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Kopmar NE, Quach K, Gooley TA, Martino CH, Cherian S, Percival MEM, Halpern AB, Ghiuzeli CM, Oehler VG, Abkowitz JL, Walter RB, Cassaday RD. Dose-Adjusted EPOCH Plus Inotuzumab Ozogamicin in Adults With Relapsed or Refractory B-Cell ALL: A Phase 1 Dose-Escalation Trial. JAMA Oncol 2024:2818572. [PMID: 38722664 PMCID: PMC11082746 DOI: 10.1001/jamaoncol.2024.0967] [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: 10/01/2023] [Accepted: 12/14/2023] [Indexed: 05/12/2024]
Abstract
Importance Options for adults with relapsed or refractory B-cell acute lymphoblastic leukemia or lymphoma (B-ALL) are limited, and new approaches are needed. Inotuzumab ozogamicin (InO) has been combined with low-intensity chemotherapy, with modest improvements over historical controls, and dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) treatment is safe and active for newly diagnosed ALL. Objective To assess the safety and clinical activity of DA-EPOCH and InO in adults with relapsed or refractory B-ALL. Design, Setting, and Participants This single-center, single-arm, nonrandomized, phase 1 dose-escalation trial included adults with relapsed or refractory CD22+ B-ALL and was conducted between September 2019 and November 2022. At least 5% blood or marrow blasts or measurable extramedullary disease (EMD) was required for enrollment. Interventions DA-EPOCH was given on days 1 to 5, while InO was given on day 8 and day 15 of a 28-day cycle. Three dose levels were studied using a bayesian optimal interval design. Main Outcomes and Measures The primary outcome was the maximum tolerated dose of InO when combined with DA-EPOCH, defined as the highest dose level that produced a rate of dose-limiting toxicity below 33%. Secondary objectives included response rates, survival estimates, and descriptions of toxic effects. Results A total of 24 participants were screened and enrolled (median age, 46 [range, 28-76] years; 15 [62%] male). The median number of lines of prior therapy was 3 (range, 1-12). Three of 11 participants (27%) treated at the highest dose level (InO, 0.6 mg/m2, on day 8 and day 15) experienced dose-limiting toxicity, making this the maximum tolerated dose. No deaths occurred during the study, and only 1 patient (4%; 95% CI, 0.1%-21%) developed sinusoidal obstructive syndrome after poststudy allograft. The morphologic complete response rate was 84% (95% CI, 60%-97%), 88% (95% CI, 62%-98%) of which was measurable residual disease negative by flow cytometry. Five of 6 participants with EMD experienced treatment response. The overall response rate was 83% (95% CI, 63%-95%). Median overall survival, duration of response, and event-free survival were 17.0 (95% CI, 8.4-not reached), 15.0 (95% CI, 6.7-not reached), and 9.6 (95% CI, 4.5-not reached) months, respectively. Conclusions In this study, adding InO to DA-EPOCH in adults with relapsed or refractory B-ALL was feasible, with high response rates and sinusoidal obstructive syndrome occurring rarely in a heavily pretreated population. Many patients were able to proceed to poststudy consolidative allogeneic hematopoietic cell transplant and/or chimeric antigen receptor T-cell therapy. Further investigation of this combination is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT03991884.
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Affiliation(s)
- Noam E. Kopmar
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Kim Quach
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Ted A. Gooley
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Christen H. Martino
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Sindhu Cherian
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Mary-Elizabeth M. Percival
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Anna B. Halpern
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Cristina M. Ghiuzeli
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Vivian G. Oehler
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Janis L. Abkowitz
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Roland B. Walter
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Ryan D. Cassaday
- Division of Hematology-Oncology, Department of Medicine, University of Washington School of Medicine, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
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Krakow EF, Brault M, Summers C, Cunningham TM, Biernacki MA, Black RG, Woodward KB, Vartanian N, Kanaan SB, Yeh AC, Dossa RG, Bar M, Cassaday RD, Dahlberg A, Till BG, Denker AE, Yeung CCS, Gooley TA, Maloney DG, Riddell SR, Greenberg PD, Chapuis AG, Newell EW, Furlan SN, Bleakley M. HA-1-targeted T cell receptor (TCR) T cell therapy for recurrent leukemia after hematopoietic stem cell transplantation. Blood 2024:blood.2024024105. [PMID: 38683966 DOI: 10.1182/blood.2024024105] [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: 01/29/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
Relapse is the leading cause of death after allogeneic hematopoietic stem cell transplantation (HCT) for leukemia. T cells engineered by gene transfer to express T cell receptors (TCR; TCR-T) specific for hematopoietic-restricted minor histocompatibility (H) antigens may provide a potent selective anti-leukemic effect post-HCT. We conducted a phase I clinical trial employing a novel TCR-T product targeting the minor H antigen HA-1 to treat or consolidate treatment of persistent or recurrent leukemia and myeloid neoplasms. The primary objective was to evaluate the feasibility and safety of administration of HA-1 TCR-T post-HCT. CD8+ and CD4+ T cells expressing the HA-1 TCR and a CD8-co-receptor were successfully manufactured from HA-1 disparate HCT donors. One or more infusions of HA-1 TCR-T following lymphodepleting chemotherapy were administered to nine HCT recipients who had developed disease recurrence post-HCT. TCR-T cells expanded and persisted in vivo after adoptive transfer. No dose-limiting toxicities occurred. Although the study was not designed to assess efficacy, four patients achieved or maintained complete remissions following lymphodepletion and HA-1 TCR-T, with one ongoing at >2 years. Single-cell RNA sequencing of relapsing/progressive leukemia after TCR-T therapy identified upregulated molecules associated with T cell dysfunction or cancer cell survival. HA-1 TCR-T therapy appears feasible and safe and shows preliminary signals of efficacy. This clinical trial is registered at clinicaltrials.gov as NCT03326921.
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Affiliation(s)
| | | | - Corinne Summers
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Tanya M Cunningham
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | | | - R Graeme Black
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | | | - Nicole Vartanian
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Sami B Kanaan
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Albert C Yeh
- University of Washington School of Medicine, United States
| | - Robson G Dossa
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Merav Bar
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Ryan D Cassaday
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Ann Dahlberg
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
| | - Brian G Till
- University of Washington School of Medicine, United States
| | | | | | - Ted A Gooley
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | | | | | | | - Aude G Chapuis
- University of Washington School of Medicine, United States
| | - Evan W Newell
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Scott N Furlan
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Marie Bleakley
- Fred Hutchinson Cancer Center, Seattle, Washington, United States
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Orozco JJ, Vo PT, Gooley TA, Haaf RL, Lundberg SJ, Hamlin DK, Wilbur DS, Matesan MC, Fisher DR, Gopal AK, Green DJ, Pagel JM, Sandmaier BM. Targeted Radiation Delivery before Haploidentical HCT for High-risk Leukemia or MDS Patients Yields Long-term Survivors. Clin Cancer Res 2024; 30:274-282. [PMID: 37939122 PMCID: PMC10843688 DOI: 10.1158/1078-0432.ccr-23-1200] [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: 05/02/2023] [Revised: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Hematopoietic cell transplantation (HCT) has curative potential for myeloid malignancies, though many patients cannot tolerate myeloablative conditioning with high-dose chemotherapy alone or with total-body irradiation (TBI). Here we report long-term outcomes from a phase I/II study using iodine-131 (131I)-anti-CD45 antibody BC8 combined with nonmyeloablative conditioning prior to HLA-haploidentical HCT in adults with high-risk relapsed/ refractory acute myeloid or lymphoid leukemia (AML or ALL), or myelodysplastic syndrome (MDS; ClinicalTrials.gov, NCT00589316). PATIENTS AND METHODS Patients received a tracer diagnostic dose before a therapeutic infusion of 131I-anti-CD45 to deliver escalating doses (12-26 Gy) to the dose-limiting organ. Patients subsequently received fludarabine, cyclophosphamide (CY), and 2 Gy TBI conditioning before haploidentical marrow HCT. GVHD prophylaxis was posttransplant CY plus tacrolimus and mycophenolate mofetil. RESULTS Twenty-five patients (20 with AML, 4 ALL and 1 high-risk MDS) were treated; 8 had ≥ 5% blasts by morphology (range 9%-20%), and 7 had previously failed HCT. All 25 patients achieved a morphologic remission 28 days after HCT, with only 2 patients showing minimal residual disease (0.002-1.8%) by flow cytometry. Median time to engraftment was 15 days for neutrophils and 23 days for platelets. Point estimates for overall survival and progression-free survival were 40% and 32% at 1 year, and 24% at 2 years, respectively. Point estimates of relapse and nonrelapse mortality at 1 year were 56% and 12%, respectively. CONCLUSIONS 131I-anti-CD45 radioimmunotherapy prior to haploidentical HCT is feasible and can be curative in some patients, including those with disease, without additional toxicity.
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Affiliation(s)
- Johnnie J Orozco
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Phuong T Vo
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Robyn L Haaf
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Sally J Lundberg
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Donald K Hamlin
- Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - D Scott Wilbur
- Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Manuela C Matesan
- Nuclear Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Darrell R Fisher
- Versant Medical Physics and Radiation Safety, Richland, Washington
| | - Ajay K Gopal
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Damian J Green
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - John M Pagel
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Brenda M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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Ujjani C, Gooley TA, Spurgeon SE, Stephens DM, Lai C, Broome CM, O’Brien S, Zhu H, Laing KJ, Winter AM, Pongas G, Greninger AL, Koelle DM, Siddiqi T, Davids MS, Rogers KA, Danilov AV, Sperling A, Tu B, Sorensen T, Launchbury K, Burrow CJ, Quezada G, Hill JA, Shadman M, Thompson PA. Diminished humoral and cellular responses to SARS-CoV-2 vaccines in patients with chronic lymphocytic leukemia. Blood Adv 2023; 7:4728-4737. [PMID: 36516082 PMCID: PMC9906469 DOI: 10.1182/bloodadvances.2022009164] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Previous studies have demonstrated low rates of seroconversion to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients with chronic lymphocytic leukemia (CLL). In this national collaboration of 11 cancer centers in the United States, we aimed to further characterize and understand vaccine-induced immune responses, including T-cell responses, and the impact of CLL therapeutics (#NCT04852822). Eligible patients were enrolled in 2 cohorts (1) at the time of initial vaccination and (2) at the time of booster vaccination. The serologic response rates (anti-S) from 210 patients in the initial vaccination cohort and 117 in the booster vaccination cohort were 56% (95% confidence interval [CI], 50-63) and 68% (95% CI, 60-77), respectively. Compared with patients not on therapy, those receiving B-cell-directed therapy were less likely to seroconvert (odds ratio [OR], 0.27; 95% CI, 0.15-0.49). Persistence of response was observed at 6 months; anti-S titers increased with the administration of booster vaccinations. In the initial vaccination cohort, positive correlations were observed between the quantitative serologic response and CD4 T-cell response for the Wuhan variant and, to a lesser degree, for the Omicron variant (Spearman P = 0.45 Wuhan; P = 0.25 Omicron). In the booster vaccination cohort, positive correlations were observed between serologic responses and CD4 T-cell responses for both variants (P = 0.58 Wuhan; P = 0.57 Omicron) and to a lesser degree for CD8 T-cell responses (P = 0.33 Wuhan; P = 0.22 Omicron). Although no deaths from coronavirus disease 2019 (COVID-19) have been reported after booster vaccinations, patients should use caution as newer variants emerge and escape vaccine-induced immunity. This trial was registered at www.clinicaltrials.gov as #NCT04852822.
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Affiliation(s)
- Chaitra Ujjani
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | - Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Catherine M. Broome
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC
| | - Susan O’Brien
- Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA
| | - Haiying Zhu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Kerry J. Laing
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Georgios Pongas
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - David M. Koelle
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
- Benaroya Research Institute, Seattle, WA
| | | | | | - Kerry A. Rogers
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | | | | | - Brian Tu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | | | | | | | | | - Joshua A. Hill
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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Dean D, Lee SJ, Cutler C, Gooley TA, Hujoel P, Oh U(Y, Bennett-Johnson L, Hagstrom MK, Rothen M, Lloid M, Sroussi H, Treister N. Dental evaluation and clearance prior to allogeneic hematopoietic cell transplantation. Oral Dis 2023:10.1111/odi.14717. [PMID: 37650229 PMCID: PMC10902180 DOI: 10.1111/odi.14717] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Dental examination and stabilization are performed prior to allogeneic hematopoietic cell transplantation to decrease infection risk during neutropenia. Burden of dental disease and treatment need is not well characterized in this population. OBJECTIVES This report describes the dental status of a cohort of patients within the Chronic Graft-versus-Host Disease Consortium and treatment rendered prior to transplant. METHODS The cohort included 486 subjects (Fred Hutchinson: n = 245; Dana-Farber: n = 241). Both centers have institutional-based dental clearance programs. Data were retrospectively abstracted from medical records by calibrated oral health specialists. RESULTS The median age at transplant was 55.9 years, 62.1% were male, and 88% were white. Thirteen patients were edentulous (2.7%). The mean teeth among dentate patients before clearance was 26.0 (SD, 4.6). Dental findings included untreated caries (31.2%), restorations (91.6%), endodontically treated teeth (48.1%), and dental implants (5.7%). Pretransplant procedures during clearance included endodontic therapy (3.6%; mean = 0.1 teeth), restorations (25.1%; mean = 0.7), dental prophylaxis (59.2%), scaling/root planing (5.1%), and extraction (13.2%; mean = 0.3). The mean teeth after clearance was 25.6 (SD, 5.0). CONCLUSIONS Retrospective analysis of pre-AlloHCT dental data in subjects at two large transplant centers identified low levels of dental need. Findings suggest high access to care.
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Affiliation(s)
- David Dean
- University of Washington School of Dentistry, Seattle, WA
| | | | | | - Ted A Gooley
- Clinical Research Division, Fred Cancer Center, Seattle, WA
| | | | | | | | | | | | - Michele Lloid
- University of Washington School of Dentistry, Seattle, WA
| | | | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA
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Lopedote P, Xue E, Chotivatanapong J, Pao EC, Wychera C, Dahlberg AE, Thur L, Roberts L, Baker K, Gooley TA, Hingorani S, Milano F. Acute kidney injury and chronic kidney disease in umbilical cord blood transplant recipients. Front Oncol 2023; 13:1186503. [PMID: 37260983 PMCID: PMC10229046 DOI: 10.3389/fonc.2023.1186503] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Acute kidney injury (AKI) is a frequent early complication post hematopoietic stem cell transplant (HSCT), associated with high morbidity and mortality. Cord blood transplant (CBT) recipients are potentially exposed to more nephrotoxic insults, compared to patients undergoing HSCT from other donor sources. We aimed to identify risk factors for AKI in patients undergoing CBT. We also aimed to identify the impact of AKI on chronic kidney disease (CKD) and survival outcomes by one-year post-CBT. Methods Adults and children who underwent a first CBT at our Institution were retrospectively evaluated. AKI was staged according to Kidney Disease Improving Global Outcomes (KDIGO) definitions. Cox regression models were used to estimate the association of demographic factors and post-CBT parameters with the cause-specific hazard of AKI. Results We identified 276 patients. Median age was 32 years, 28% (77/276) were children (<18 years) and 129 (47%) were white. A myeloablative conditioning regimen was administered to 243 patients (88%) and 248 (90%) received cyclosporine for GVHD prophylaxis. One-hundred and eighty-six patients (67%) developed AKI by day 60 post-transplant, with 72 (26%) developing severe AKI (stage 2 and 3). In a multivariable analysis, each increase in bilirubin level of 1 mg/dL was associated with a 23% increase in the risk of severe AKI (adjusted HR 1.23, 95% CI 1.13 - 1.34, p<.0001). Conversely, systemic steroid administration appeared to be protective of severe AKI (unadjusted HR 0.36, 95% CI 0.18 - 0.72, p=.004) in a univariate model . Two-hundred-forty-seven patients were evaluable at the one-year time point. Among those, 100 patients (40%) developed CKD one-year post-CBT. Severe AKI was associated with a higher hazard of non-relapse mortality (adjusted HR=3.26, 95% CI 1.65-6.45, p=.001) and overall mortality (adjusted HR=2.28, 95% CI 1.22-4.27, p=.01). Discussion AKI is a frequent complication after CBT and is associated with worse outcomes. Questions remain as to the mechanism of the protective role of steroids on kidney function in the setting of CBT.
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Affiliation(s)
- Paolo Lopedote
- Department of Medicine, St. Elizabeth’s Medical Center, Boston University, Boston, MA, United States
| | - Elisabetta Xue
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Julie Chotivatanapong
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Emily C. Pao
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Chiara Wychera
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Ann E. Dahlberg
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Laurel Thur
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Laura Roberts
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Kelsey Baker
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Ted A. Gooley
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Sangeeta Hingorani
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
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Gauthier J, Wu QV, Gooley TA. Correction: Cubic splines to model relationships between continuous variables and outcomes: a guide for clinicians. Bone Marrow Transplant 2023:10.1038/s41409-023-01993-7. [PMID: 37138021 DOI: 10.1038/s41409-023-01993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- J Gauthier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA.
| | - Q V Wu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - T A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Ueda Oshima M, Xie H, Zamora D, Flowers ME, Hill GR, Mielcarek MB, Sandmaier BM, Gooley TA, Boeckh MJ. Impact of GVHD prophylaxis on CMV reactivation and disease after HLA-matched peripheral blood stem cell transplantation. Blood Adv 2023; 7:1394-1403. [PMID: 36595478 PMCID: PMC10139935 DOI: 10.1182/bloodadvances.2022009112] [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: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
The kinetics of early and late cytomegalovirus (CMV) reactivation after hematopoietic cell transplantation using various methods of graft-versus-host-disease (GVHD) prophylaxis are poorly defined. We retrospectively compared CMV reactivation and disease among 780 seropositive patients given HLA-matched peripheral blood stem cell (PBSC) grafts and calcineurin inhibitor plus posttransplantation cyclophosphamide (PTCy; n = 44), mycophenolate mofetil (MMF; n = 414), or methotrexate (MTX; n = 322). Transplantation occurred between 2007 and 2018; CMV monitoring/management followed uniform standard practice. Hazards of CMV reactivation at various thresholds were compared. Spline curves were fit over average daily viral load and areas under the curve (AUC) within 1 year were calculated. PTCy and MMF were associated with an increased risk of early (day ≤100) CMV reactivation ≥250 IU/mL after multivariate adjustment. The viral load AUC at 1 year was highest with MMF (mean difference = 0.125 units vs MTX group) and similar between PTCy and MTX (mean difference = 0.016 units vs MTX group). CMV disease risk was similar across groups. There was no interaction between GVHD prophylaxis and CMV reactivation on chronic GVHD risk. Despite PTCy-associated increased risk of early CMV reactivation, the CMV disease risk by 1 year was low in HLA-matched PBSC transplant recipients. In contrast, MMF was associated with higher overall CMV viral burden in the 1 year posttransplant. Although different mechanisms of immunosuppressive agents may affect CMV reactivation risk, effective prevention of GVHD may reduce corticosteroid exposure and mitigate infection risk over time.
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Affiliation(s)
- Masumi Ueda Oshima
- Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Hu Xie
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Danniel Zamora
- Fred Hutchinson Cancer Center, Seattle, WA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| | - Mary E. Flowers
- Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Geoffrey R. Hill
- Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Marco B. Mielcarek
- Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Brenda M. Sandmaier
- Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | - Michael J. Boeckh
- Fred Hutchinson Cancer Center, Seattle, WA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
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Roberts L, Milano F, Gooley TA, Mielcarek M, Linenberger M, Petersdorf EW, Sandmaier PBM, Connelly-Smith L. Fresh Versus Cryopreserved Allograft Outcomes in Peripheral Blood Stem Cell Transplantations. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00375-5] [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: 02/07/2023]
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10
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Croicu A, Gooley TA, Persinger H, Dahlberg A, Hadland B, Furlan SN, Thakar MS, Bleakley M, Summers C. Outcomes for Pediatric Myeloid Malignancy Patients Requiring Pediatric Intensive Care Unit (ICU) Admission Post-HCT. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00238-5] [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: 02/07/2023]
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11
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Chen DYB, Farhan S, Lekakis LJ, Schiller GJ, Yared JA, Assal A, Lee DD, Lane H, Gooley TA, DeFilipp Z, Saad DA. Efficacy of the Addition of RGI-2001 to Tacrolimus and Methotrexate for Acute Gvhd Prevention in Myeloablative HSCT Using HLA-Matched Donors. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00395-0] [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: 02/07/2023]
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12
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Chen W, Bhatia S, Brohl AS, Chandra S, Dakhil S, Fecher LA, Gao L, Gooley TA, Hanna GJ, Hibbert R, Kelly CM, Kiriluk SM, Lewis K, Moschos S, Nghiem P, Thompson JA, Tykodi SS. ADAM Trial: A multicenter, randomized, double-blinded, placebo-controlled, phase 3 trial of adjuvant avelumab (anti-PD-L1 antibody) in Merkel cell carcinoma patients with lymph node metastases; NCT03271372. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Petersdorf EW, Bengtsson M, Horowitz M, McKallor C, Spellman SR, Spierings E, Gooley TA, Stevenson P. HLA-DQ heterodimers in hematopoietic cell transplantation. Blood 2022; 139:3009-3017. [PMID: 35271697 PMCID: PMC9121842 DOI: 10.1182/blood.2022015860] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 02/08/2022] [Accepted: 02/24/2022] [Indexed: 11/20/2022] Open
Abstract
HLA-DQ heterodimers increase the susceptibility to autoimmune diseases, but their role in hematopoietic cell transplantation is unknown. We tested the hypothesis that outcome after HLA-matched and HLA-DQ-mismatched hematopoietic cell transplantation is influenced by HLA-DQ heterodimers. Heterodimers were defined in 5164 HLA-matched and 520 HLA-DQ-mismatched patients and their transplant donors according to well-established crystallographic criteria. Group 1 (G1) heterodimers are any DQA1*02/03/04/05/06α paired with any DQB1*02/03/04β. Group 2 (G2) heterodimers are DQA1*01α paired with any DQB1*05/06β. Multivariable models identified significantly higher relapse risk in G1G2 and G2G2 compared with G1G1 HLA-matched patients with malignant disease; risk increased with an increasing number of G2 molecules. In HLA-DQ-mismatched transplantation for malignant diseases, matching or mismatching for G2 increased relapse risk. G2 lowered disease-free survival after both HLA-matched and HLA-DQ-mismatched transplantation. A paradigm based on HLA-DQ heterodimers provides a functional definition of the hematopoietic cell transplantation barrier and a means to lower risks for future patients.
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Affiliation(s)
- Effie W Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Mats Bengtsson
- Department of Immunology, Genetics, and Pathology, University of Uppsala, Uppsala, Sweden
| | - Mary Horowitz
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Caroline McKallor
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Eric Spierings
- Matchis Foundation, Leiden, The Netherlands; and
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ted A Gooley
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Phil Stevenson
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
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14
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Portuguese AJ, Tykodi SS, Blosser CD, Gooley TA, Thompson JA, Hall ET. Immune Checkpoint Inhibitor Use in Solid Organ Transplant Recipients: A Systematic Review. J Natl Compr Canc Netw 2022; 20:406-416.e11. [PMID: 35390767 DOI: 10.6004/jnccn.2022.7009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
Abstract
Chronic immunosuppression in solid organ transplant recipients (SOTRs) leads to an increased risk of a wide variety of cancers. Immune checkpoint inhibitor (ICI) therapy is indicated for many of these; however, the risks and benefits of ICI use in the SOTR population have not been well characterized. We performed a systematic literature review identifying 119 reported cases of ICI use among SOTRs. Treatments used included PD-1 inhibition (75.6%), CTLA-4 inhibition (12.6%), PD-L1 inhibition (1.7%), and combination and/or sequential ICI therapy (10.1%). The most common cancers included cutaneous melanoma (35.3%), hepatocellular carcinoma (22.7%), and cutaneous squamous cell carcinoma (18.5%). The overall objective response rate (ORR) was 34.5%, with a median duration of response of 8.0 months. Ongoing response was seen in 21.0%. Cutaneous squamous cell carcinoma had significantly better ORR compared with other cancer types (68.2% vs 26.8%; odds ratio [OR], 5.85; P =.0006). Factors associated with improved ORR included increasing time from transplant to ICI (OR, 1.09; P =.008) and preemptive reduction in intensity of the graft maintenance immunosuppressive regimen (50.0% vs 18.5%; OR, 4.40; P =.0088). Rejection occurred in 41.2%, graft failure in 23.5%, and immune-related adverse events in 18.5%. Factors significantly associated with allograft rejection included allograft PD-L1 positivity (100% vs 0%; P<.0001) and absence of tacrolimus in the immunosuppressive regimen (48.7% vs 25.6%; OR, 0.36; P =.019). The most common cause of death was progressive malignancy (64.0%), followed by graft failure (24.0%). Our analysis provides current benchmark data to help inform management of SOTRs with advanced cancers that are reflected by our patient cohort. Biomarker development, more robust datasets, and prospective study of concomitant immunosuppression management may help refine decision-making in this complex scenario in the future. Close coordination of care between the medical oncologist and transplant specialist is encouraged to help optimize treatment outcomes.
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Affiliation(s)
| | - Scott S Tykodi
- University of Washington.,Fred Hutchinson Cancer Research Center, and
| | | | | | - John A Thompson
- University of Washington.,Fred Hutchinson Cancer Research Center, and
| | - Evan T Hall
- University of Washington.,Fred Hutchinson Cancer Research Center, and
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15
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Gooley TA. Two Biologic-Assignment Studies Evaluating the Efficacy of Hematopoietic Cell Transplant Among Older Patients With High-Risk Myelodysplastic Syndrome. J Clin Oncol 2021; 39:3311-3314. [PMID: 34491784 DOI: 10.1200/jco.21.01594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ted A Gooley
- Fred Hutchinson Cancer Research Center, Seattle, WA
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16
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Inamoto Y, Martin PJ, Onstad LE, Cheng GS, Williams KM, Pusic I, Ho VT, Arora M, Pidala J, Flowers MED, Gooley TA, Lawler RL, Hansen JA, Lee SJ. Relevance of Plasma Matrix Metalloproteinase-9 for Bronchiolitis Obliterans Syndrome after Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2021; 27:759.e1-759.e8. [PMID: 34126278 DOI: 10.1016/j.jtct.2021.06.006] [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: 03/29/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
Bronchiolitis obliterans syndrome (BOS) is a highly morbid form of chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT). Several plasma proteins have been identified as biomarkers for BOS after lung transplantation. The relevance of these biomarkers in BOS patients after allogeneic HCT has not been examined. We hypothesized that biomarkers associated with BOS after lung transplantation are also associated with BOS after allogeneic HCT. We tested plasma samples from 33 adult HCT patients who participated in a phase II multicenter study of fluticasone, azithromycin, and montelukast (FAM) treatment for new-onset BOS (NCT01307462), and matched control samples of HCT patients who had non-BOS chronic GVHD (n = 31) and those who never experienced chronic GVHD (n = 29) (NCT00637689 and NCT01902576). Candidate biomarkers included matrix metalloproteinase-9 (MMP-9), MMP-3, and chitinase-3-like-1 glycoprotein (YKL-40). MMP-9 concentrations were higher in the patients with BOS compared with those with non-BOS chronic GVHD (P = .04) or no chronic GVHD (P < .001). MMP-3 concentrations were higher in patients with BOS (P < .001) or non-BOS chronic GVHD (P < .001) compared with those with no chronic GVHD. YKL-40 concentrations did not differ statistically among the 3 groups. MMP-9 concentrations before starting FAM therapy were higher in patients who experienced treatment failure within 6 months compared with those with treatment success (P = .006), whereas MMP-3 or YKL-40 concentrations did not differ statistically between these 2 groups. Patients with an MMP-9 concentration ≥200,000 pg/mL before starting FAM therapy had worse overall survival compared with those with lower MMP-9 concentrations. Our data suggest that plasma MMP-9 concentration could serve as a relevant biomarker at diagnosis of BOS after allogeneic HCT for prognostication of survival and for prediction of treatment response. Further validation is needed to confirm our findings.
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Affiliation(s)
- Yoshihiro Inamoto
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Lynn E Onstad
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Guang-Shing Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Kirsten M Williams
- Division of Blood and Marrow Transplantation, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Iskra Pusic
- Division of Medicine and Oncology, Washington University, Saint Louis, Missouri
| | - Vincent T Ho
- Division of Hematological Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Mukta Arora
- Division of Hematology/Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Richard L Lawler
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - John A Hansen
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
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17
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DeFilipp Z, Couriel DR, Lazaryan A, Bhatt VR, Buxbaum NP, Alousi AM, Olivieri A, Pulanic D, Halter JP, Henderson LA, Zeiser R, Gooley TA, MacDonald KPA, Wolff D, Schultz KR, Paczesny S, Inamoto Y, Cutler CS, Kitko CL, Pidala JA, Lee SJ, Socie G, Sarantopoulos S, Pavletic SZ, Martin PJ, Blazar BR, Greinix HT. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: III. The 2020 Treatment of Chronic GVHD Report. Transplant Cell Ther 2021; 27:729-737. [PMID: 34147469 DOI: 10.1016/j.jtct.2021.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
Positive results from recent clinical trials have significantly expanded current therapeutic options for patients with chronic graft-versus-host disease (GVHD). However, new insights into the associations between clinical characteristics of chronic GVHD, pathophysiologic mechanisms of disease, and the clinical and biological effects of novel therapeutic agents are required to allow for a more individualized approach to treatment. The current report is focused on setting research priorities and direction in the treatment of chronic GVHD. Detailed correlative scientific studies should be conducted in the context of clinical trials to evaluate associations between clinical outcomes and the biological effect of systemic therapeutics. For patients who require systemic therapy but not urgent initiation of glucocorticoids, clinical trials for initial systemic treatment of chronic GVHD should investigate novel agents as monotherapy without concurrently starting glucocorticoids, to avoid confounding biological, pathological, and clinical assessments. Clinical trials for treatment-refractory disease should specifically target patients with incomplete or suboptimal responses to most recent therapy who are early in their disease course. Close collaboration between academic medical centers, medical societies, and industry is needed to support an individualized, biology-based strategic approach to chronic GVHD therapy.
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Affiliation(s)
- Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel R Couriel
- Huntsman Cancer Center, University of Utah, Salt Lake City, Utah
| | - Aleksandr Lazaryan
- Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nataliya P Buxbaum
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Amin M Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Attilio Olivieri
- Hematology and Stem Cell Transplant, Università Politecnica delle Marche, Ancona, Italy
| | - Drazen Pulanic
- Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - Joerg P Halter
- Division of Hematology, Department of Medicine, University Hospital of Basel, Basel, Switzerland
| | - Lori A Henderson
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Robert Zeiser
- Department of Internal Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, Division of Hematology, Oncology and Stem Cell Transplantation, University clinic of Freiburg, Freiburg, Germany
| | - Ted A Gooley
- Clinical Research Division. Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kelli P A MacDonald
- Department of Immunology, Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Daniel Wolff
- Department of Internal Medicine III, University Hospital of Regensburg, Regensburg, Germany
| | - Kirk R Schultz
- Pediatric Hematology/Oncology/BMT, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Sophie Paczesny
- Department of Microbiology and Immunology and Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Corey S Cutler
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Carrie L Kitko
- Pediatric Blood and Marrow Transplantation Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph A Pidala
- Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Stephanie J Lee
- Clinical Research Division. Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Gerard Socie
- Hematology Transplantation, AP-HP Saint Louis Hospital & University of Paris, Paris, France
| | - Stefanie Sarantopoulos
- Division of Hematological Malignancies and Cellular Therapy, Duke University Department of Medicine, Duke Cancer Institute, Durham, North Carolina
| | - Steven Z Pavletic
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul J Martin
- Clinical Research Division. Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Bruce R Blazar
- Department of Pediatrics, Division of Blood & Marrow Transplantation & Cellular Therapy, University of Minnesota, Minneapolis, Minnesota
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18
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Coffey DG, Cowan AJ, DeGraaff B, Martins TJ, Curley N, Green DJ, Libby EN, Silbermann R, Chien S, Dai J, Morales A, Gooley TA, Warren EH, Becker PS. High-Throughput Drug Screening and Multi-Omic Analysis to Guide Individualized Treatment for Multiple Myeloma. JCO Precis Oncol 2021; 5:PO.20.00442. [PMID: 34250400 PMCID: PMC8232547 DOI: 10.1200/po.20.00442] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/14/2021] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Multiple myeloma (MM) is a genetically heterogeneous malignancy characterized by variable treatment responses. Although numerous drugs have been approved in recent years, the ability to predict treatment response and tailor individual therapy is limited by the absence of robust predictive biomarkers. The goal of this clinical trial was to use ex vivo, high-throughput screening (HTS) of 170 compounds to predict response among patients with relapsed or refractory MM and inform the next treatment decisions. Additionally, we integrated HTS with multi-omic analysis to uncover novel associations between in vitro drug sensitivity and gene expression and mutation profiles. MATERIALS AND METHODS Twenty-five patients with relapsed or refractory MM underwent a screening bone marrow or soft tissue biopsy. Sixteen patients were found to have sufficient plasma cells for HTS. Targeted next-generation sequencing was performed on plasma cell-free DNA from all patients who underwent HTS. RNA and whole-exome sequencing of bone marrow plasma cells were performed on eight and seven patients, respectively. RESULTS Results of HTS testing were made available to treating physicians within a median of 5 days from the biopsy. An actionable treatment result was identified in all 16 patients examined. Among the 13 patients who received assay-guided therapy, 92% achieved stable disease or better. The expression of 105 genes and mutations in 12 genes correlated with in vitro cytotoxicity. CONCLUSION In patients with relapsed or refractory MM, we demonstrate the feasibility of ex vivo drug sensitivity testing on isolated plasma cells from patient bone marrow biopsies or extramedullary plasmacytomas to inform the next line of therapy.
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Affiliation(s)
- David G. Coffey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Brotman Baty Institute for Precision Medicine, Seattle, WA
| | - Andrew J. Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Bret DeGraaff
- Department of Medicine, University of Washington, Seattle, WA
| | - Timothy J. Martins
- Quellos High Throughput Screening Core, Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA
| | - Niall Curley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Damian J. Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Edward N. Libby
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Rebecca Silbermann
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Sylvia Chien
- Department of Medicine, University of Washington, Seattle, WA
| | - Jin Dai
- Department of Medicine, University of Washington, Seattle, WA
| | - Alicia Morales
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ted A. Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Edus H. Warren
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Brotman Baty Institute for Precision Medicine, Seattle, WA
| | - Pamela S. Becker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Brotman Baty Institute for Precision Medicine, Seattle, WA
- Quellos High Throughput Screening Core, Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA
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19
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Panaite L, Behnia F, Stevenson PA, Gooley TA, Mireles L, Karami M, Tseng YD, Chung KH, Smith SD, Lynch RC, Ujjani CS, Georges GE, Shustov AR, Till BG, Gauthier J, Chow VA, Maloney DG, Gopal AK, Holmberg LA, Shadman M. Multifocal Not Single-Site FDG-PET Residual Disease Prior to Autologous Stem Cell Transplant for Hodgkin Lymphoma Associated with Adverse Outcome. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00506-6] [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: 11/17/2022]
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20
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Chow VA, Cassaday RD, Gooley TA, Sandmaier BM, Smith SD, Green DJ, Orozco JJ, Tuazon SA, Matesan MC, Press OW, Gopal AK. Phase II Study of Mega-Dose 90Y-Ibritumomab Tiuxetan, Fludarabine and Low-Dose TBI Followed By Allogeneic Hematopoietic Transplantation for Relapsed or Refractory Aggressive Large B-Cell Lymphoma: Long-Term Outcomes. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00510-8] [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: 10/22/2022]
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21
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Patel K, Gooley TA, Bailey N, Bailey M, Hegerova L, Batchelder A, Holdread H, Dunleavy V, Downey T, Frisvold J, Megrath S, Pagarigan K, Szeto J, Rueda J, Islam A, Maree C, Nyatsatsang S, Bork SE, Lipke A, O'Mahony DS, Wagner T, Pulido J, Mignone J, Youssef S, Hartman M, Goldman JD, Pagel JM. Use of the IL-6R antagonist tocilizumab in hospitalized COVID-19 patients. J Intern Med 2021; 289:430-433. [PMID: 32745348 PMCID: PMC7436582 DOI: 10.1111/joim.13163] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 01/10/2023]
Affiliation(s)
- K Patel
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - T A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - N Bailey
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - M Bailey
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - L Hegerova
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - A Batchelder
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - H Holdread
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - V Dunleavy
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - T Downey
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - J Frisvold
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - S Megrath
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - K Pagarigan
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - J Szeto
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
| | - J Rueda
- Infectious Disease, Swedish Medical Center, Seattle, WA, USA
| | - A Islam
- Infectious Disease, Swedish Medical Center, Seattle, WA, USA
| | - C Maree
- Infectious Disease, Swedish Medical Center, Seattle, WA, USA
| | - S Nyatsatsang
- Infectious Disease, Swedish Medical Center, Seattle, WA, USA
| | - S E Bork
- Hospital Medicine, Swedish Medical Center, Seattle, WA, USA
| | - A Lipke
- Pulmonary and Critical Care, Swedish Medical Center, Seattle, WA, USA
| | - D S O'Mahony
- Pulmonary and Critical Care, Swedish Medical Center, Seattle, WA, USA
| | - T Wagner
- Pulmonary and Critical Care, Swedish Medical Center, Seattle, WA, USA
| | - J Pulido
- US Anesthesia Partners, Seattle, WA, USA.,Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA, USA
| | - J Mignone
- Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA, USA
| | - S Youssef
- Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA, USA
| | - M Hartman
- Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA, USA
| | - J D Goldman
- Infectious Disease, Swedish Medical Center, Seattle, WA, USA
| | - J M Pagel
- From the Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA, USA
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Sandmaier BM, Wilbur DS, Hamlin DK, Vo P, Wong R, Baker K, Haaf R, Bouvier ME, Matesan MC, Li Y, Orozco JJ, Nartea M, Santos EB, Dorman E, Vesselle H, Lewis DH, Behnia S, Green DJ, Emery RC, Rajendran JG, Gooley TA, Storb R. A Phase I Trial of First-in-Human Alpha-Emitter Astatine-211-Labeled Anti-CD45 Antibody (211At-BC8-B10) in Combination with Fludarabine and TBI As Conditioning for Allogeneic Hematopoietic Cell Transplantation (HCT) for Patients with Refractory/Relapsed Leukemia or High-Risk Myelodysplastic Syndrome (MDS): Preliminary Results of Dose Escalation. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00083-x] [Citation(s) in RCA: 2] [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: 10/22/2022]
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23
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Eghtedar A, Nash R, Gooley TA, Gregory T, Matous J, Mountjoy L, Murphy J, Rotta M, Schade H, Tees M, McSweeney PA, Maris M. Non-Myeloablative Hematopoietic Stem Cell Transplantation (NMA HSCT) Utilizing Low-Dose Total Body Irradiation (TBI) Plus Fludarabine (Flu): A Comparison of Single-Center Based Flu 150 mg/m2 Plus 400 Cgy TBI Versus Flu 90 mg/m2 and 200 Cgy TBI Containing Regimens. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00281-5] [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: 10/22/2022]
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Watkins B, Qayed M, McCracken C, Bratrude B, Betz K, Suessmuth Y, Yu A, Sinclair S, Furlan S, Bosinger S, Tkachev V, Rhodes J, Tumlin AG, Narayan A, Cribbin K, Gillespie S, Gooley TA, Pasquini MC, Hebert K, Kapoor U, Rogatko A, Tighiouart M, Kim S, Bresee C, Choi SW, Davis J, Duncan C, Giller R, Grimley M, Harris AC, Jacobsohn D, Lalefar N, Norkin M, Farhadfar N, Pulsipher MA, Shenoy S, Petrovic A, Schultz KR, Yanik GA, Waller EK, Levine JE, Ferrara JL, Blazar BR, Langston A, Horan JT, Kean LS. Phase II Trial of Costimulation Blockade With Abatacept for Prevention of Acute GVHD. J Clin Oncol 2021; 39:1865-1877. [PMID: 33449816 DOI: 10.1200/jco.20.01086] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Severe (grade 3-4) acute graft-versus-host disease (AGVHD) is a major cause of death after unrelated-donor (URD) hematopoietic cell transplant (HCT), resulting in particularly high mortality after HLA-mismatched transplantation. There are no approved agents for AGVHD prevention, underscoring the critical unmet need for novel therapeutics. ABA2 was a phase II trial to rigorously assess safety, efficacy, and immunologic effects of adding T-cell costimulation blockade with abatacept to calcineurin inhibitor (CNI)/methotrexate (MTX)-based GVHD prophylaxis, to test whether abatacept could decrease AGVHD. METHODS ABA2 enrolled adults and children with hematologic malignancies under two strata: a randomized, double-blind, placebo-controlled stratum (8/8-HLA-matched URD), comparing CNI/MTX plus abatacept with CNI/MTX plus placebo, and a single-arm stratum (7/8-HLA-mismatched URD) comparing CNI/MTX plus abatacept versus CNI/MTX CIBMTR controls. The primary end point was day +100 grade 3-4 AGVHD, with day +180 severe-AGVHD-free-survival (SGFS) a key secondary end point. Sample sizes were calculated using a higher type-1 error (0.2) as recommended for phase II trials, and were based on predicting that abatacept would reduce grade 3-4 AGVHD from 20% to 10% (8/8s) and 30% to 10% (7/8s). ABA2 enrolled 142 recipients (8/8s, median follow-up = 716 days) and 43 recipients (7/8s, median follow-up = 708 days). RESULTS In 8/8s, grade 3-4 AGVHD was 6.8% (abatacept) versus 14.8% (placebo) (P = .13, hazard ratio = 0.45). SGFS was 93.2% (CNI/MTX plus abatacept) versus 82% (CNI/MTX plus placebo, P = .05). In the smaller 7/8 cohort, grade 3-4 AGVHD was 2.3% (CNI/MTX plus abatacept, intention-to-treat population), which compared favorably with a nonrandomized matched cohort of CNI/MTX (30.2%, P < .001), and the SGFS was better (97.7% v 58.7%, P < .001). Immunologic analysis revealed control of T-cell activation in abatacept-treated patients. CONCLUSION Adding abatacept to URD HCT was safe, reduced AGVHD, and improved SGFS. These results suggest that abatacept may substantially improve AGVHD-related transplant outcomes, with a particularly beneficial impact on HLA-mismatched HCT.
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Affiliation(s)
- Benjamin Watkins
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA
| | | | - Brandi Bratrude
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Kayla Betz
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Yvonne Suessmuth
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA
| | - Alison Yu
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | | | - Scott Furlan
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Steven Bosinger
- Emory University, Yerkes National Primate Research Center, Atlanta, GA
| | - Victor Tkachev
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - James Rhodes
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Audrey Grizzle Tumlin
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | | | | | | | - Ted A Gooley
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Kyle Hebert
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | - Sungjin Kim
- Cedars Sinai Medical Center, Los Angeles, CA
| | | | | | - Jeffrey Davis
- BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Christine Duncan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Roger Giller
- Center for Cancer and Blood Disorders, Children Hospital of Colorado, University of Colorado, Aurora, CO
| | - Michael Grimley
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew C Harris
- University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | | | - Nahal Lalefar
- University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Maxim Norkin
- Baptist Medical Center Jacksonville, Jacksonville, FL
| | - Nosha Farhadfar
- University of Florida, UF Health Shands Hospital, Gainesville, FL
| | - Michael A Pulsipher
- Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA
| | | | | | - Kirk R Schultz
- BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | | | | | | | | | - Bruce R Blazar
- University of Minnesota, Department of Pediatrics, Division of Blood and Marrow Transplantation, Minneapolis, MN
| | | | - John T Horan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Leslie S Kean
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
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Xue E, Chotivatanapong J, Pao EC, Baker K, Gooley TA, Milano F, Hingorani S. High Incidence of Acute Kidney Injury after Cord Blood Transplant. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.662] [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: 11/30/2022]
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McDonald GB, Sandmaier BM, Mielcarek M, Sorror M, Pergam SA, Cheng GS, Hingorani S, Boeckh M, Flowers MD, Lee SJ, Appelbaum FR, Storb R, Martin PJ, Deeg HJ, Schoch G, Gooley TA. Survival, Nonrelapse Mortality, and Relapse-Related Mortality After Allogeneic Hematopoietic Cell Transplantation: Comparing 2003-2007 Versus 2013-2017 Cohorts. Ann Intern Med 2020; 172:229-239. [PMID: 31958813 PMCID: PMC7847247 DOI: 10.7326/m19-2936] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation is indicated for refractory hematologic cancer and some nonmalignant disorders. Survival is limited by recurrent cancer and organ toxicity. OBJECTIVE To determine whether survival has improved over the past decade and note impediments to better outcomes. DESIGN The authors compared cohorts that had transplants during 2003 to 2007 versus 2013 to 2017. Survival outcome measures were analyzed, along with transplant-related complications. SETTING A center performing allogeneic transplant procedures. PARTICIPANTS All recipients of a first allogeneic transplant during 2003 to 2007 and 2013 to 2017. INTERVENTION Patients received a conditioning regimen, infusion of donor hematopoietic cells, then immunosuppressive drugs and antimicrobial approaches to infection control. MEASUREMENTS Day-200 nonrelapse mortality (NRM), recurrence or progression of cancer, relapse-related mortality, and overall mortality, adjusted for comorbidity scores, source of donor cells, donor type, patient age, disease severity, conditioning regimen, patient and donor sex, and cytomegalovirus serostatus. RESULTS During the 2003-to-2007 and 2013-to-2017 periods, 1148 and 1131 patients, respectively, received their first transplant. Over the decade, decreases were seen in the adjusted hazards of day-200 NRM (hazard ratio [HR], 0.66 [95% CI, 0.48 to 0.89]), relapse of cancer (HR, 0.76 [CI, 0.61 to 0.94]), relapse-related mortality (HR, 0.69 [CI, 0.54 to 0.87]), and overall mortality (HR, 0.66 [CI, 0.56 to 0.78]). The degree of reduction in overall mortality was similar for patients who received myeloablative versus reduced-intensity conditioning, as well as for patients whose allograft came from a matched sibling versus an unrelated donor. Reductions were also seen in the frequency of jaundice, renal insufficiency, mechanical ventilation, high-level cytomegalovirus viremia, gram-negative bacteremia, invasive mold infection, acute and chronic graft-versus-host disease, and prednisone exposure. LIMITATION Cohort studies cannot determine causality, and current disease severity criteria were not available for patients in the 2003-to-2007 cohort. CONCLUSION Improvement in survival and reduction in complications were substantial after allogeneic transplant. Relapse of cancer remains the largest obstacle to better survival outcomes. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- George B McDonald
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Brenda M Sandmaier
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Marco Mielcarek
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Mohamed Sorror
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Steven A Pergam
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Guang-Shing Cheng
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Sangeeta Hingorani
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Michael Boeckh
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Mary D Flowers
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Stephanie J Lee
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Frederick R Appelbaum
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Rainer Storb
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Paul J Martin
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, Washington (G.B.M., B.M.S., M.M., M.S., S.A.P., G.C., S.H., M.B., M.D.F., S.J.L., F.R.A., R.S., P.J.M., H.J.D.)
| | - Gary Schoch
- Fred Hutchinson Cancer Research Center, Seattle, Washington (G.S., T.A.G.)
| | - Ted A Gooley
- Fred Hutchinson Cancer Research Center, Seattle, Washington (G.S., T.A.G.)
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Salit RB, Baker KK, Edwards R, Tobin G, Kicska G, Gooley TA, Joachim Deeg H, Scott BL, Cheng GS. Diagnosis of pulmonary hypertension by noninvasive methods in hematopoietic cell transplant patients with myelofibrosis. Bone Marrow Transplant 2019; 55:1681-1683. [DOI: 10.1038/s41409-019-0769-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 10/15/2019] [Accepted: 11/29/2019] [Indexed: 11/09/2022]
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28
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Vo P, Gooley TA, Rajendran JG, Fisher DR, Orozco JJ, Green DJ, Gopal AK, Haaf R, Nartea M, Storb R, Appelbaum FR, Press OW, Pagel JM, Sandmaier BM. Yttrium-90-labeled anti-CD45 antibody followed by a reduced-intensity hematopoietic cell transplantation for patients with relapsed/refractory leukemia or myelodysplasia. Haematologica 2019; 105:1731-1737. [PMID: 31582553 PMCID: PMC7271581 DOI: 10.3324/haematol.2019.229492] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 06/13/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022] Open
Abstract
Outcomes of patients with persistent high-risk leukemia or myelodysplasia prior to allogeneic hematopoietic cell transplantation are dismal. We therefore conducted a phase I trial evaluating the use of CD45-targeted radiotherapy preceding hematopoietic cell transplantation with the goal of improving outcomes for this high-risk scenario. Fifteen patients, median age 62 (range 37-76) years, were treated: ten with advanced acute myeloid leukemia, five with high-risk myelodysplastic syndrome. All patients had evidence of disease prior to treatment including nine with marrow blast counts ranging from 7-84% and six with minimal residual disease. Patients received escalating doses of yttrium-90-labeled anti-CD45 antibody followed by fludarabine and 2 Gy total body irradiation prior to human leukocyte antigen-matched, related or unrelated hematopoietic cell transplantation. Although a maximum dose of 30 Gy was delivered to the liver, no dose-limiting toxicity was observed. Therefore, the maximum-tolerated dose could not be estimated. Treatment led to complete remission in 13 patients (87%). All patients engrafted by day 28. Six patients relapsed, median of 59 (range 6-351) days, after transplantation. The 1-year estimate of relapse was 41%. Eight patients (53%) are surviving with median follow up of 1.8 (range 0.9-5.9) years. Estimated overall survival at one and two years was 66% and 46%, respectively, with progression-free survival estimated to be 46% at each time point. In conclusion, the combination of 90Y-DOTA-BC8 with an allogeneic hematopoietic cell transplantation regimen was feasible and tolerable. This approach appears promising in this high-risk leukemia/myelodysplasia patient population with active disease. (Trial registered at clinicaltrials.gov identifier: NCT01300572.)
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Affiliation(s)
- Phuong Vo
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Ted A Gooley
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle.,Department of Medicine, University of Washington, Seattle
| | | | | | - Johnnie J Orozco
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Damian J Green
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Ajay K Gopal
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Robyn Haaf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle
| | - Margaret Nartea
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle
| | - Rainer Storb
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Frederick R Appelbaum
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Oliver W Press
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle.,Department of Medicine, University of Washington, Seattle
| | | | - Brenda M Sandmaier
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle .,Department of Medicine, University of Washington, Seattle
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Cassaday RD, Press OW, Pagel JM, Rajendran JG, Gooley TA, Fisher DR, Holmberg LA, Miyaoka RS, Sandmaier BM, Green DJ, Gopal AK. Phase I Study of a CD45-Targeted Antibody-Radionuclide Conjugate for High-Risk Lymphoma. Clin Cancer Res 2019; 25:6932-6938. [PMID: 31481510 DOI: 10.1158/1078-0432.ccr-19-1567] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/01/2019] [Accepted: 08/19/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE External-beam radiation is the single most effective therapy for localized lymphoma. However, toxicity limits its use for multifocal disease. We evaluated CD45 as a therapeutic target for an antibody-radionuclide conjugate (ARC) for the treatment of lymphoma based on its ubiquitous expression, infrequent antigen loss or blockade, and the ability to target minimal disease based on panhematopoietic expression. PATIENTS AND METHODS We performed a phase I trial of escalating doses of single-agent CD45-targeted ARC based on per-patient dosimetry using the BC8 antibody labeled with iodine-131 (131I) followed by autologous stem cell support in adults with relapsed, refractory, or high-risk B-cell non-Hodgkin lymphoma (B-NHL), T-cell NHL (T-NHL), or Hodgkin lymphoma. The primary objective was to estimate the maximum tolerated radiation absorbed dose. RESULTS Sixteen patients were enrolled: 7 patients had B-NHL, 6 had Hodgkin lymphoma, and 3 had T-NHL. Median number of prior therapies was three (range: 2-12). Absorbed doses up to 32 Gy to liver were delivered. No dose-limiting toxicities occurred. Nonhematologic toxicity was infrequent and manageable. Objective responses were seen across histologies. Fourteen patients had measurable disease at enrollment, 57% of whom achieved complete remission (CR), including all 3 with T-NHL. Three patients with B-NHL treated among the highest dose levels (26-32 Gy) remain in CR without subsequent therapy 35-41 months later. CONCLUSIONS CD45-targeted ARC therapy is well-tolerated at doses up to at least 32 Gy to the liver. Objective responses and long-term remissions were observed in patients with relapsed/refractory lymphoma. These data validate continued evaluation of anti-CD45 ARCs in lymphoma.
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Affiliation(s)
- Ryan D Cassaday
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Oliver W Press
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington. .,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Joseph G Rajendran
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington
| | - Darrell R Fisher
- Versant Medical Physics and Radiation Safety, Richland, Washington
| | - Leona A Holmberg
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Robert S Miyaoka
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Brenda M Sandmaier
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Damian J Green
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ajay K Gopal
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington. .,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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30
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Storb R, Georges GE, Gooley TA. Total Body Irradiation-Based versus Chemotherapy-Based Myeloablative Conditioning for Allogeneic Hematopoietic Cell Transplant. Biol Blood Marrow Transplant 2019; 25:e356-e362. [PMID: 31419567 DOI: 10.1016/j.bbmt.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Rainer Storb
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - George E Georges
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington
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31
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Chow VA, Gopal AK, Maloney DG, Turtle CJ, Smith SD, Ujjani CS, Shadman M, Cassaday RD, Till BG, Tseng YD, Warren EH, Shustov AR, Menon MP, Bhark S, Acharya UH, Mullane E, Hannan LM, Voutsinas JM, Gooley TA, Lynch RC. Outcomes of patients with large B-cell lymphomas and progressive disease following CD19-specific CAR T-cell therapy. Am J Hematol 2019; 94:E209-E213. [PMID: 31056762 DOI: 10.1002/ajh.25505] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Victor A. Chow
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | - Ajay K. Gopal
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | - David G. Maloney
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | - Cameron J. Turtle
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | - Stephen D. Smith
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | - Chaitra S. Ujjani
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | - Mazyar Shadman
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | - Ryan D. Cassaday
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of HematologyUniversity of Washington Seattle Washington
| | - Brian G. Till
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | - Yolanda D. Tseng
- Seattle Cancer Care Alliance Seattle Washington
- Department of Radiation OncologyUniversity of Washington Seattle Washington
| | - Edus H. Warren
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | - Andrei R. Shustov
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of HematologyUniversity of Washington Seattle Washington
| | - Manoj P. Menon
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Department of Medicine, Division of HematologyUniversity of Washington Seattle Washington
| | - Sandra Bhark
- Seattle Cancer Care Alliance Seattle Washington
- Fred Hutchinson Cancer Research Center, Public Health DivisionFred Hutchinson Cancer Research Center Seattle Washington
| | - Utkarsh H. Acharya
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
- Department of Medical Oncology, Divisions of Hematologic Malignancies and Cellular TherapyDana Farber Cancer Institute Boston Massachusetts
| | | | - Lindsay M. Hannan
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
| | | | - Ted A. Gooley
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Swedish Cancer Institute Seattle Washington
| | - Ryan C. Lynch
- Clinical Research DivisionFred Hutchinson Cancer Research Center Seattle Washington
- Seattle Cancer Care Alliance Seattle Washington
- Department of Medicine, Division of Medical OncologyUniversity of Washington Seattle Washington
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Chapuis AG, Egan DN, Bar M, Schmitt TM, McAfee MS, Paulson KG, Voillet V, Gottardo R, Ragnarsson GB, Bleakley M, Yeung CC, Muhlhauser P, Nguyen HN, Kropp LA, Castelli L, Wagener F, Hunter D, Lindberg M, Cohen K, Seese A, McElrath MJ, Duerkopp N, Gooley TA, Greenberg PD. T cell receptor gene therapy targeting WT1 prevents acute myeloid leukemia relapse post-transplant. Nat Med 2019; 25:1064-1072. [PMID: 31235963 DOI: 10.1038/s41591-019-0472-9] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 01/12/2023]
Abstract
Relapse after allogeneic hematopoietic cell transplantation (HCT) is the leading cause of death in patients with acute myeloid leukemia (AML) entering HCT with poor-risk features1-3. When HCT does produce prolonged relapse-free survival, it commonly reflects graft-versus-leukemia effects mediated by donor T cells reactive with antigens on leukemic cells4. As graft T cells have not been selected for leukemia specificity and frequently recognize proteins expressed by many normal host tissues, graft-versus-leukemia effects are often accompanied by morbidity and mortality from graft-versus-host disease5. Thus, AML relapse risk might be more effectively reduced with T cells expressing receptors (TCRs) that target selected AML antigens6. We therefore isolated a high-affinity Wilms' Tumor Antigen 1-specific TCR (TCRC4) from HLA-A2+ normal donor repertoires, inserted TCRC4 into Epstein-Bar virus-specific donor CD8+ T cells (TTCR-C4) to minimize graft-versus-host disease risk and enhance transferred T cell survival7,8, and infused these cells prophylactically post-HCT into 12 patients ( NCT01640301 ). Relapse-free survival was 100% at a median of 44 months following infusion, while a concurrent comparative group of 88 patients with similar risk AML had 54% relapse-free survival (P = 0.002). TTCR-C4 maintained TCRC4 expression, persisted long-term and were polyfunctional. This strategy appears promising for preventing AML recurrence in individuals at increased risk of post-HCT relapse.
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Affiliation(s)
- Aude G Chapuis
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Daniel N Egan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Merav Bar
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Thomas M Schmitt
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Megan S McAfee
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kelly G Paulson
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Valentin Voillet
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Raphael Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gunnar B Ragnarsson
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Landspítali Háskólasjúkrahús, Reykjavík, Iceland
| | - Marie Bleakley
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Cecilia C Yeung
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | | | - Hieu N Nguyen
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Alpine Biotech, Seattle, WA, USA
| | - Lara A Kropp
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Therapeutic Products Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Luca Castelli
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Therapeutic Products Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Felecia Wagener
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniel Hunter
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcus Lindberg
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Kristen Cohen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Aaron Seese
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M Juliana McElrath
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Natalie Duerkopp
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Philip D Greenberg
- Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,University of Washington School of Medicine, Seattle, WA, USA. .,Departments of Immunology and Medicine, University of Washington, Seattle, WA, USA.
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Salit RB, Scott BL, Stevens EA, Baker KK, Gooley TA, Deeg HJ. Pre-hematopoietic cell transplant Ruxolitinib in patients with primary and secondary myelofibrosis. Bone Marrow Transplant 2019; 55:70-76. [PMID: 30962501 DOI: 10.1038/s41409-019-0523-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 11/09/2022]
Abstract
Ruxolitinib (Rux), a Jak1/2 inhibitor, results in reduced spleen size and improvement in constitutional symptoms in the majority of patients with myelofibrosis (MF). Therefore Rux, when given prior to hematopoietic cell transplantation (HCT) in patients with MF was hypothesized to improve engraftment, decrease incidence and severity of graft-versus-host disease, and lower non-relapse mortality (NRM). We conducted a phase II prospective trial to assess the effects of pre-HCT Rux on post-HCT outcomes in patients with MF. The primary endpoint was 2-year overall survival. To date, 28 patients (median age 56 years) have been transplanted. The median time on Rux pre-HCT was 7 months. Twenty-three patients received myeloablative and five reduced intensity conditioning. Donors included 14 HLA-matched siblings, 11 matched unrelated, 1 allele mismatched unrelated, and 3 umbilical cord blood. There have been no episodes of cytokine release syndrome and all patients achieved sustained engraftment. Two patients died from NRM and two patients relapsed. With a median follow-up of 13 months, overall survival is 93% (95% CI: 0.73, 0.98) at 1 year and 86% (95% CI: 0.61, 0.96) at 2 years post-HCT. This study demonstrates that pre-HCT Rux is well tolerated and suggests that pre-HCT Rux may improve post-HCT outcome.
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Affiliation(s)
- Rachel B Salit
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,Department of Medicine, University of Washington Medical Center, Seattle, WA, USA.
| | - Bart L Scott
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Emily A Stevens
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Kelsey K Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - H Joachim Deeg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
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Hirayama AV, Gauthier J, Hay KA, Voutsinas JM, Wu Q, Gooley TA, Li D, Sheih A, Purushe J, Cherian S, Chen X, Pender BS, Hawkins RM, Vakil A, Phi TD, Steinmetz RN, Acharya UH, Chapuis AG, Dhawale T, Hendrie PC, Kiem HP, Lynch RC, Ramos J, Shadman M, Till BG, Riddell SR, Maloney DG, Turtle CJ. Multivariate Analyses Indicate That the Cytokine Response to Lymphodepletion May be Better Associated Than Lymphodepletion Intensity with the Efficacy of CD19 CAR-T Cell Immunotherapy for Aggressive B-Cell Non-Hodgkin Lymphoma. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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35
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Ueda M, Mielcarek MB, Sandmaier BM, Xie H, Davis C, Gooley TA, Boeckh MJ. CMV Viral Load after Peripheral Blood Stem Cell Transplantation (PBSCT) and Posttransplant High-Dose Cyclophosphamide (PTCy). Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McDonald GB, Evans AT, McCune JS, Schoch G, Ostrow JD, Gooley TA. Mortality outcomes after busulfan-containing conditioning treatment and haemopoietic cell transplantation in patients with Gilbert's syndrome: a retrospective cohort study. Lancet Haematol 2018; 3:e516-e525. [PMID: 27968820 DOI: 10.1016/s2352-3026(16)30149-1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/12/2016] [Accepted: 08/18/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Gilbert's syndrome is a common inherited disorder of bilirubin metabolism, characterised by mild, unconjugated hyperbilirubinaemia. However, the effect of Gilbert's syndrome on the disposition of some drugs can lead to unexpected toxicity. We tested the hypothesis that patients undergoing myeloablative conditioning and haemopoietic cell transplantation would have different mortality outcomes depending on whether or not they had laboratory evidence of Gilbert's syndrome. METHODS In this retrospective cohort study, we used clinical and laboratory data of patients who had haemopoietic cell transplantation from Jan 1, 1991, to Dec 31, 2011. Patients were included if they had received high-dose conditioning regimens of cyclophosphamide plus total body irradiation (CY/TBI), busulfan plus cyclophosphamide (BU/CY), busulfan plus melphalan plus thioTEPA (BUMELTT), or melphalan before transplant. Patients were excluded if their original consent forms to report transplant outcomes were not signed, if consent was withdrawn, or if they were a prisoner. Patients with Gilbert's syndrome were defined as having laboratory values before the start of conditioning therapy for unconjugated serum bilirubin concentrations of at least 17·1 μmol/L (≥1 mg/dL), normal conjugated serum bilirubin, and no evidence of hepatitis, cholestasis, or haemolysis. We assessed the association of Gilbert's syndrome with overall mortality and non-relapse mortality using adjusted Cox regression models at day 200 after transplantation. FINDINGS Our study cohort was 3379 patients-1855 (55%) allograft and 1524 (45%) autograft recipients. 211 (6%) patients had Gilbert's syndrome and 3168 (94%) did not have this condition. Most patients were adults (median age 45·8 years [IQR 33·2-55·5]) with haematological malignancies. For overall mortality 664 (20%) patients had died by day 200 after transplant (47 [22%] of 211 who had Gilbert's syndrome vs 617 [19%] of 3168 who did not have Gilbert's syndrome), and for non-relapse mortality 499 (92%) patients had died before relapse was recorded (38 [18%] who had Gilbert's syndrome vs 461 [15%] who did not have Gilbert's syndrome). The effect of Gilbert's syndrome on the risk of overall mortality and non-relapse mortality by transplant day 200 varied between the conditioning regimens and donor groups. In patients conditioned with a myeloablative regimen that contained busulfan (n=1131), those with Gilbert's syndrome (n=60) were at a significantly increased risk of death and non-relapse mortality by day 200 compared with those without Gilbert's syndrome (n=1071; hazard ratio [HR] 2·30, 95% CI 1·47-3·61, p=0·00030; and 2·77, 1·71-4·49, p<0·0001). In patients who received CY/TBI or melphalan conditioning regimens, those with Gilbert's syndrome had similar outcomes to those without Gilbert's syndrome (overall mortality at day 200 HR 0·90, 95% CI 0·60-1·34, p=0·60; non-relapse mortality at day 200: 0·90, 0·56-1·45, p=0·65). Analyses of causes of death and busulfan disposition provided no mechanistic explanation for the differences in mortality. INTERPRETATION Overall mortality and non-relapse mortality at day 200 after transplant were significantly worse in patients with Gilbert's syndrome who received busulfan-containing myeloablative conditioning regimens, compared with non-Gilbert's syndrome patients. Patients with Gilbert's syndrome should receive busulfan-containing myeloablative conditioning regimens with caution. FUNDING US National Institutes of Health.
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Affiliation(s)
- George B McDonald
- Gastroenterology/Hepatology, Clinical Statistics, and Transplantation Biology Sections, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; School of Medicine, University of Washington, Seattle, WA, USA.
| | - Ashley T Evans
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Jeannine S McCune
- Gastroenterology/Hepatology, Clinical Statistics, and Transplantation Biology Sections, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Gary Schoch
- Gastroenterology/Hepatology, Clinical Statistics, and Transplantation Biology Sections, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J Donald Ostrow
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Ted A Gooley
- Gastroenterology/Hepatology, Clinical Statistics, and Transplantation Biology Sections, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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37
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Myerson D, Steinbach G, Gooley TA, Shulman HM. Graft-versus-Host Disease of the Gut: A Histologic Activity Grading System and Validation. Biol Blood Marrow Transplant 2017; 23:1573-1579. [PMID: 28533059 DOI: 10.1016/j.bbmt.2017.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/16/2017] [Indexed: 02/08/2023]
Abstract
The pathologic interpretation of gut biopsies in hematopoietic cell transplant recipients to assess graft-versus-host disease (GVHD) is well accepted and supplements clinical and endoscopic findings. However, the histologic activity grading of GVHD is controversial, with attempts to predict prognosis or response to treatment largely unsuccessful. GVHD is being diagnosed earlier in its course, raising the possibility that the pathologic grading system can be profitably modified. We developed a histologic activity grading system designed to replace the commonly used modified Lerner grading systems. Our system stratifies the low-level Lerner grade I category into 4 activity grade categories, based on the average frequency of apoptotic cells. The results are expressed as ordinal categories: GVHD of minimal, mild, moderate, severe histologic activity, or severe histologic activity with destruction (activity grades 1 to 5). In a retrospective study, we studied 87 consecutive cases with 201 post-transplantation specimens (median, 48 days; range, 18 to 1479 days) of stomach, duodenum, and colorectum, which had been activity graded at the time of the original diagnosis. Most of the biopsies diagnosed as GVHD were low grade-minimal (11%) or mild (71%) histologic activity. We hypothesized that the higher activity grades would be associated with more therapeutic intervention. The odds of increased therapy in the combined all-site specimens were increased as activity grade increased (odds ratio, 2.9 [95% confidence interval {CI}, 1.9 to 4.5]; P = < .0001). Thus, our grading system was validated. To investigate whether the activity grade was associated with therapy within the formerly undivided Lerner grade I category, the analysis was restricted to these 174 all-site specimens. The validation result was similar (odds ratio, 3.1 [95% CI, 1.3 to 7.2]; P = .009). This result interestingly suggests that there is useful information hidden in the Lerner grade I category, which could potentially guide immediately actionable treatment decisions. This histologic activity grade system has been in use at our institution for over 2 years with good acceptance.
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Affiliation(s)
- David Myerson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pathology, University of Washington, Seattle, Washington.
| | - Gideon Steinbach
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Howard M Shulman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pathology, University of Washington, Seattle, Washington
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38
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Boudreau JE, Giglio F, Gooley TA, Stevenson PA, Le Luduec JB, Shaffer BC, Rajalingam R, Hou L, Hurley CK, Noreen H, Reed EF, Yu N, Vierra-Green C, Haagenson M, Malkki M, Petersdorf EW, Spellman S, Hsu KC. KIR3DL1/HLA-B Subtypes Govern Acute Myelogenous Leukemia Relapse After Hematopoietic Cell Transplantation. J Clin Oncol 2017; 35:2268-2278. [PMID: 28520526 DOI: 10.1200/jco.2016.70.7059] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Disease relapse remains a major challenge to successful outcomes in patients who undergo allogeneic hematopoietic cell transplantation (HCT). Donor natural killer (NK) cell alloreactivity in HCT can control leukemic relapse, but capturing alloreactivity in HLA-matched HCT has been elusive. HLA expression on leukemia cells-upregulated in the post-HCT environment-signals for NK cell inhibition via inhibitory killer immunoglobulin-like (KIR) receptors and interrupts their antitumor activity. We hypothesized that varied strengths of inhibition among subtypes of the ubiquitous KIR3DL1 and its cognate ligand, HLA-B, would titrate NK reactivity against acute myelogenous leukemia (AML). Patients and Methods By using an algorithm that was based on polymorphism-driven expression levels and specificities, we predicted and tested inhibitory and cytotoxic NK potential on the basis of KIR3DL1/HLA-B subtype combinations in vitro and evaluated their impact in 1,328 patients with AML who underwent HCT from 9/10 or 10/10 HLA-matched unrelated donors. Results Segregated by KIR3DL1 subtype, NK cells demonstrated reproducible patterns of strong, weak, or noninhibition by target cells with defined HLA-B subtypes, which translated into discrete cytotoxic hierarchies against AML. In patients, KIR3DL1 and HLA-B subtype combinations that were predictive of weak inhibition or noninhibition were associated with significantly lower relapse (hazard ratio [HR], 0.72; P = .004) and overall mortality (HR, 0.84; P = .030) compared with strong inhibition combinations. The greatest effects were evident in the high-risk group of patients with all KIR ligands (relapse: HR, 0.54; P < .001; and mortality: HR, 0.74; P < .008). Beneficial effects of weak and noninhibiting KIR3DL1 and HLA-B subtype combinations were separate from and additive to the benefit of donor activating KIR2DS1. Conclusion Consideration of KIR3DL1-mediated inhibition in donor selection for HLA-matched HCT may achieve superior graft versus leukemia effects, lower risk for relapse, and an increase in survival among patients with AML.
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Affiliation(s)
- Jeanette E Boudreau
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Fabio Giglio
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Ted A Gooley
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Philip A Stevenson
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Jean-Benoît Le Luduec
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Brian C Shaffer
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Raja Rajalingam
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Lihua Hou
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Carolyn Katovich Hurley
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Harriet Noreen
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Elaine F Reed
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Neng Yu
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Cynthia Vierra-Green
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Michael Haagenson
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Mari Malkki
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Effie W Petersdorf
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Stephen Spellman
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
| | - Katharine C Hsu
- Jeanette E. Boudreau, Fabio Giglio, Jean-Benoît Le Luduec, Brian C. Shaffer, and Katharine C. Hsu, Memorial Sloan Kettering Cancer Center; Brian C. Shaffer and Katharine C. Hsu, Weill Cornell Medical College, New York, NY; Ted A. Gooley, Philip A. Stevenson, Mari Malkki, and Effie W. Petersdorf, Fred Hutchinson Cancer Research Center, Seattle, WA; Raja Rajalingam, University of California, San Francisco, San Francisco; Elaine F. Reed, University of California, Los Angeles, Los Angeles, CA; Lihua Hou and Carolyn Katovich Hurley, Georgetown University Medical Center, Washington, DC; Harriet Noreen, University of Minnesota; Cynthia Vierra-Green, Michael Haagenson, and Stephen Spellman, Center for International Blood and Marrow Transplant Research, Minneapolis, MN; and Neng Yu, American Red Cross Blood Services, Dedham, MA
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Cowan AJ, Stevenson PA, Gooley TA, Frayo SL, Oliveira GR, Smith SD, Green DJ, Roden JE, Pagel JM, Wood BL, Press OW, Gopal AK. Results of a phase I-II study of fenretinide and rituximab for patients with indolent B-cell lymphoma and mantle cell lymphoma. Br J Haematol 2017; 176:583-590. [PMID: 28055107 DOI: 10.1111/bjh.14451] [Citation(s) in RCA: 7] [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: 08/09/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022]
Abstract
Fenretinide, a synthetic retinoid, induces apoptotic cell death in B-cell non-Hodgkin lymphoma (B-NHL) and acts synergistically with rituximab in preclinical models. We report results from a phase I-II study of fenretinide with rituximab for B-NHLs. Eligible diagnoses included indolent B-NHL or mantle cell lymphoma. The phase I design de-escalated from fenretinide at 900 mg/m2 PO BID for days 1-5 of a 7-day cycle. The phase II portion added 375 mg/m2 IV rituximab weekly on weeks 5-9 then every 3 months. Fenretinide was continued until progression or intolerance. Thirty-two patients were treated: 7 in phase I, and 25 in phase II of the trial. No dose-limiting toxicities were observed. The phase II component utilized fenretinide 900 mg/m2 twice daily with rituximab. The most common treatment-related adverse events of grade 3 or higher were rash (n = 3) and neutropenia (n = 3). Responses were seen in 6 (24%) patients on the phase II study, with a median duration of response of 47 months (95% confidence interval, 2-56). The combination of fenretinide and rituximab was well tolerated, yielded a modest overall response rate, but with prolonged remission durations. Further study should focus on identifying the responsive subset of B-NHL.
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Affiliation(s)
- Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Phillip A Stevenson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Shani L Frayo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - George R Oliveira
- Department of Radiology, Harvard Medical School, MGH Hospital, Boston, MA, USA
| | - Stephen D Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Damian J Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer E Roden
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Brent L Wood
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Hematopathology, Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Oliver W Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ajay K Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
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40
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Milano F, Merriam F, Nicoud I, Li J, Gooley TA, Heimfeld S, Imren S, Delaney C. Notch-Expanded Murine Hematopoietic Stem and Progenitor Cells Mitigate Death from Lethal Radiation and Convey Immune Tolerance in Mismatched Recipients. Stem Cells Transl Med 2016; 6:566-575. [PMID: 28191773 PMCID: PMC5442821 DOI: 10.5966/sctm.2016-0112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/28/2016] [Indexed: 12/12/2022] Open
Abstract
The hematopoietic syndrome of acute radiation syndrome (h‐ARS) is characterized by severe bone marrow aplasia, resulting in a significant risk for bleeding, infections, and death. To date, clinical management of h‐ARS is limited to supportive care dictated by the level of radiation exposure, with a high incidence of mortality in those exposed to high radiation doses. The ideal therapeutic agent would be an immediately available, easily distributable single‐agent therapy capable of rapid in vivo hematopoietic reconstitution until recovery of autologous hematopoiesis occurs. Using a murine model of h‐ARS, we herein demonstrate that infusion of ex vivo expanded murine hematopoietic stem and progenitor cells (HSPCs) into major histocompatibility complex mismatched recipient mice exposed to a lethal dose of ionizing radiation (IR) led to rapid myeloid recovery and improved survival. Survival benefit was significant in a dose‐dependent manner even when infusion of the expanded cell therapy was delayed 3 days after lethal IR exposure. Most surviving mice (80%) demonstrated long‐term in vivo persistence of donor T cells at low levels, and none had evidence of graft versus host disease. Furthermore, survival of donor‐derived skin grafts was significantly prolonged in recipients rescued from h‐ARS by infusion of the mismatched expanded cell product. These findings provide evidence that ex vivo expanded mismatched HSPCs can provide rapid, high‐level hematopoietic reconstitution, mitigate IR‐induced mortality, and convey donor‐specific immune tolerance in a murine h‐ARS model. Stem Cells Translational Medicine2017;6:566–575
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Affiliation(s)
- Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Fabiola Merriam
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ian Nicoud
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jianqiang Li
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ted A. Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Shelly Heimfeld
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Suzan Imren
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Colleen Delaney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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41
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Cohen SA, Turner EH, Beightol MB, Jacobson A, Gooley TA, Salipante SJ, Haraldsdottir S, Smith C, Scroggins S, Tait JF, Grady WM, Lin EH, Cohn DE, Goodfellow PJ, Arnold MW, de la Chapelle A, Pearlman R, Hampel H, Pritchard CC. Frequent PIK3CA Mutations in Colorectal and Endometrial Tumors With 2 or More Somatic Mutations in Mismatch Repair Genes. Gastroenterology 2016; 151:440-447.e1. [PMID: 27302833 PMCID: PMC5016834 DOI: 10.1053/j.gastro.2016.06.004] [Citation(s) in RCA: 32] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Some colorectal and endometrial tumors with microsatellite instability not attributable to MLH1 hypermethylation or germline mutations contain 2 or more somatic mutations in genes encoding mismatch repair (MMR) proteins. We sought to define the molecular phenotype of this newly recognized tumor subtype. METHODS From 2 prospective studies of the efficacy of screening for Lynch syndrome, we identified patients with colorectal and endometrial tumors who had 2 or more somatic (but not germline) mutations in genes encoding MMR proteins (double somatic). We determined the frequencies of tumor mutations in PIK3CA, BRAF, KRAS, NRAS, and PTEN by targeted next-generation sequencing and used logistic-regression models to compare them with those from patients with Lynch syndrome, MLH1-hypermethylated, or microsatellite-stable tumors. We validated our findings using independent data sets from The Cancer Genome Atlas. RESULTS Among colorectal cancer cases, we found that 14 of 21 (67%) patients with double somatic tumors also had PIK3CA mutations, compared with 4 of 18 (22%) tumors from patients with Lynch syndrome, 2 of 10 (20%) tumors with MLH1 hypermethylation, and 12 of 78 (15%) tumors with microsatellite stability (P < .0001 for patients with double somatic tumors vs other subgroups). Mutations in PIK3CA were detected in all 13 patients with double somatic endometrial cancers (P = .04 compared with other subgroups). We did not detect BRAF mutations in patients with double somatic colorectal tumors or Lynch syndrome. We found highly similar results in a validation cohort from The Cancer Genome Atlas (113 patients with colorectal tumors, 178 endometrial tumors); 100% of double somatic cases had a somatic mutation in PIK3CA (P < .0001 compared with other subgroups). CONCLUSIONS Most patients with colorectal or endometrial tumors with 2 or more somatic (but not germline) mutations in MMR proteins also have mutations in PIK3CA; mutations in PIK3CA are detected at substantially higher frequencies in these double somatic tumors than in other microsatellite-instability subgroups. PIK3CA mutation status might be used to identify a specific group of colorectal tumors, and to select treatment or determine prognosis.
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Affiliation(s)
- Stacey A. Cohen
- University of Washington, Department of Medicine, Division of Medical Oncology, Seattle, WA,Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - Emily H. Turner
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | | | - Angela Jacobson
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Ted A. Gooley
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | | | | | - Christina Smith
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Sheena Scroggins
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | - Jonathan F. Tait
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
| | - William M. Grady
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA,University of Washington, Department of Medicine, Division of Gastroenterology, Seattle, WA
| | - Edward H. Lin
- University of Washington, Department of Medicine, Division of Medical Oncology, Seattle, WA,Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - David E. Cohn
- The Ohio State University Comprehensive Cancer Center, Division of Gynecologic Oncology, Columbus, OH
| | - Paul J. Goodfellow
- The Ohio State University Comprehensive Cancer Center, Division of Gynecologic Oncology, Columbus, OH
| | - Mark W. Arnold
- The Ohio State University College of Medicine, Department of Surgery, Columbus, OH
| | - Albert de la Chapelle
- The Ohio State University Comprehensive Cancer Center, Department of Molecular Virology, Immunology, and Medical Genetics, Columbus, OH
| | - Rachel Pearlman
- The Ohio State University Comprehensive Cancer Center, Division of Human Genetics, Columbus, OH
| | - Heather Hampel
- The Ohio State University Comprehensive Cancer Center, Division of Human Genetics, Columbus, OH
| | - Colin C. Pritchard
- Univeristy of Washington, Department of Laboratory Medicine, Seattle, WA
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Becker PS, Gooley TA, Green DJ, Burwick N, Kim TY, Kojouri K, Inoue Y, Moore DJ, Nelli E, Dennie T, Bensinger WI. A phase 2 study of bortezomib, cyclophosphamide, pegylated liposomal doxorubicin and dexamethasone for newly diagnosed multiple myeloma. Blood Cancer J 2016; 6:e422. [PMID: 27176798 PMCID: PMC4916300 DOI: 10.1038/bcj.2016.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- P S Becker
- Divisions of Hematology and Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - T A Gooley
- Divisions of Hematology and Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - D J Green
- Divisions of Hematology and Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - N Burwick
- Divisions of Hematology and Medical Oncology, University of Washington, Seattle, WA, USA
| | - T Y Kim
- Skagit Valley Hospital Regional Cancer Care Center, Mount Vernon, WA, USA
| | - K Kojouri
- Skagit Valley Hospital Regional Cancer Care Center, Mount Vernon, WA, USA
| | - Y Inoue
- Providence Regional Cancer Partnership, Everett, WA, USA
| | - D J Moore
- Seattle Cancer Care Alliance, Seattle, WA, USA.,SCCA at Evergreen Health, Kirkland, WA, USA
| | - E Nelli
- Hematology Oncology Associates, Medford, OR, USA
| | - T Dennie
- MultiCare Health System, Tacoma, WA, USA
| | - W I Bensinger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Swedish Cancer Institute, Seattle, WA, USA
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Seo S, Gooley TA, Kuypers JM, Stednick Z, Jerome KR, Englund JA, Boeckh M. Human Metapneumovirus Infections Following Hematopoietic Cell Transplantation: Factors Associated With Disease Progression. Clin Infect Dis 2016; 63:178-85. [PMID: 27143659 PMCID: PMC4928387 DOI: 10.1093/cid/ciw284] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/23/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Human metapneumovirus (HMPV) is a newly identified pulmonary pathogen that can cause fatal lower respiratory tract disease (LRD) in hematopoietic cell transplantation (HCT) recipients. Little is known about progression rates from upper respiratory tract infection (URI) to LRD and risk factors associated with progression. METHODS A total of 118 HCT recipients receiving transplantation between 2004 and 2014 who had HMPV detected in nasopharyngeal, bronchoalveolar lavage, or lung biopsy samples by real-time reverse transcription polymerase chain reaction were retrospectively analyzed. RESULTS More than 90% of the cases were identified between December and May. Among the 118 HCT patients, 88 and 30 had URI alone and LRD, respectively. Among 30 patients with LRD, 17 patients progressed from URI to LRD after a median of 7 days (range, 2-63 days). The probability of progression to LRD within 40 days after URI was 16%. In Cox regression analysis, steroid use ≥1 mg/kg prior to URI diagnosis (hazard ratio [HR], 5.10; P = .004), low lymphocyte count (HR, 3.43; P = .011), and early onset of HMPV infection after HCT (before day 30 after HCT; HR, 3.54; P = .013) were associated with higher progression to LRD. The median viral load in nasal wash samples was 1.1 × 10(6) copies/mL (range, 3.3 × 10(2)-1.7 × 10(9)) with no correlation between the viral load and progression. CONCLUSIONS Progression from URI to LRD occurred in up to 60% of HCT recipients with risk factors such as systemic corticosteroid use or low lymphocyte counts. Further studies are needed to define the role of viral load in the pathogenesis of progressive disease.
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Affiliation(s)
- Sachiko Seo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington Department of Hematology and Oncology, National Cancer Research Center East, Chiba, Japan
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Jane M Kuypers
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington Department of Laboratory Medicine
| | - Zachary Stednick
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington Department of Laboratory Medicine
| | - Janet A Englund
- Department of Pediatrics, University of Washington Pediatric Infectious Diseases Division, Seattle Children's Hospital
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington Clinical Research Division, Fred Hutchinson Cancer Research Center Department of Medicine, University of Washington, Seattle
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44
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Bensinger WI, Becker PS, Gooley TA, Chauncey TR, Maloney DG, Gopal AK, Green DJ, Press OW, Lill M, Ifthikharuddin JJ, Vescio R, Holmberg LA, Phillips GL. A randomized study of melphalan 200 mg/m(2) vs 280 mg/m(2) as a preparative regimen for patients with multiple myeloma undergoing auto-SCT. Bone Marrow Transplant 2015; 51:67-71. [PMID: 26367217 DOI: 10.1038/bmt.2015.211] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 12/22/2022]
Abstract
We aimed to examine whether doses of melphalan higher than 200 mg/m(2) improve response rates when used as conditioning before autologous transplant (ASCT) in multiple myeloma (MM) patients. Patients with MM, n=131, were randomized to 200 mg/m(2) (mel200) vs 280 mg/m(2) (mel280) using amifostine pretreatment. The primary end point was the proportion of patients achieving near complete response (⩾nCR). No treatment-related deaths occurred in this study. Responses following ASCT were for mel200 vs mel280, respectively, ⩾nCR 22 vs 39%, P=0.03, ⩾PR 57 vs 74%, P=0.04. The hazard of mortality was not statistically significantly different between groups (mel200 vs mel280; hazard ratio (HR)=1.15 (95% confidence interval (CI), 0.62-2.13, P=0.66)) nor was the rate of progression/mortality (HR=0.81 (0.52-1.27, P=0.36)). The estimated PFS at 1 and 3 years were 83 and 46%, respectively, for mel200 and 78 and 54%, respectively, for mel280. Amifostine and mel280 were well tolerated, with no grade 4 regimen-related toxicities and only one grade 3 mucositis (none with mel200) and three grade 3 gastrointestinal (GI) toxicities (two in mel200). Hospitalization rates were more frequent in the mel280 group (59 vs 43%, P=0.08). Mel280 resulted in a higher major response rate (CR+nCR) and should be evaluated in larger studies.
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Affiliation(s)
- W I Bensinger
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - P S Becker
- University of Washington, Seattle, WA, USA
| | - T A Gooley
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - T R Chauncey
- University of Washington, Seattle, WA, USA.,VA Puget Sound Health Care System, Seattle, WA, USA
| | - D G Maloney
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - A K Gopal
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - D J Green
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - O W Press
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - M Lill
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - J J Ifthikharuddin
- James P Wilmot Cancer Center, University of Rochester, Rochester, NY, USA
| | - R Vescio
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - L A Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - G L Phillips
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Bleakley M, Heimfeld S, Loeb KR, Jones LA, Chaney C, Seropian S, Gooley TA, Sommermeyer F, Riddell SR, Shlomchik WD. Outcomes of acute leukemia patients transplanted with naive T cell-depleted stem cell grafts. J Clin Invest 2015; 125:2677-89. [PMID: 26053664 DOI: 10.1172/jci81229] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/30/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Graft-versus-host disease (GVHD) is a major cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation (HCT). In mice, naive T cells (TN) cause more severe GVHD than memory T cells (TM). We hypothesized that selective depletion of TN from human allogeneic peripheral blood stem cell (PBSC) grafts would reduce GVHD and provide sufficient numbers of hematopoietic stem cells and TM to permit hematopoietic engraftment and the transfer of pathogen-specific T cells from donor to recipient, respectively. METHODS In a single-arm clinical trial, we transplanted 35 patients with high-risk leukemia with TN-depleted PBSC grafts following conditioning with total body irradiation, thiotepa, and fludarabine. GVHD prophylactic management was with tacrolimus immunosuppression alone. Subjects received CD34-selected PBSCs and a defined dose of TM purged of CD45RA+ TN. Primary and secondary objectives included engraftment, acute and chronic GVHD, and immune reconstitution. RESULTS All recipients of TN-depleted PBSCs engrafted. The incidence of acute GVHD was not reduced; however, GVHD in these patients was universally corticosteroid responsive. Chronic GVHD was remarkably infrequent (9%; median follow-up 932 days) compared with historical rates of approximately 50% with T cell-replete grafts. TM in the graft resulted in rapid T cell recovery and transfer of protective virus-specific immunity. Excessive rates of infection or relapse did not occur and overall survival was 78% at 2 years. CONCLUSION Depletion of TN from stem cell allografts reduces the incidence of chronic GVHD, while preserving the transfer of functional T cell memory. TRIAL REGISTRATION ClinicalTrials.gov (NCT 00914940).
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Buckley SA, Mawad R, Gooley TA, Becker PS, Sandhu V, Hendrie P, Scott BL, Wood BL, Walter RB, Smith K, Dean C, Estey EH, Pagel JM. A phase I/II study of oral clofarabine plus low-dose cytarabine in previously treated acute myeloid leukaemia and high-risk myelodysplastic syndrome patients at least 60 years of age. Br J Haematol 2015; 170:349-55. [PMID: 25854284 DOI: 10.1111/bjh.13437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/09/2015] [Indexed: 11/28/2022]
Abstract
Outcomes for older adults with acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) are generally poor, and new effective therapies are needed. We investigated oral clofarabine combined with low-dose cytarabine (LDAC) in patients aged 60 years and above with relapsed or refractory AML or high-risk MDS in a phase I/II trial. A 3 + 3 dose escalation of oral clofarabine was followed by a phase II expansion with the aim of obtaining a complete response (CR) rate ≥30%. We identified 20 mg/d for 5 d as the maximum tolerated dose (MTD) of oral clofarabine. A total of 35 patients, with a median age of 72 years, were treated. Of 26 patients enrolled at the MTD, 4 had treatment-related grade 3-4 non-haematological toxicities, but none died within 28 d. The observed CR rate and median survival were 34% [95% confidence interval (CI), 18-50%] and 6.8 months overall and 38% [95% CI, 19-57%] and 7.2 months at the MTD. The median disease-free survival was 7.4 months. Fifty-two percent (23/44) of cycles administered at the MTD were done without hospital admission. This combination of oral clofarabine and LDAC demonstrated efficacy with a CR rate of >30% and acceptable toxicity in older patients.
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Affiliation(s)
- Sarah A Buckley
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Raya Mawad
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ted A Gooley
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Pamela S Becker
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Vicky Sandhu
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Paul Hendrie
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bart L Scott
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Brent L Wood
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Roland B Walter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kelly Smith
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Carol Dean
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elihu H Estey
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - John M Pagel
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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Orozco JJ, Balkin ER, Gooley TA, Kenoyer A, Hamlin DK, Wilbur DS, Fisher DR, Hylarides MD, Shadman M, Green DJ, Gopal AK, Press OW, Pagel JM. Anti-CD45 radioimmunotherapy with 90Y but not 177Lu is effective treatment in a syngeneic murine leukemia model. PLoS One 2014; 9:e113601. [PMID: 25460570 PMCID: PMC4252056 DOI: 10.1371/journal.pone.0113601] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/24/2014] [Indexed: 11/19/2022] Open
Abstract
Radioimmunotherapy (RIT) for treatment of hematologic malignancies has primarily employed monoclonal antibodies (Ab) labeled with 131I or 90Y which have limitations, and alternative radionuclides are needed to facilitate wider adoption of RIT. We therefore compared the relative therapeutic efficacy and toxicity of anti-CD45 RIT employing 90Y and 177Lu in a syngeneic, disseminated murine myeloid leukemia (B6SJLF1/J) model. Biodistribution studies showed that both 90Y- and 177Lu-anti-murine CD45 Ab conjugates (DOTA-30F11) targeted hematologic tissues, as at 24 hours 48.8 ± 21.2 and 156 ± 14.6% injected dose per gram of tissue (% ID/g) of 90Y-DOTA-30F11 and 54.2 ± 9.5 and 199 ± 11.7% ID/g of 177Lu-DOTA-30F11 accumulated in bone marrow (BM) and spleen, respectively. However, 90Y-DOTA-30F11 RIT demonstrated a dose-dependent survival benefit: 60% of mice treated with 300 µCi 90Y-DOTA-30F11 lived over 180 days after therapy, and mice treated with 100 µCi 90Y-DOTA-30F11 had a median survival 66 days. 90Y-anti-CD45 RIT was associated with transient, mild myelotoxicity without hepatic or renal toxicity. Conversely, 177Lu- anti-CD45 RIT yielded no long-term survivors. Thus, 90Y was more effective than 177Lu for anti-CD45 RIT of AML in this murine leukemia model.
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Affiliation(s)
- Johnnie J. Orozco
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Hematology Division, University of Washington, Seattle, WA, United States of America
| | - Ethan R. Balkin
- Radiation Oncology, University of Washington, Seattle, WA, United States of America
| | - Ted A. Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Aimee Kenoyer
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Donald K. Hamlin
- Radiation Oncology, University of Washington, Seattle, WA, United States of America
| | - D. Scott Wilbur
- Radiation Oncology, University of Washington, Seattle, WA, United States of America
| | | | - Mark D. Hylarides
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Hematology Division, University of Washington, Seattle, WA, United States of America
| | - Damian J. Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Medical Oncology, University of Washington, Seattle, WA, United States of America
| | - Ajay K. Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Medical Oncology, University of Washington, Seattle, WA, United States of America
| | - Oliver W. Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Medical Oncology, University of Washington, Seattle, WA, United States of America
| | - John M. Pagel
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- Medical Oncology, University of Washington, Seattle, WA, United States of America
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Venstrom JM, Dupont B, Hsu KC, Pittari G, Gooley TA, Chewning JH, Spellman S, Haagenson M, Gallagher MM, Malkki M, Petersdorf E. Donor activating KIR2DS1 in leukemia. N Engl J Med 2014; 371:2042. [PMID: 25409391 DOI: 10.1056/nejmc1411443] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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49
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Mawad R, Gooley TA, Rajendran JG, Fisher DR, Gopal AK, Shields AT, Sandmaier BM, Sorror ML, Deeg HJ, Storb R, Green DJ, Maloney DG, Appelbaum FR, Press OW, Pagel JM. Radiolabeled anti-CD45 antibody with reduced-intensity conditioning and allogeneic transplantation for younger patients with advanced acute myeloid leukemia or myelodysplastic syndrome. Biol Blood Marrow Transplant 2014; 20:1363-8. [PMID: 24858425 DOI: 10.1016/j.bbmt.2014.05.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/09/2014] [Indexed: 11/27/2022]
Abstract
We treated patients under age 50 years with iodine-131 ((131)I)-anti-CD45 antibody combined with fludarabine and 2 Gy total body irradiation to create an improved hematopoietic cell transplantation (HCT) strategy for advanced acute myeloid leukemia or high-risk myelodysplastic syndrome patients. Fifteen patients received 332 to 1561 mCi of (131)I, delivering an average of 27 Gy to bone marrow, 84 Gy to spleen, and 21 Gy to liver. Although a maximum dose of 28 Gy was delivered to the liver, no dose-limiting toxicity was observed. Marrow doses were arbitrarily capped at 43 Gy to avoid radiation-induced stromal damage; however, no graft failure or evidence of stromal damage was observed. Twelve patients (80%) developed grade II graft-versus-host disease (GVHD), 1 patient developed grade III GVHD, and no patients developed grade IV GVHD during the first 100 days after HCT. Of the 12 patients with chronic GVHD data, 10 developed chronic GVHD, generally involving the skin and mouth. Six patients (40%) are surviving after a median of 5.0 years (range, 4.2 to 8.3 years). The estimated survival at 1 year was 73% among the 15 treated patients. Eight patients relapsed, 7 of whom subsequently died. The median time to relapse among these 8 patients was 54 days (range, 26 to 1364 days). No cases of nonrelapse mortality were observed in the first year after transplantation. However, 2 patients died in remission from complications of chronic GVHD and cardiomyopathy, at 18 months and 14 months after transplantation, respectively. This study suggests that patients may tolerate myeloablative doses >28 Gy delivered to the liver using (131)I-anti-CD45 antibody in addition to standard reduced-intensity conditioning. Moreover, the arbitrary limit of 43 Gy to the marrow may be unnecessarily conservative, and continued escalation of targeted radioimmunotherapy doses may be feasible to further reduce relapse.
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Affiliation(s)
- Raya Mawad
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Ted A Gooley
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Ajay K Gopal
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Andrew T Shields
- Department of Radiology, University of Washington, Seattle, Washington
| | - Brenda M Sandmaier
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Mohamed L Sorror
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Hans Joachim Deeg
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Rainer Storb
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Damian J Green
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - David G Maloney
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Frederick R Appelbaum
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Oliver W Press
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - John M Pagel
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
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50
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Gopal AK, Gooley TA, Rajendran JG, Pagel JM, Fisher DR, Maloney DG, Appelbaum FR, Cassaday RD, Shields A, Press OW. Myeloablative I-131-tositumomab with escalating doses of fludarabine and autologous hematopoietic transplantation for adults age ≥ 60 years with B cell lymphoma. Biol Blood Marrow Transplant 2014; 20:770-5. [PMID: 24530971 DOI: 10.1016/j.bbmt.2014.02.004] [Citation(s) in RCA: 20] [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: 12/19/2013] [Accepted: 02/05/2014] [Indexed: 11/29/2022]
Abstract
Myeloablative therapy and autologous stem cell transplantation (ASCT) are underutilized in older patients with B cell non-Hodgkin (B-NHL) lymphoma. We hypothesized that myeloablative doses of (131)I-tositumomab could be augmented by concurrent fludarabine, based on preclinical data indicating synergy. Patients were ≥ 60 years of age and had high-risk, relapsed, or refractory B-NHL. Therapeutic infusions of (131)I-tositumomab were derived from individualized organ-specific absorbed dose estimates delivering ≤ 27 Gy to critical organs. Fludarabine was initiated 72 hours later followed by ASCT to define the maximally tolerated dose. Thirty-six patients with a median age of 65 years (range, 60 to 76), 2 (range, 1 to 9) prior regimens, and 33% with chemoresistant disease were treated on this trial. Dose-limiting organs included lung (30), kidney (4), and liver (2) with a median administered (131)I activity of 471 mCi (range, 260 to 1620). Fludarabine was safely escalated to 30 mg/m(2) × 7 days. Engraftment was prompt, there were no early treatment-related deaths, and 2 patients had ≥ grade 4 nonhematologic toxicities. The estimated 3-year overall survival, progression-free survival, and nonrelapse mortality were 54%, 53%, and 7%, respectively (median follow up of 3.9 years). Fludarabine up to 210 mg/m(2) can be safely delivered with myeloablative (131)I-tositumomab and ASCT in older adults with B-NHL.
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Affiliation(s)
- Ajay K Gopal
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joseph G Rajendran
- Division of Nuclear Medicine, Department of Radiology, University of Washington, Seattle, Washington
| | - John M Pagel
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - David G Maloney
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Frederick R Appelbaum
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ryan D Cassaday
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Andrew Shields
- Division of Nuclear Medicine, Department of Radiology, University of Washington, Seattle, Washington
| | - Oliver W Press
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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