas I, Novelli S, Saavedra SD, Esquirol A, Granell M, Briones J, Moreno C, Brunet S, Giménez A, Hidalgo A, Sánchez F, Sierra J. Low Rate of Invasive Fungal Infections During Induction and Consolidation Chemotherapy for Adults with De Novo Acute Myeloid Leukemia Without Anti-mold Prophylaxis: Single-Center 2002-2018 Empirical/Pre-emptive Approach. Mycopathologia 2020; 185:639-652. [PMID: 32564177 DOI: 10.1007/s11046-020-00461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Broad-spectrum antifungal prophylaxis is currently considered the standard of care for adults with de novo AML for the prevention of invasive fungal infections (IFIs), especially invasive pulmonary aspergillosis (IPA). Because fluconazole has been used in our center as anti-yeast prophylaxis, we sought to analyze in detail the incidence of IFIs over a 17-year period, as well as their impact on outcome. A standardized protocol of patient management, including serum galactomannan screening and thoracic CT-guided diagnostic-driven antifungal therapy, was used in all patients. A total of 214 consecutive adults with de novo AML who were treated in 3 CETLAM (Grupo Cooperativo para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias) protocols from 2002 to 2018 were included. The 90-day incidence of any IFI (including possible cases) was 11% (95% CI 4-15%), most cases occurred during induction chemotherapy (8%, 95% CI 4-12%), and most cases were probable/proven IPA (8%, 95% CI 3-13%). Developing an IFI during induction and consolidation had no impact on 1-year survival. A case-control study with 23 cases of IPA and 69 controls identified induction/re-induction chemotherapy, chronic pulmonary disease and age > 60 years/poor baseline performance status as potential pretreatment risk factors. The current study proves that inpatient induction and consolidation chemotherapy for de novo AML can be given in areas with "a priori" high-burden of airborne molds with fluconazole prophylaxis, while the selective use of anti-mold prophylaxis in patients at very high risk may further reduce the incidence of IFI in this specific clinical scenario.
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Affiliation(s)
- Rodrigo Martino
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain.
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Ana Garrido
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Marta Santaliestra
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Irene García-Cadenas
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Silvana Novelli
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Silvanna Daniella Saavedra
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Albert Esquirol
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Miquel Granell
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Javier Briones
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Carolina Moreno
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Salut Brunet
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ana Giménez
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Alberto Hidalgo
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Fernando Sánchez
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
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Mehta RS, Holtan SG, Wang T, Hemmer MT, Spellman SR, Arora M, Couriel DR, Alousi AM, Pidala J, Abdel-Azim H, Agrawal V, Ahmed I, Al-Homsi AS, Aljurf M, Antin JH, Askar M, Auletta JJ, Bhatt VR, Chee L, Chhabra S, Daly A, DeFilipp Z, Gajewski J, Gale RP, Gergis U, Hematti P, Hildebrandt GC, Hogan WJ, Inamoto Y, Martino R, Majhail NS, Marks DI, Nishihori T, Olsson RF, Pawarode A, Diaz MA, Prestidge T, Rangarajan HG, Ringden O, Saad A, Savani BN, Schoemans H, Seo S, Schultz KR, Solh M, Spitzer T, Storek J, Teshima T, Verdonck LF, Wirk B, Yared JA, Cahn JY, Weisdorf DJ. Composite GRFS and CRFS Outcomes After Adult Alternative Donor HCT. J Clin Oncol 2020; 38:2062-2076. [PMID: 32364845 PMCID: PMC7302955 DOI: 10.1200/jco.19.00396] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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] [Accepted: 03/13/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE There is no consensus on the best choice of an alternative donor (umbilical cord blood [UCB], haploidentical, one-antigen mismatched [7/8]-bone marrow [BM], or 7/8-peripheral blood [PB]) for hematopoietic cell transplantation (HCT) for patients lacking an HLA-matched related or unrelated donor. METHODS We report composite end points of graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) and chronic GVHD (cGVHD)-free relapse-free survival (CRFS) in 2,198 patients who underwent UCB (n = 838), haploidentical (n = 159), 7/8-BM (n = 241), or 7/8-PB (n = 960) HCT. All groups were divided by myeloablative conditioning (MAC) intensity or reduced intensity conditioning (RIC), except haploidentical group in which most received RIC. To account for multiple testing, P < .0071 in multivariable analysis and P < .00025 in direct pairwise comparisons were considered statistically significant. RESULTS In multivariable analysis, haploidentical group had the best GRFS, CRFS, and overall survival (OS). In the direct pairwise comparison of other groups, among those who received MAC, there was no difference in GRFS or CRFS among UCB, 7/8-BM, and 7/8-PB with serotherapy (alemtuzumab or antithymocyte globulin) groups. In contrast, the 7/8-PB without serotherapy group had significantly inferior GRFS, higher cGVHD, and a trend toward worse CRFS (hazard ratio [HR], 1.38; 95% CI, 1.13 to 1.69; P = .002) than the 7/8-BM group and higher cGVHD and trend toward inferior CRFS (HR, 1.36; 95% CI, 1.14 to 1.63; P = .0006) than the UCB group. Among patients with RIC, all groups had significantly inferior GRFS and CRFS compared with the haploidentical group. CONCLUSION Recognizing the limitations of a registry retrospective analysis and the possibility of center selection bias in choosing donors, our data support the use of UCB, 7/8-BM, or 7/8-PB (with serotherapy) grafts for patients undergoing MAC HCT and haploidentical grafts for patients undergoing RIC HCT. The haploidentical group had the best GRFS, CRFS, and OS of all groups.
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Affiliation(s)
- Rohtesh S. Mehta
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Tao Wang
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Michael T. Hemmer
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI
| | | | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | | | - Amin M. Alousi
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Vaibhav Agrawal
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Ibrahim Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Joseph H. Antin
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Medhat Askar
- Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX
| | - Jeffery J. Auletta
- Blood and Marrow Transplant Program and Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children’s Hospital, Columbus, OH
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Lynette Chee
- Royal Melbourne Hospital City Campus, Victoria, Australia
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | | | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
| | | | - William J. Hogan
- Division of Hematology/Bone Marrow Transplantation, Mayo Clinic, Rochester, MN
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Navneet S. Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - David I. Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol National Health Service Trust, Bristol, United Kingdom
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Richard F. Olsson
- Translational Cell Therapy Research, Clintec, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children’s Hospital, Auckland, New Zealand
| | - Hemalatha G. Rangarajan
- Blood and Marrow Transplant Program and Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children’s Hospital, Columbus, OH
| | - Olle Ringden
- Translational Cell Therapy Research, Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Ayman Saad
- Division of Hematology, Ohio State University, Columbus, OH
| | - Bipin N. Savani
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Hélène Schoemans
- University Hospital Leuven and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sachiko Seo
- Department of Hematology & Oncology, National Cancer Research Center East, Chiba, Japan
| | - Kirk R. Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia’s Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA
| | | | - Jan Storek
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Leo F. Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA
| | - Jean A. Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD
| | - Jean-Yves Cahn
- Department of Hematology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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Affiliation(s)
- Nil Albiol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas, 90, 08041, Barcelona, Spain.
| | - Rahinatu Awol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas, 90, 08041, Barcelona, Spain
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Im A, Rashidi A, Wang T, Hemmer M, MacMillan ML, Pidala J, Jagasia M, Pavletic S, Majhail NS, Weisdorf D, Abdel-Azim H, Agrawal V, Al-Homsi AS, Aljurf M, Askar M, Auletta JJ, Bashey A, Beitinjaneh A, Bhatt VR, Byrne M, Cahn JY, Cairo M, Castillo P, Cerny J, Chhabra S, Choe H, Ciurea S, Daly A, Perez MAD, Farhadfar N, Gadalla SM, Gale R, Ganguly S, Gergis U, Hanna R, Hematti P, Herzig R, Hildebrandt GC, Lad DP, Lee C, Lehmann L, Lekakis L, Kamble RT, Kharfan-Dabaja MA, Khandelwal P, Martino R, Murthy HS, Nishihori T, O'Brien TA, Olsson RF, Patel SS, Perales MA, Prestidge T, Qayed M, Romee R, Schoemans H, Seo S, Sharma A, Solh M, Strair R, Teshima T, Urbano-Ispizua A, Van der Poel M, Vij R, Wagner JL, William B, Wirk B, Yared JA, Spellman SR, Arora M, Hamilton BK. Risk Factors for Graft-versus-Host Disease in Haploidentical Hematopoietic Cell Transplantation Using Post-Transplant Cyclophosphamide. Biol Blood Marrow Transplant 2020; 26:1459-1468. [PMID: 32434056 DOI: 10.1016/j.bbmt.2020.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/31/2020] [Accepted: 05/04/2020] [Indexed: 01/17/2023]
Abstract
Post-transplant cyclophosphamide (PTCy) has significantly increased the successful use of haploidentical donors with a relatively low incidence of graft-versus-host disease (GVHD). Given its increasing use, we sought to determine risk factors for GVHD after haploidentical hematopoietic cell transplantation (haplo-HCT) using PTCy. Data from the Center for International Blood and Marrow Transplant Research on adult patients with acute myeloid leukemia, acute lymphoblastic leukemia, myelodysplastic syndrome, or chronic myeloid leukemia who underwent PTCy-based haplo-HCT (2013 to 2016) were analyzed and categorized into 4 groups based on myeloablative (MA) or reduced-intensity conditioning (RIC) and bone marrow (BM) or peripheral blood (PB) graft source. In total, 646 patients were identified (MA-BM = 79, MA-PB = 183, RIC-BM = 192, RIC-PB = 192). The incidence of grade 2 to 4 acute GVHD at 6 months was highest in MA-PB (44%), followed by RIC-PB (36%), MA-BM (36%), and RIC-BM (30%) (P = .002). The incidence of chronic GVHD at 1 year was 40%, 34%, 24%, and 20%, respectively (P < .001). In multivariable analysis, there was no impact of stem cell source or conditioning regimen on grade 2 to 4 acute GVHD; however, older donor age (30 to 49 versus <29 years) was significantly associated with higher rates of grade 2 to 4 acute GVHD (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.11 to 2.12; P = .01). In contrast, PB compared to BM as a stem cell source was a significant risk factor for the development of chronic GVHD (HR, 1.70; 95% CI, 1.11 to 2.62; P = .01) in the RIC setting. There were no differences in relapse or overall survival between groups. Donor age and graft source are risk factors for acute and chronic GVHD, respectively, after PTCy-based haplo-HCT. Our results indicate that in RIC haplo-HCT, the risk of chronic GVHD is higher with PB stem cells, without any difference in relapse or overall survival.
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Affiliation(s)
- Annie Im
- University of Pittsburgh/UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Armin Rashidi
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Tao Wang
- Department of Medicine, Medical College of Wisconsin, CIBMTR® (Center for International Blood and Marrow Transplant Research), Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Hemmer
- Department of Medicine, Medical College of Wisconsin, CIBMTR® (Center for International Blood and Marrow Transplant Research), Milwaukee, Wisconsin
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Joseph Pidala
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Madan Jagasia
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Steven Pavletic
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Hisham Abdel-Azim
- (0)Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Vaibhav Agrawal
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - A Samer Al-Homsi
- (2)New York University Langone Medical Center, New York, New York
| | - Mahmoud Aljurf
- (3)Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Medhat Askar
- (4)Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, Texas
| | - Jeffery J Auletta
- (5)Blood and Marrow Transplant Program and Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Asad Bashey
- (6)Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Amer Beitinjaneh
- (7)Department of Hematology and Oncology, University of Miami, Miami, Florida
| | - Vijaya Raj Bhatt
- (8)The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Mitchell Cairo
- (0)Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Paul Castillo
- (1)UF Health Shands Children's Hospital, Gainesville, Florida
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Saurabh Chhabra
- Department of Medicine, Medical College of Wisconsin, CIBMTR® (Center for International Blood and Marrow Transplant Research), Milwaukee, Wisconsin
| | - Hannah Choe
- (3)James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Stefan Ciurea
- (4)The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew Daly
- (5)Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Miguel Angel Diaz Perez
- (6)Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Nosha Farhadfar
- (7)Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Shahinaz M Gadalla
- (8)Division of Cancer Epidemiology & Genetics, NIH-NCI Clinical Genetics Branch, Rockville, Maryland
| | - Robert Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Siddhartha Ganguly
- (0)Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - Usama Gergis
- (1)Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rabi Hanna
- (2)Cleveland Clinic Foundation, Cleveland, Ohio
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Roger Herzig
- (4)University of Kentucky Chandler Medical Center, Louisville, Kentucky
| | | | - Deepesh P Lad
- (6)Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Catherine Lee
- (7)Utah Blood and Marrow Transplant Program at Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Leslie Lehmann
- (8)Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts
| | - Lazaros Lekakis
- (7)Department of Hematology and Oncology, University of Miami, Miami, Florida
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Mohamed A Kharfan-Dabaja
- (0)Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Pooja Khandelwal
- (1)Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; (2)Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Rodrigo Martino
- (3)Divison of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Hemant S Murthy
- (0)Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, Florida
| | - Tracey A O'Brien
- (5)Blood & Marrow Transplant Program, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Richard F Olsson
- (6)Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; (7)Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Sagar S Patel
- (8)Blood and Marrow Transplant Program, University of Utah, Salt Lake City, Utah
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tim Prestidge
- (0)Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Muna Qayed
- (1)Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Rizwan Romee
- (2)Dana Farber Cancer Institute, Boston, Massachusetts
| | - Hélène Schoemans
- (3)Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Sachiko Seo
- (4)Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melhem Solh
- (6)The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | - Roger Strair
- (7)Rutgers Cancer Institute of New Jersey, Rutgers University, Brunswick, New Jersey
| | | | - Alvaro Urbano-Ispizua
- Department of Hematology, Hospital Clinic, University of Barcelona, IDIBAPS, and Institute of Research Josep Carreras, Barcelona, Spain
| | | | - Ravi Vij
- (1)Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - John L Wagner
- (2)Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Basem William
- (3)Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Baldeep Wirk
- (4)Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Jean A Yared
- (5)Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Steve R Spellman
- Department of Medicine, Medical College of Wisconsin, CIBMTR® (Center for International Blood and Marrow Transplant Research), Milwaukee, Wisconsin
| | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
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Dandoy CE, Kim S, Chen M, Ahn KW, Ardura MI, Brown V, Chhabra S, Diaz MA, Dvorak C, Farhadfar N, Flagg A, Ganguly S, Hale GA, Hashmi SK, Hematti P, Martino R, Nishihori T, Nusrat R, Olsson RF, Rotz SJ, Sung AD, Perales MA, Lindemans CA, Komanduri KV, Riches ML. Incidence, Risk Factors, and Outcomes of Patients Who Develop Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infections in the First 100 Days After Allogeneic Hematopoietic Stem Cell Transplant. JAMA Netw Open 2020; 3:e1918668. [PMID: 31913492 PMCID: PMC6991246 DOI: 10.1001/jamanetworkopen.2019.18668] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Patients undergoing hematopoietic stem cell transplant (HSCT) are at risk for bloodstream infection (BSI) secondary to translocation of bacteria through the injured mucosa, termed mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI), in addition to BSI secondary to indwelling catheters and infection at other sites (BSI-other). OBJECTIVE To determine the incidence, timing, risk factors, and outcomes of patients who develop MBI-LCBI in the first 100 days after HSCT. DESIGN, SETTING, AND PARTICIPANTS A case-cohort retrospective analysis was performed using data from the Center for International Blood and Marrow Transplant Research database on 16 875 consecutive pediatric and adult patients receiving a first allogeneic HSCT from January 1, 2009, to December 31, 2016. Patients were classified into 4 categories: MBI-LCBI (1481 [8.8%]), MBI-LCBI and BSI-other (698 [4.1%]), BSI-other only (2928 [17.4%]), and controls with no BSI (11 768 [69.7%]). Statistical analysis was performed from April 5 to July 17, 2018. MAIN OUTCOMES AND MEASURES Demographic characteristics and outcomes, including overall survival, chronic graft-vs-host disease, and transplant-related mortality (only for patients with malignant disease), were compared among groups. RESULTS Of the 16 875 patients in the study (9737 [57.7%] male; median [range] age, 47 [0.04-82] years) 13 686 (81.1%) underwent HSCT for a malignant neoplasm, and 3189 (18.9%) underwent HSCT for a nonmalignant condition. The cumulative incidence of MBI-LCBI was 13% (99% CI, 12%-13%) by day 100, and the cumulative incidence of BSI-other was 21% (99% CI, 21%-22%) by day 100. Median (range) time from transplant to first MBI-LCBI was 8 (<1 to 98) days vs 29 (<1 to 100) days for BSI-other. Multivariable analysis revealed an increased risk of MBI-LCBI with poor Karnofsky/Lansky performance status (hazard ratio [HR], 1.21 [99% CI, 1.04-1.41]), cord blood grafts (HR, 2.89 [99% CI, 1.97-4.24]), myeloablative conditioning (HR, 1.46 [99% CI, 1.19-1.78]), and posttransplant cyclophosphamide graft-vs-host disease prophylaxis (HR, 1.85 [99% CI, 1.38-2.48]). One-year mortality was significantly higher for patients with MBI-LCBI (HR, 1.81 [99% CI, 1.56-2.12]), BSI-other (HR, 1.81 [99% CI, 1.60-2.06]), and MBI-LCBI plus BSI-other (HR, 2.65 [99% CI, 2.17-3.24]) compared with controls. Infection was more commonly reported as a cause of death for patients with MBI-LCBI (139 of 740 [18.8%]), BSI (251 of 1537 [16.3%]), and MBI-LCBI plus BSI (94 of 435 [21.6%]) than for controls (566 of 4740 [11.9%]). CONCLUSIONS AND RELEVANCE In this cohort study, MBI-LCBI, in addition to any BSIs, were associated with significant morbidity and mortality after HSCT. Further investigation into risk reduction should be a clinical and scientific priority in this patient population.
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Affiliation(s)
- Christopher E. Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Soyoung Kim
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee
| | - Min Chen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee
| | - Monica I. Ardura
- Division of Infectious Disease, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Valerie Brown
- Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children’s Hospital and College of Medicine, Hershey, Pennsylvania
| | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Divsion of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Christopher Dvorak
- Divsion of Pediatric Allergy, Immunology & Bone Marrow Transplantation, Benioff Children’s Hospital, University of California, San Francisco
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville
| | - Aron Flagg
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale New Haven Hospital, New Haven, Connecticut
| | - Siddartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City
| | - Gregory A. Hale
- Department of Hematology/Oncology, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
| | - Shahrukh K. Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Roomi Nusrat
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Richard F. Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Seth J. Rotz
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children’s Hospital, Cleveland, Ohio
| | - Anthony D. Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Caroline A. Lindemans
- Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht University, Netherlands
- Division of Pediatric Stem Cell Transplantation, Department of Pediatrics, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Marcie L. Riches
- Division of Hematology/Oncology, The University of North Carolina at Chapel Hill
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García-Cadenas I, Awol R, Esquirol A, Saavedra S, Bosch-Vilaseca A, Novelli S, Garrido A, López J, Granell M, Moreno C, Briones J, Brunet S, Sierra J, Martino R. Incorporating posttransplant cyclophosphamide-based prophylaxis as standard-of-care outside the haploidentical setting: challenges and review of the literature. Bone Marrow Transplant 2019; 55:1041-1049. [PMID: 31822813 DOI: 10.1038/s41409-019-0771-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/21/2019] [Accepted: 11/29/2019] [Indexed: 11/09/2022]
Abstract
Posttransplant high-dose cyclophosphamide (PTCy) effectively prevents GvHD after haploidentical SCT. However, its use in HLA-matched SCT has been less explored. Fifty-six consecutive patients who underwent allo-SCT for hematological malignancies have been included in this prospective single-center protocol. Donors have been HLA-identical siblings, fully-matched unrelated or 1-allele-mismatched unrelated donors in 30%, 32%, and 37% of cases, respectively. Nine patients have received a TBI-containing MAC regimen, while the remaining (84%) received RIC platforms based on Fludarabine plus Busulfan/Melphalan. Due to the high graft failure (GF) rate (21%) in a preliminary analysis in the allo-RIC cohort (n = 29), protocol amendments have been implemented, with no further cases of GF after the introduction of mini-thiotepa (0/18). The overall incidence of grade II-IV acute GvHD is 24% (95% CI: 17-31%) with four steroid-refractory cases. Severe chronic GvHD has occurred in only 1 of 43 evaluable cases. The 1-year NRM and relapse are 18% (95% CI: 12-26%) and 30% (18-42%) and the OS and DFS are 78% and 64%, respectively. These outcomes support the feasibility of using PTCy as a SOC outside the haplo-setting, albeit mini-thiotepa (3 mg/kg) was incorporated in the standard allo-RIC platforms to prevent GF. Despite the limitations of a single-center experience and the short follow-up, these protocols show promising results with particular benefit in reducing the occurrence of moderate-to-severe GvHD.
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Affiliation(s)
- I García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain.
| | - R Awol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - A Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - S Saavedra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - A Bosch-Vilaseca
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - S Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - A Garrido
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - J López
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - M Granell
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - C Moreno
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - J Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - S Brunet
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - J Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - R Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
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46
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Schmidt-Hieber M, Engelhard D, Ullmann A, Ljungman P, Maertens J, Martino R, Rovira M, Shaw PJ, Robin C, Faraci M, Byrne J, Schäfer-Eckart K, Einsele H, Faber E, Rigacci L, Saccardi R, Balaguer-Rosello A, Isaksson C, Christopeit M, Tridello G, Wang J, Knelange N, Mikulska M, Cesaro S, Styczynski J. Central nervous system disorders after hematopoietic stem cell transplantation: a prospective study of the Infectious Diseases Working Party of EBMT. J Neurol 2019; 267:430-439. [PMID: 31664549 DOI: 10.1007/s00415-019-09578-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/28/2019] [Accepted: 10/10/2019] [Indexed: 12/18/2022]
Abstract
We performed a prospective study to evaluate the types and characteristics of central nervous system (CNS) disorders in patients after hematopoietic stem cell transplantation. The study included 163 episodes of CNS disorders of which 58 (36%) were infections. Proven or probable infections were documented in 34 patients and included fungi (n = 10, 29%), viruses (n = 12, 35%), Toxoplasma spp. (n = 9, 27%) and bacteria (n = 3, 9%). Non-infectious neurological disorders (n = 105, 64%) frequently encompassed metabolic/drug-induced abnormalities (n = 28, 27%) or cerebral vascular events (n = 22, 21%). Median onset times were later for infectious (day + 101) vs non-infectious neurological disorders (day + 50, p = 0.009). An unremarkable cranial CT scan was found in 33% of infection episodes. Absence of cerebrospinal fluid pleocytosis despite a normal or increased peripheral blood white blood cell count occurred in 26% of infections. Day-30 mortality rates were significantly higher for fungal (87%) vs non-fungal infections (40%, p < 0.001). Significantly higher mortality rates were also documented for cerebral vascular events than for other non-infectious disorders (86% vs 34%, p < 0.001). Our prospective study shows that diagnostic findings in CNS infections might differ between hematopoietic stem cell transplant recipients and immunocompetent hosts. Special awareness and timely initiation of adequate diagnostics are crucial to improve the prognosis of these patients.
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Affiliation(s)
- Martin Schmidt-Hieber
- Clinic for Hematology and Oncology, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany.
| | - Dan Engelhard
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Andrew Ullmann
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Per Ljungman
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Rodrigo Martino
- Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Department of Hematology, Institute of Hematology and Oncology, IDIBAPS, Hospital Clinic, University of Barcelona, Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Peter J Shaw
- The Children's Hospital at Westmead, Sydney, Australia
| | - Christine Robin
- Assistance Publique-Hopitaux de Paris, Henri Mondor University Hospital, Hematology Department and UPEC, Créteil France Hôspital Henri Mondor, Créteil, France
| | - Maura Faraci
- Hematopoietic Stem Cell Unit Transplantation, IRCCS Instituto G. Gaslini, Genova, Italy
| | - Jenny Byrne
- Nottingham University Hospital, Nottingham, UK
| | - Kerstin Schäfer-Eckart
- Clinic for Hematology and Oncology, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Edgar Faber
- Department of Hemato-Oncology, Faculty Hospital Olomouc, Faculty of Medicine and Dentistry Palacky University, Olomouc, Czech Republic
| | | | | | | | | | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Eppendorf, Hamburg, Germany
| | - Gloria Tridello
- Pediatric Hematology Oncology, Mother and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,EBMT Data Office, Leiden, The Netherlands
| | | | | | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genova, DISSAL, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Mother and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum UMK, Bydgoszcz, Poland
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47
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Ahmed S, Kanakry JA, Ahn KW, Litovich C, Abdel-Azim H, Aljurf M, Bacher VU, Bejanyan N, Cohen JB, Farooq U, Fuchs EJ, Bolaños-Meade J, Ghosh N, Herrera AF, Hossain NM, Inwards D, Kanate AS, Martino R, Munshi PN, Murthy H, Mussetti A, Nieto Y, Perales MA, Romee R, Savani BN, Seo S, Wirk B, Yared JA, Sureda A, Fenske TS, Hamadani M. Lower Graft-versus-Host Disease and Relapse Risk in Post-Transplant Cyclophosphamide-Based Haploidentical versus Matched Sibling Donor Reduced-Intensity Conditioning Transplant for Hodgkin Lymphoma. Biol Blood Marrow Transplant 2019; 25:1859-1868. [PMID: 31132455 PMCID: PMC6755039 DOI: 10.1016/j.bbmt.2019.05.025] [Citation(s) in RCA: 50] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/30/2019] [Accepted: 05/20/2019] [Indexed: 11/21/2022]
Abstract
Classic Hodgkin lymphoma (cHL) patients with relapsed or refractory disease may benefit from allogeneic hematopoietic cell transplantation (allo-HCT), but many lack a matched sibling donor (MSD). Herein, we compare outcomes of 2 reduced-intensity conditioning (RIC) HCT platforms in cHL: T cell-replete related donor haploidentical (haplo) HCT with a post-transplant cyclophosphamide (PTCy)-based approach versus an MSD/calcineurin inhibitor (CNI)-based approach. The study included 596 adult patients who underwent a first RIC allo-HCT for cHL between 2008 and 2016 using either a haplo-PTCy (n = 139) or MSD/CNI-based (n = 457) approach. Overall survival (OS) was the primary endpoint. Secondary endpoints included acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD), nonrelapse mortality (NRM), relapse/progression, and progression-free survival (PFS). On multivariate analysis, there was no significant difference between haplo/PTCy and MDS/CNI-based approaches in terms of OS (hazard ratio [HR], 1.07; 95% confidence interval [CI], .79 to 1.45; P = .66) or PFS (HR, .86; 95% CI, .68 to 1.10; P = .22). Haplo/PTCy was associated with a significantly higher risk of grades II to IV aGVHD (odds ratio [OR], 1.73, 95% CI, 1.16 to 2.59; P = .007), but the risk of grades III to IV aGVHD was not significantly different between the 2 cohorts (OR, .61; 95% CI, .29 to 1.27; P = .19). The haplo/PTCy platform provided a significant reduction in cGVHD risk (HR, .45; 95% CI, .32 to .64; P < .001), and a significant reduction in relapse risk (HR, .74; 95% CI, .56 to .97; P = .03). There was a statistically nonsignificant trend toward higher NRM with a haplo/PTCy approach (HR, 1.65; 95% CI, .99 to 2.77; P = .06). Haplo/PTCy-based approaches are associated with lower incidences of cGVHD and relapse, with PFS and OS outcomes comparable with MSD/CNI-based approaches. There was a leaning toward higher NRM with a haplo/PTCy-based platform. These data show that haplo/PTCy allo-HCT in cHL results in survival comparable with MSD/CNI-based allo-HCT.
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Affiliation(s)
- Sairah Ahmed
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Kanakry
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kwang W Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carlos Litovich
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California; University of Southern California Keck School of Medicine, Los Angeles, California
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Ephraim J Fuchs
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Nasheed M Hossain
- Department of Medicine, Division of Hematology/Oncology, Loyola University Chicago-Stritch School of Medicine, Maywood, Illinois
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Abraham S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Rodrigo Martino
- Divison of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Hemant Murthy
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Alberto Mussetti
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Yago Nieto
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rizwan Romee
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sachiko Seo
- Department of Haematology and Oncology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Ana Sureda
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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48
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Saad A, Lamb L, Wang T, Hemmer MT, Spellman S, Couriel D, Alousi A, Pidala J, Abdel-Azim H, Agrawal V, Aljurf M, Beitinjaneh AM, Bhatt VR, Buchbinder D, Byrne M, Cahn JY, Cairo M, Castillo P, Chhabra S, Diaz MA, Farhan S, Floisand Y, Frangoul HA, Gadalla SM, Gajewski J, Gale RP, Gandhi M, Gergis U, Hamilton BK, Hematti P, Hildebrandt GC, Kamble RT, Kanate AS, Khandelwal P, Lazaryan A, MacMillan M, Marks DI, Martino R, Mehta PA, Nishihori T, Olsson RF, Patel SS, Qayed M, Rangarajan HG, Reshef R, Ringden O, Savani BN, Schouten HC, Schultz KR, Seo S, Shaffer BC, Solh M, Teshima T, Urbano-Ispizua A, Verdonck LF, Vij R, Waller EK, William B, Wirk B, Yared JA, Yu LC, Arora M, Hashmi S. Impact of T Cell Dose on Outcome of T Cell-Replete HLA-Matched Allogeneic Peripheral Blood Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1875-1883. [PMID: 31085303 PMCID: PMC7071947 DOI: 10.1016/j.bbmt.2019.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/11/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 01/24/2023]
Abstract
Data on whether the T cell dose of allogeneic peripheral blood stem cell (PBSC) products influences transplantation outcomes are conflicting. Using the Center for International Blood and Marrow Transplant Research database, we identified 2736 adult patients who underwent first allogeneic PBSC transplantation for acute leukemia or myelodysplastic syndrome between 2008 and 2014 using an HLA-matched sibling donor (MSD) or an 8/8-matched unrelated donor (MUD). We excluded ex vivo and in vivo T cell-depleted transplantations. Correlative analysis was performed between CD3+ T cell dose and the risk of graft-versus-host-disease (GVHD), relapse, nonrelapse mortality (NRM), disease-free survival (DFS), and overall survival (OS). Using maximum likelihood estimation, we identified CD3+ T cell dose cutoff that separated the risk of acute GVHD (aGVHD) grade II-IV in both the MSD and MUD groups. A CD3+ T cell dose cutoff of 14 × 107 cells/kg identified MSD/low CD3+ (n = 223) and MSD/high CD3+ (n = 1214), and a dose of 15 × 107 cells/kg identified MUD/low CD3+ (n = 197) and MUD/high CD3+ (n = 1102). On univariate analysis, the MSD/high CD3+ group had a higher cumulative incidence of day +100 aGVHD grade II-IV compared with the MSD/low CD3+ group (33% versus 25%; P = .009). There were no differences between the 2 groups in engraftment rate, risk of aGVHD grade III-IV or chronic GVHD (cGVHD), NRM, relapse, DFS, or OS. The MUD/high CD3+ group had a higher cumulative incidence of day +100 aGVHD grade II-IV compared with the MUD/low CD3+ group (49% versus 41%; P = .04). There were no differences between the 2 groups in engraftment rate, risk of severe aGVHD or cGVHD, NRM, relapse, DFS, or OS. Multivariate analysis of the MSD and MUD groups failed to show an association between CD3+ T cell dose and the risk of either aGVHD grade II-IV (P = .10 and .07, respectively) or cGVHD (P = .80 and .30, respectively). Subanalysis of CD4+ T cells, CD8+ T cells, and CD4+/CD8+ ratio failed to identify cutoff values predictive of transplantation outcomes; however, using the log-rank test, the sample size was suboptimal for identifying a difference at this cutoff cell dose. In this registry study, the CD3+ T cell dose of PBSC products did not influence the risk of aGVHD or cGVHD or other transplantation outcomes when using an MSD or an 8/8-matched MUD. Subset analyses of CD4+ and CD8+ T cell doses were not possible given our small sample size.
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Affiliation(s)
- Ayman Saad
- Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Lawrence Lamb
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Tao Wang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael T Hemmer
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Daniel Couriel
- Utah Blood and Marrow Transplant Program, Salt Lake City, Utah
| | - Amin Alousi
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Vaibhav Agrawal
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, California
| | - Michael Byrne
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Mitchell Cairo
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, New York, New York
| | - Paul Castillo
- UF Health Shands Children's Hospital, Gainesville, Florida
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Shatha Farhan
- Henry Ford Hospital Bone Marrow Transplant Program, Detroit, Michigan
| | | | - Hadar A Frangoul
- Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, Tennessee
| | - Shahinaz M Gadalla
- Division of Cancer Epidemiology & Genetics, Clinical Genetics Branch, National Cancer Institute, Rockville, Maryland
| | | | - Robert Peter Gale
- Hematology Research Center, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Manish Gandhi
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota
| | - Usama Gergis
- Hematologic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Betty Ky Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Abraham S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Pooja Khandelwal
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aleksandr Lazaryan
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Margaret MacMillan
- University of Minnesota Blood and Marrow Transplant Program, Pediatrics, Minneapolis, Minnesota
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Parinda A Mehta
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Sagar S Patel
- Blood and Marrow Transplant Program, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Muna Qayed
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Hemalatha G Rangarajan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio
| | - Ran Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunobiology, Columbia University Medical Center, New York, New York
| | - Olle Ringden
- Translational Cell Therapy Research, Karolinska Institute, Stockholm, Sweden
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, Britich Columbia, Canada
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | | | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia
| | | | - Alvaro Urbano-Ispizua
- Department of Hematology, Hospital Clinic, University of Barcelona, IDIBAPS, and Josep Carreras Institute of Research, Barcelona, Spain
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Basem William
- Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Lolie C Yu
- Division of Hematology/Oncology and HSCT, Center for Cancer and Blood Disorders, Children's Hospital/Louisiana State University Medical Center, New Orleans, Louisiana
| | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
| | - Shahrukh Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Sabloff M, Chhabra S, Wang T, Fretham C, Kekre N, Abraham A, Adekola K, Auletta JJ, Barker C, Beitinjaneh AM, Bredeson C, Cahn JY, Diaz MA, Freytes C, Gale RP, Ganguly S, Gergis U, Guinan E, Hamilton BK, Hashmi S, Hematti P, Hildebrandt G, Holmberg L, Hong S, Lazarus HM, Martino R, Muffly L, Nishihori T, Perales MA, Yared J, Mineishi S, Stadtmauer EA, Pasquini MC, Loren AW. Comparison of High Doses of Total Body Irradiation in Myeloablative Conditioning before Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:2398-2407. [PMID: 31473319 DOI: 10.1016/j.bbmt.2019.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022]
Abstract
Malignancy relapse is the most common cause of treatment failure among recipients of hematopoietic cell transplantation (HCT). Conditioning dose intensity can reduce disease relapse but is offset by toxicities. Improvements in radiotherapy techniques and supportive care may translate to better outcomes with higher irradiation doses in the modern era. This study compares outcomes of recipients of increasing doses of high-dose total body irradiation (TBI) divided into intermediate high dose (IH; 13-13.75 Gy) and high dose (HD; 14 Gy) with standard dose (SD; 12 Gy) with cyclophosphamide. A total of 2721 patients ages 18 to 60 years with hematologic malignancies receiving HCT from 2001 to 2013 were included. Cumulative incidences of nonrelapse mortality (NRM) at 5 years were 28% (95% confidence interval [CI], 25% to 30%), 32% (95% CI, 29% to 36%), and 34% (95% CI, 28% to 39%) for SD, IH, and HD, respectively (P = .02). Patients receiving IH-TBI had a 25% higher risk of NRM compared with those receiving SD-TBI (12 Gy) (P = .007). Corresponding cumulative incidences of relapse were 36% (95% CI, 34% to 38%), 32% (95% CI, 29% to 36%), and 26% (95% CI, 21% to 31%; P = .001). Hazard ratios for mortality compared with SD were 1.06 (95% CI, .94 to 1.19; P = .36) for IH and .89 (95% CI, .76 to 1.05; P = .17) for HD. The study demonstrates that despite improvements in supportive care, myeloablative conditioning using higher doses of TBI (with cyclophosphamide) leads to worse NRM and offers no survival benefit over SD, despite reducing disease relapse.
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Affiliation(s)
- Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Tao Wang
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Caitrin Fretham
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Natasha Kekre
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC
| | - Kehinde Adekola
- Division of Hematology/Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jeffery J Auletta
- Blood and Marrow Transplant Program and Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Christopher Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Cesar Freytes
- Adult Blood & Marrow Transplant Program, Texas Transplant Institute, San Antonio, Texas
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Eva Guinan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | | | - Leona Holmberg
- Division of Medical Oncology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sanghee Hong
- Department of Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland Ohio
| | | | - Rodrigo Martino
- Divison of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, California
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jean Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Shin Mineishi
- Division of Hematology and Oncology, Department of Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Edward A Stadtmauer
- Division of Hematology/Oncology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alison W Loren
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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50
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Santaliestra M, Garrido A, Carricondo M, Bussaglia E, Pratcorona M, Blanco ML, Gich I, Hoyos M, Esquirol A, García‐Cadenas I, Brunet S, Martino R, Sierra J, Nomdedéu JF. Bone marrow WT1 levels in patients with myeloid neoplasms treated with 5‐azacytidine: Identification of responding patients. Eur J Haematol 2019; 103:208-214. [DOI: 10.1111/ejh.13275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Marta Santaliestra
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - Ana Garrido
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Maite Carricondo
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - Elena Bussaglia
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - Marta Pratcorona
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Maria L. Blanco
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Ignasi Gich
- Epidemiology Department Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Montserrat Hoyos
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Irene García‐Cadenas
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Salut Brunet
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Josep F. Nomdedéu
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
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