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Kassim AA, de la Fuente J, Nur E, Wilkerson K, Alahmari A, Seber A, Bonfim CMS, Simões BP, Alzahrani M, Eckrich MJ, Horn B, Hanna R, Dhedin N, Rangarajan HG, Gouveia RV, Almohareb F, Aljurf M, Essa M, Alahmari B, Gatwood KS, Connelly JA, Dovern E, Rodeghier M, DeBaun MR. An International Learning Collaborative Phase 2 Trial for Haploidentical Bone Marrow Transplant in Sickle Cell Disease. Blood 2024:blood.2023023301. [PMID: 38493482 DOI: 10.1182/blood.2023023301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 03/19/2024] Open
Abstract
In the setting of a learning collaborative, we conducted an international multicenter phase 2 clinical trial testing the hypothesis that non-myeloablative related haploidentical BMT with thiotepa and post-transplant cyclophosphamide (PTCy) will result in 2-year event-free survival (no graft failure or death) of at least 80%. A total of 70 participants (median age 19.1 (IQR 14.1 - 25.0) were evaluable based on the conditioning protocol. Graft failure occurred in 11.4% (8/70) and only in participants <18 years (p=0.001); all had autologous reconstitution. After a median follow-up of 2.4 years (IQR 1.5-3.9), the 2-year Kaplan-Meier-based probability of event-free survival was 82.6% (95% CI 71.4%-89.7%). The 2-year overall survival was 94.1% (95% CI 84.9%-97.7%) with no difference between the child and adult participants (p=0.889). After excluding participants with graft failure (n=8), participants with engraftment had median whole blood donor chimerism values at D+180 and D+365 post-transplant of 100.0% (IQR 99.8 - 100.0%; n=59) and 100.0% (IQR 100.0 - 100.0%; n=58), respectively, and 96.6% (57/59) were off immunosuppression at 1-year post-transplant. The 1-year grades III-IV acute graft versus host disease (GvHD) rate was 10.0% (95% CI 4.6 - 18.6%), and the 2-year moderate-severe chronic GvHD rate was 10.0% (95% CI 4.6 - 18.6%). Five participants (7.1%) died from infectious complications. We demonstrate that non-myeloablative haploidentical BMT with thiotepa and PTCy is a readily available curative therapy for most adults, even those with organ damage, instead of the more expensive myeloablative gene therapy and gene editing. Additional strategies are required for children to decrease graft failure rates (ClinicalTrials.gov identifier NCT01850108).
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Affiliation(s)
- Adetola A Kassim
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | - Erfan Nur
- Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Karina Wilkerson
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Ali Alahmari
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, Riyadh, Saudi Arabia
| | | | - Carmem M S Bonfim
- Hospital Pequeno Principe/Pele Pequeno Príncipe Research Institute, Curitiba, Brazil
| | - Belinda Pinto Simões
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil, Ribeirão Preto, Brazil
| | | | - Michael J Eckrich
- Levine Children's Hospital, Charlotte, North Carolina, United States
| | - Biljana Horn
- Shands HealthCare & University of Florida, Gainesville, Florida, United States
| | - Rabi Hanna
- Cleveland Clinic, Cleveland, Ohio, United States
| | | | | | | | | | | | - Mohammed Essa
- King Abdulaziz Medical City; King Abdullah International Medical Research Center; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Katie S Gatwood
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - James A Connelly
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | | | - Michael R DeBaun
- Vanderbilt UniversityVanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Nashville, Tennessee, United States
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Oliveira CMCZ, Gouveia RV, Zamperlini G, Ginani VC, Matos MGAD, Monteiro CN, Domingues LDS, Soriano PAM, Pupim MV, Marques JF, Santos FVBD, Andrade CF, Paiva PM, Seber A. TRANSPLANTE ALOGÊNICO DE CÉLULAS-TRONCO HEMATOPOIÉTICAS (TCTH) PARA TRATAMENTO DE DOENÇA FALCIFORME (DF): ESTRATÉGIAS E COMPLICAÇÕES DISTINTAS, MAS RESULTADOS SEMELHANTES COM TCTH HAPLOIDÊNTICO (HAPLO) E IRMÃO HLA-IDÊNTICO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Gouveia RV, Ginani VC, Zamperlini G, Oliveira CMCZ, Breviglieri CNM, Matos MGAD, Domingues LDS, Pupim MV, Marques JF, Paiva PM, Soriano PA, Santos FVB, Andrade CF, Seber A. EXPERIÊNCIA DO RUXOLITINIB NO TRATAMENTO DE DOENÇA DO ENXERTO CONTRA O HOSPEDEIRO CRÔNICA EM CRIANÇAS SUBMETIDAS A TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOIÉTICAS (TCTH). Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.442] [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: 11/27/2022] Open
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Gouveia RV, Ginani VC, Zamperlini G, Matos MGAD, Monteiro CN, Domingues LDS, Oliveira CMCZ, Soriano PAM, Marques JF, Pupim MV, Seber A, Santos FVB, Paiva PM, Andrade CF, Seber A. REVERSÃO DE QUIMERISMO MISTO COM INFUSÃO DE LEUCÓCITOS DE DOADOR EM CRIANÇAS SUBMETIDAS A TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOIÉTICAS (TCTH) HAPLOIDÊNTICO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Breviglieri CNM, Gouveia RV, Ginani VC, Oliveira CMCZ, Domingues LDS, Alves MGM, Zamperlini G, Soriano PAM, Marques JF, Seber A. EXPERIÊNCIA COM REGIMES DE CONDICIONAMENTO SUGERIDOS PELO GRUPO DE ESTUDOS DE LEUCEMIA MIELÓIDE AGUDA INFANTIL (GELMAI). Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Matos MGAD, Domingues LDS, Gouveia RV, Ginani VC, Zamperlini G, Oliveira CMCZ, Pupim MV, Soriano PA, Monteiro CN, Marques JF, Santos FVBD, Andrade CF, Seber A. O USO DE CICLOFOSFAMIDA 50 MG/KG EM REGIMES DE CONDICIONAMENTO DE TOXICIDADE REDUZIDA PROPORCIONAM ENXERTIA DE TODAS AS CRIANÇAS PORTADORAS DE APLASIA GRAVE DE MEDULA ÓSSEA SUBMETIDAS A TRANSPLANTES ALOGÊNICOS DE DOADOR NÃO APARENTADO E HAPLOIDÊNTICO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.067] [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: 11/27/2022] Open
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Zamperlini G, Gouveia RV, Ginani VC, Oliveira CMCZ, Matos MGAD, Monteiro CN, Domingues LDS, Pupim MV, Soriano PAM, Marques JF, Andrade CF, Santos FVBD, Paiva PM, Seber A. RESULTADO DO TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOIÉTICAS COM DOADORES ALTERNATIVOS APÓS BLINATUMOMAB EM CRIANÇAS COM LEUCEMIA LINFÓIDE AGUDA DE LINHAGEM B (LLA-B) RECIDIVADA OU REFRATÁRIA. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Domingues LDS, Zamperlini G, Gouveia RV, Ginani VC, Matos MGAD, Oliveira CMCZ, Monteiro CN, Pupim MV, Soriano PAM, Marques JF, Santos FVBD, Andrade CF, Paiva PM, Seber A. A ASSOCIAÇÃO DE BLINATUMOMAB (BLINA) E INOTUZUMAB (INO) PODE INDUZIR RESPOSTA COMPLETA DE LEUCEMIA LINFÓIDE AGUDA DE LINHAGEM B (LLA-B) REFRATÁRIA E PERMITIR O TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOIÉTICAS (TCTH) EM REMISSÃO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Félix OMWDO, Tunes G, Ginani VC, Simões PC, Barros DP, Delbuono E, Alves MTDS, Petrilli AS, Lee MLDM, Gouveia RV, Zecchin VG, Seber A. The influence of cell concentration at cryopreservation on neutrophil engraftment after autologous peripheral blood stem cell transplantation. Hematol Transfus Cell Ther 2018; 40:233-239. [PMID: 30128431 PMCID: PMC6098178 DOI: 10.1016/j.htct.2018.01.007] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 01/22/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Peripheral blood stem cell concentrations are traditionally adjusted to 20-40 × 106 leukocytes/mL prior to freezing. This low cell concentration at cryopreservation implies larger volumes with more dimethyl sulfoxide being used, and higher cost and toxicity at the time of transplant. Higher cell concentrations have been reported but this is not widely accepted. Moreover, the influence of cell concentration on engraftment has not been well documented. Therefore, this study retrospectively analyzed the influence of peripheral blood stem cell concentration at freezing on engraftment after autologous hematopoietic stem cell transplantation. METHOD Leukapheresis products were plasma-depleted and cryopreserved with 5% dimethyl sulfoxide, 6% hydroxyethylamide solution and 4% albumin in a -80 °C freezer. Individual patient data from hospital records were reviewed. RESULTS Fifty consecutive patients with oncological diseases underwent 88 leukaphereses. Median age was six years (range: 1-32 years) and median weight was 19 kg (range: 8-94 kg). Median leukocyte concentration was 109 × 106/mL at collection and 359 × 106 (range: 58-676 × 106) at freezing with 78% viability (range: 53-95%); leukocyte recovery after thawing was 95% (range: 70-100%). In multivariate analysis, cell concentration (p-value = 0.001) had a negative impact on engraftment. Patients infused with bags frozen with <200 × 106 leukocytes/mL engrafted after a median of nine days (range: 8-12 days), 200-400 × 106 leukocytes/mL after 11 days (range: 9-20 days); 400-600 × 106 leukocytes/mL after 12 days (range: 8-19 days) and with cell concentrations >600 × 106 leukocytes/mL, engraftment was after 14 days (range: 13-22 days). CONCLUSION In patients with adequate CD34 cell collections, total leukocyte concentrations of 282 × 106/mL, freezing with 5% dimethyl sulfoxide and 6% hydroxyethylamide solution without a controlled-rate freezer, and storing cells at -80 °C yielded excellent engraftment. Further increases in cell concentration may delay engraftment, without affecting safety.
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Affiliation(s)
| | - Gisela Tunes
- Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Paulo César Simões
- Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e a Criança com Câncer (GRAACC), São Paulo, SP, Brazil
| | - Daniele Porto Barros
- Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e a Criança com Câncer (GRAACC), São Paulo, SP, Brazil
| | - Elizabete Delbuono
- Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e a Criança com Câncer (GRAACC), São Paulo, SP, Brazil
| | | | - Antonio Sérgio Petrilli
- Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e a Criança com Câncer (GRAACC), São Paulo, SP, Brazil
| | - Maria Lúcia de Martino Lee
- Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e a Criança com Câncer (GRAACC), São Paulo, SP, Brazil
| | | | - Victor Gottardello Zecchin
- Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e a Criança com Câncer (GRAACC), São Paulo, SP, Brazil
| | - Adriana Seber
- Hospital Samaritano de São Paulo, São Paulo, SP, Brazil.
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Soto M, Lalla RV, Gouveia RV, Zecchin VG, Seber A, Lopes NNF. Pilot Study on the Efficacy of Combined Intraoral and Extraoral Low-Level Laser Therapy for Prevention of Oral Mucositis in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplantation. Photomed Laser Surg 2015; 33:540-6. [DOI: 10.1089/pho.2015.3954] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Marcos Soto
- Pediatric Oncology Institute, GRAACC, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rajesh V. Lalla
- Section of Oral Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | | | | | - Adriana Seber
- Pediatric Oncology Institute, GRAACC, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Nilza Nelly Fontana Lopes
- Division of Dentistry, Pediatric Oncology Institute, GRAACC, Universidade Federal de São Paulo, São Paulo, Brazil
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Gouveia RV, Neto-Silva DA, Sousa BM, Novelli IA. Evaluation of injuries caused by anthropic action in snakes from Brazil. BRAZ J BIOL 2015; 75:535-40. [PMID: 26465721 DOI: 10.1590/1519-6984.15513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 05/13/2014] [Indexed: 11/22/2022] Open
Abstract
Human behavior toward wild animals is defined by cultural influences and often is affected by lack of knowledge, mainly in situations of confrontation. The present study was conducted between 2008 and 2013, involving analysis of snakes that had suffered injuries belonging to the reptile collections of Centro Universitário de Lavras and Universidade Federal de Juiz de Fora. The injuries were classified according to location on the body. Among the 449 specimens analyzed, 245 specimens showed injury to some part of the body. The nonvenomous snakes were the most representative and had a higher rate of injury (66.3%) than the venomous ones (18.2%). The body region where the greatest percentage of injuries was recorded was the anterior (39.6%), followed by the middle (36.5%) and posterior (8.4%). We believe this fact may have resulted due the lack of knowledge on how to differentiate species. Studies of the relationship between schooling level and contact with environmental education activities demonstrate reduction of attacks on these animals. This fact indicates that the preservation of many species is related to awareness and education of the population.
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Affiliation(s)
- R V Gouveia
- Universidade Federal de Juiz de Fora, Juiz de Fora, MG, BR
| | - D A Neto-Silva
- Laboratório de Zoologia, Centro Universitário de Lavras, Lavras, MG, BR
| | - B M Sousa
- Universidade Federal de Juiz de Fora, Juiz de Fora, MG, BR
| | - I A Novelli
- Universidade Federal de Juiz de Fora, Juiz de Fora, MG, BR
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Santos MVC, Paiva MG, Macedo CRDP, Petrilli AS, Azeka E, Jatene IB, Castro Junior CG, Seber A, Miachon AS, Tanaka ACS, Castro MAS, Carvalho AC, Nars CCF, Terzian CN, Santos CCL, Guerra CCS, Silva DCB, Bassi DU, Feitosa FA, Hamamoto F, Szarf G, Lederman HM, Rigon Junior HJ, Mota ICF, Perrud JÁ, Soares Junior J, Gutierrez JA, Perin JPM, Catani LH, Tsai LY, Vianna LC, Santos MJ, Ishigai MMS, Diógenes MSB, Alves MTS, Piedade MTC, Parreiras M, Cypriano M, Negrini NS, Campos Filho O, Figueiredo PA, Novaes PE, Camargo PR, Maia OS, Petrilli R, Arduini RG, Gouveia RV, Teruya SBM, Moisés VA, Morais VLL. I Diretriz Brasileira de Cardio-Oncologia Pediátrica da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2013; 100:1-68. [DOI: 10.5935/abc.2013s005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Souto MAA, Lalla RV, Rojz J, Gouveia RV, Seber A, Lopes NNF. Preventive action of LLLT in oral mucositis (OM) in patients undergoing hematopoetic stem cell transplantation (HSCT) - retrospectively controlled. Med Oral Patol Oral Cir Bucal 2012. [DOI: 10.4317/medoral.17643761] [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: 11/05/2022] Open
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