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Sayyed A, Chen C, Gerbitz A, Kim DDH, Kumar R, Lam W, Law AD, Lipton JH, Michelis FV, Novitzky-Basso I, Viswabandya A, Mattsson J, Pasic I. Pretransplant Blinatumomab Improves Outcomes in B Cell Acute Lymphoblastic Leukemia Patients Who Undergo Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2024; 30:520.e1-520.e12. [PMID: 38462215 DOI: 10.1016/j.jtct.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/17/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Blinatumomab, a bispecific monoclonal antibody, effectively controls refractory B cell acute lymphoblastic leukemia (ALL) and promotes measurable residual disease (MRD) negativity. This study investigated the impact of pretransplant blinatumomab on allogeneic hematopoietic cell transplantation (HCT) outcomes in B cell ALL patients. METHODS We analyzed the effect of pretransplant blinatumomab on transplant outcomes of 117 adults undergoing allogeneic HCT for B cell ALL at Princess Margaret Hospital, Toronto, between 2010 and 2021. Outcomes assessed included overall survival (OS), graft-versus-host disease and relapse-free survival (GRFS), cumulative incidences of relapse (CIR), and nonrelapse mortality (NRM). RESULTS The median follow-up was 36 months. Thirty-one participants (26.5%) received blinatumomab. Blinatumomab group had higher proportions of individuals with high disease risk index, primary induction failure and was more likely to receive dual T cell depletion with antithymocyte globulin and post-transplant cyclophosphamide. Two-year OS, GRFS, NRM, and CIR in the blinatumomab and nonblinatumomab groups were, respectively: 65.4% versus 45.6% (P = .05), 42.2% versus 17.3% (P = .01), 3.2% versus 43.0% (P = .007) and 34.4% versus 14.4% (P = .02). Blinatumomab was associated with a lower incidence of day-100 grade 2 to 4 and grade 3 to 4 acute graft-versus-host disease (aGVHD): 27.5% versus 56.7% (P = .009), and 10.9% versus 34.7% (P = .04), respectively. Multivariate analysis confirmed the association between pretransplant blinatumomab and improved OS and NRM. CONCLUSIONS Pretransplant blinatumomab is associated with improved OS and lower risk of NRM in B cell ALL patients undergoing allogeneic HCT, likely reflecting lower burden of treatment-related toxicity in this population. Larger prospective trials are warranted to validate our findings.
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Affiliation(s)
- Ayman Sayyed
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada
| | - Carol Chen
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada
| | - Armin Gerbitz
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Dennis Dong Hwan Kim
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Rajat Kumar
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Wilson Lam
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Arjun Datt Law
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Jeffrey H Lipton
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Fotios V Michelis
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Igor Novitzky-Basso
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Auro Viswabandya
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Jonas Mattsson
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Ivan Pasic
- Division of Medical Oncology and Hematology, Hans Messner Allogeneic Transplant Program, Princess Margaret Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
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Huang X, Wang S, Xu Y, Mei C, Han Q, Wu X, Du F, Ren Y, Jin J, Tong H, Qian J. Thiotepa-busulfan-fludarabine-based conditioning as a promising approach prior to allogeneic hematopoietic stem cell transplantation in patients with blastic plasmacytoid dendritic cell neoplasm. Ann Hematol 2024:10.1007/s00277-024-05749-1. [PMID: 38584216 DOI: 10.1007/s00277-024-05749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive myeloid malignancy associated with a poor prognosis. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) has emerged as a potential treatment strategy for BPDCN, standardized conditioning regimens remain lacking. In this manuscript, we present two cases of BPDCN that were treated with a thiotepa-busulfan-fludarabine (TBF)-based conditioning regimen prior to allo-HSCT. Both cases demonstrated complete remission post-transplantation, sustained donor chimerism, and remission maintenance, suggesting the potential efficacy of the TBF conditioning regimen for BPDCN transplantation. Given the small sample size in our study, we emphasize caution and advocate for larger studies to confirm the efficacy of TBF in the treatment of BPDCN.
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Affiliation(s)
- Xianbo Huang
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Shasha Wang
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Yu Xu
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Chen Mei
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Qingmei Han
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xianhui Wu
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Fengwei Du
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China
| | - Yanling Ren
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Jie Jin
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China.
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China.
| | - Hongyan Tong
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China.
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China.
| | - Jiejing Qian
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 366 Wutong Road, Hangzhou, China.
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China.
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Song Z, Cui X, Zhang Z, Liu R, Shi X. Haploidentical haematopoietic stem cell transplantation combined with post-transplant cyclophosphamide in neuronal ceroid lipofuscinosis: Experience in eight patients. Med Clin (Barc) 2024; 162:244-249. [PMID: 38044188 DOI: 10.1016/j.medcli.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Neuronal ceroid lipofuscinoses (NCLs) are rare lysosomal storage disorders characterized by progressive mental retardation and motor developmental regression and myoclonic seizures. Hematopoietic stem cell transplantation (HSCT) has been suggested to be used in the treatment of lysosomal disorders and brain damage caused by a deficiency of soluble lysosomal enzymes. There are no previous reports on treating NCLs with HSCT in China. MATERIAL AND METHOD NCL pediatric patients who underwent allo-HSCT at Affiliated Children's Hospital of Capital Institute of Pediatrics were involved. A combination of medical histories, clinical features, and genetic analyses was used for the diagnosis of all patients. The written consent form for allo-HSCT was attained from the patient's guardian, which was then reviewed and approved by the ethics committee before the procedure. RESULTS From January 2018 to May 2019, the haplo-HSCT followed by PT/Cy on eight NCL pediatric patients was performed. The median age was 4.5 years (ranging from 2.8 to 7 years). The donors were their haploidentical HLA-matched parents, as no identically matched donors were found. The median nucleated cell count was 25.37 (10-34.41)×108/kg, and the median CD34+ count was 13.7 (8.95-22)×106/kg. Neutrophil reconstitution occurred 12 days (11-14 days) after transplantation, and the median platelet reconstitution time was 12 days (9-14 days) after transplantation. All patients achieved full donor chimerism and did not develop Grade II-IV acute GvHD or chronic GvHD after transplantation. The median follow-up period was 2.2 (1.5-2.6) years. All patients are still alive at present and develop no severe transplantation-related complications. The mental motor disorders, myoclonic seizures, and vision loss of all patients continued to progress. However, the progression slowed at 12 months after transplantation. CONCLUSION This study demonstrated that it is safe and efficacious to treat NCLs with haplo-HSCT. Transplantation should be performed at an early stage for the survival quality of pediatric patients.
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Affiliation(s)
- Zeliang Song
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing 100020, China
| | - Xiaodai Cui
- Department of Key Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Zhaoxia Zhang
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing 100020, China
| | - Rong Liu
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing 100020, China.
| | - Xiaodong Shi
- Department of Hematology, Children's Hospital of Capital Institute of Pediatrics, Beijing 100020, China.
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Maruyama Y, Nishikii H, Kurita N, Sakamoto T, Hattori K, Suehara Y, Yokoyama Y, Kato T, Obara N, Sakata-Yanagimoto M, Chiba S. Impact of CD34 positive cell dose in donor graft on the outcomes after haploidentical peripheral blood stem cell transplantation with post-transplant cyclophosphamide - A retrospective single-center study with a Japanese cohort. Blood Cells Mol Dis 2024; 105:102820. [PMID: 38199143 DOI: 10.1016/j.bcmd.2023.102820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) with post-transplant cyclophosphamide (PTCy) is an important therapeutic option for patients lacking an HLA-matched donor. However, the significance of CD34+ cell dose in grafts has not been fully elucidated. OBJECTIVE We aimed to explore the impact of CD34+ cell dose on outcomes after haplo-PBSCT with PTCy. STUDY DESIGN We retrospectively investigated 111 consecutive patients who underwent haplo-PBSCT with PTCy or HLA-matched PBSCT from related donors. RESULTS There were no statistically significant differences in 3-year overall survival (p = 0.559) or progression-free survival (p = 0.974) between haplo-PBSCT and matched PBSCT. Delayed neutrophil engraftment and a lower incidence of graft-versus-host disease were observed in haplo-PBSCT. The median dose of CD34+ cells was 4.9 × 106 /kg in 57 haplo-PBSCT and 4.5 × 106 /kg in 54 matched PBSCTs. Importantly, patients who underwent haplo-PBSCT with the administration of CD34+ cell at a dose of ≥4.0 × 106 /kg significantly had improved OS (p = 0.015) and decreased incidence of disease relapse (p = 0.001) without increasing incidence of GVHD. CONCLUSION Our data suggest that a higher dose of CD34+ cells in haplo-PBSCT with PTCy positively impacts the outcomes without an increase of GVHD.
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Affiliation(s)
- Yumiko Maruyama
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hidekazu Nishikii
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan; Department of Hematology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoki Kurita
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan; Department of Hematology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuhiro Sakamoto
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan; Department of Hematology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keiichiro Hattori
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan; Department of Hematology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasuhito Suehara
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yasuhisa Yokoyama
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan; Department of Hematology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takayasu Kato
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan; Department of Hematology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoshi Obara
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan; Department of Hematology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mamiko Sakata-Yanagimoto
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan; Department of Hematology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Division of Advanced Hemato-Oncology, Transborder Medical Research Center, University of Tsukuba, Tsukuba, Japan
| | - Shigeru Chiba
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan; Department of Hematology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
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Montoro J, Boumendil A, Finel H, Bramanti S, Castagna L, Blaise D, Dominietto A, Kulagin A, Yakoub-Agha I, Tbakhi A, Solano C, Giebel S, Gulbas Z, López Corral L, Pérez-Simón JA, Díez Martín JL, Sanz J, Farina L, Koc Y, Socié G, Arat M, Jurado M, Bermudez A, Labussière-Wallet H, Villalba M, Ciceri F, Martinez C, Nagler A, Sureda A, Glass B. Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis in HLA-Matched and Haploidentical Donor Transplantation for Patients with Hodgkin Lymphoma: A Comparative Study of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:210.e1-210.e14. [PMID: 38043802 DOI: 10.1016/j.jtct.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
Post-transplantation cyclophosphamide (PTCy) has emerged as a promising approach for preventing graft-versus-host disease (GVHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, there is a lack of studies examining the impact of this GVHD prophylaxis when different donor types are used in patients with Hodgkin lymphoma (HL). This study compared the outcomes of patients with HL undergoing HSCT from HLA-matched donors, including matched sibling donors (MSDs) and matched unrelated donors (MUDs), and haploidentical donors, using PTCy as the GVHD prophylaxis approach in all cohorts. We retrospectively compared outcomes of allo-HSCT from 166 HLA-matched donors (96 sibling and 70 unrelated donors) and 694 haploidentical donors using PTCy-based GVHD prophylaxis in patients with HL registered in the European Society for Blood and Marrow Transplantation database from 2010 to 2020. Compared to HLA-matched HSCT, haploidentical donor HSCT was associated with a significantly lower rate of platelet engraftment (86% versus 94%; P < .001) and a higher rate of grade II-IV acute GVHD (34% versus 24%; P = .01). The 2-year cumulative incidence of nonrelapse mortality (NRM) was significantly lower in the HLA-matched cohort compared to the haploidentical cohort (10% versus 18%; P = .02), resulting in a higher overall survival (OS) rate (82% versus 70%; P = .002). There were no significant differences between the 2 cohorts in terms of relapse, progression-free survival, or GVHD-free relapse-free survival. In multivariable analysis, haploidentical HSCT was associated with an increased risk of grade II-IV acute GVHD and NRM and worse OS compared to HLA-matched HSCT. Our findings suggest that in the context of PTCy-based GVHD prophylaxis, transplantation from HLA-matched donors appears to be a more favorable option compared to haploidentical HSCT.
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Affiliation(s)
- Juan Montoro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Universidad Católica de Valencia, Spain.
| | - Ariane Boumendil
- European Society for Blood and Marrow Transplantation Lymphoma Working Party, Paris, France
| | - Hervé Finel
- European Society for Blood and Marrow Transplantation Lymphoma Working Party, Paris, France
| | - Stefania Bramanti
- Department of Oncology/Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Castagna
- Department of Oncology/Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire, Marseille, France
| | - Alida Dominietto
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Aleksandr Kulagin
- RM Gorbacheva Research Institute, Pavlov University, Saint Petersburg, Russia
| | | | | | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario-INCLIVA, Valencia, Spain
| | - Sebastian Giebel
- The Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Zafer Gulbas
- Anadolu Health Center Avliated John Hopkins, Kocaeli, Gebze, Turkey
| | | | - José A Pérez-Simón
- Servicio de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), CSIC, Universidad de Sevilla, Spain
| | | | - Jaime Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lucia Farina
- University of Milan. Hematology Division, Fondazione IRCCS Istituto. Nazionale dei Tumori di Milano, Milan, Italy
| | - Yener Koc
- Medical Park Hospitals, Beylikduzu, Istanbul, Turkey
| | - Gerard Socié
- Department of Hematology - BMT, Hematology Transplantation, Paris, France
| | - Mutlu Arat
- Demiroglu Bilim University Istanbul Florence Nightingale Hospital, Hematopoietic SCT Unit, Istanbul, Turkey
| | | | | | | | - Marta Villalba
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Milano, Italy
| | - Carmen Martinez
- Hematopoietic Stem Cell Transplantation Unit, Hospital Clínic de Barcelona, Institute of Cancer and Blood Diseases, Barcelona, Spain
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Anna Sureda
- Hematology Department. Institut Català d'Oncologia, Hospital Duran i Reynals. Institut d'Investigació Biomèdica de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Bertram Glass
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Klinik St. Georg, Hamburg, Germany
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Esquirol A, Cadenas IG, Novelli S, Garrido A, Caballero AC, Oñate G, Lopez J, Redondo S, Argüello M, Saavedra S, Moreno C, Briones J, Sierra J, Martino R. Outcome improvement over time in reduced intensity conditioning hematopoietic transplantation: a 20-year experience. Ann Hematol 2024; 103:321-334. [PMID: 37971549 DOI: 10.1007/s00277-023-05530-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
The current study includes all consecutive patients (N = 484) who received a reduced-intensity conditioning regimen (RIC) allogeneic hematopoietic stem cell transplantation in our center from 1999 to 2020. Conditioning regimens were based on fludarabine with melphalan or busulfan, with low-dose thiotepa and pharmacological GVHD prophylaxis consisted of cyclosporine A (CsA)-methotrexate (MTX)/mofetil (MMF) (n = 271), tacrolimus-sirolimus (n = 145), and post-transplantation cyclophosphamide (PTCy)-tacrolimus (n = 68). The median time of overall follow-up in survivors was 8 years (1-22 years) and was at least 3 years in all three GVHD prophylaxis groups. Thirty-three percent had a high or very high disease risk index, 56% ≥ 4 European bone marrow transplantation risk, and 65% ≥ 3 hematopoietic stem cell transplantation comorbidity index score-age score. Neutrophil and platelet engraftment was longer for PTCy-tacro (p 0.0001). Cumulative incidence of grade III-IV aGVHD was 17% at 200 days, and that of moderate-severe cGvHD was 36% at 8 years. GVHD prophylaxis was the only prognostic factor in the multivariable analyses for the development of aGVHD and moderate-severe cGVHD (p 0.0001). NRM and relapse incidences were 29% and 30% at 8 years, while OS and PFS rates were 43% and 39% at 8 years. At 3 years, OS was highest in the PTCy-tacro group (68%) than in the tacro-siro (61%) and CsA-MTX/MMF (49%) cohorts (p < 0.01). In the three groups, respectively, the 200-day incidence of grade III-IV aGvHD (6% vs. 12% vs. 23%) and 3-year moderate-severe cGVHD (8% vs. 40% vs. 38%) were lower in the PTCy cohort. These better outcomes were confirmed in multivariable analyses. Based on our recent results, the PTCy could be considered as a real GvHD prophylaxis in the RIC setting due to improve best 3-year GvHD and survival outcomes.
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Affiliation(s)
- Albert Esquirol
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain.
| | - Irene Garcia Cadenas
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Ana Garrido
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Ana Carolina Caballero
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Guadalupe Oñate
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Jordi Lopez
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Sara Redondo
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Miguel Argüello
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Silvana Saavedra
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Carolina Moreno
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
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Duléry R, Brissot E, Mohty M. Combining post-transplant cyclophosphamide with antithymocyte globulin for graft-versus-host disease prophylaxis in hematological malignancies. Blood Rev 2023; 62:101080. [PMID: 37085459 DOI: 10.1016/j.blre.2023.101080] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
In search of an ideal partner or alternative to conventional immunosuppressive agents, rabbit anti-thymocyte globulin (ATG) and, more recently, post-transplant cyclophosphamide (PT-Cy) have both emerged as valid and efficient options for preventing graft-versus-host disease (GvHD). To further reduce the risk of GvHD, strategies combining ATG and PT-Cy have recently been investigated. In a haploidentical setting, retrospective studies suggest that combining PT-Cy and ATG may result in a lower incidence of chronic GvHD without increasing the risks of infection or relapse, when compared to PT-Cy without ATG. In haploidentical or unrelated donor settings, adding reduced doses of PT-Cy to ATG may reduce the risk of acute and chronic GvHD and improve survival, particularly GvHD-free, relapse-free survival (GRFS), when compared to ATG without PT-Cy. Overall, the combination of PT-Cy and ATG is a safe and promising approach for patients with hematological malignancies undergoing allogeneic hematopoietic stem cell transplantation (HSCT).
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Affiliation(s)
- Rémy Duléry
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Eolia Brissot
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Mohamad Mohty
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France.
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8
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McCurdy SR, Luznik L. Relapse after allogeneic transplantation with post-transplant cyclophosphamide: Shattering myths and evolving insight. Blood Rev 2023; 62:101093. [PMID: 37198064 PMCID: PMC10777733 DOI: 10.1016/j.blre.2023.101093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
Early studies in allogeneic blood or marrow transplantation (alloBMT) demonstrated that HLA-mismatching was protective again relapse. However, benefits in relapse reduction were outweighed by a high risk of graft-versus-host disease (GVHD) when using conventional pharmacological immunosuppression. Post-transplant cyclophosphamide(PTCy)-based platforms abated the risk of GVHD thereby overcoming the negative effects of HLA-mismatching on survival. However, since its inception, PTCy has been shadowed by a reputation for a greater risk of relapse when compared with traditional GVHD prophylaxis. Specifically, whether PTCy reduces the anti-tumor efficacy of HLA-mismatched alloBMT by killing alloreactive T cells has been the subject of debate since the early 2000's. Here we review the many studies demonstrating the potent graft-versus-malignancy (GVM) properties of alloBMT with PTCy. We discuss the laboratory data from PTCy platforms supporting that T regulatory cells may be a major mechanism of prevention of GVHD and that natural killer (NK) cells may be early effectors of GVM. Finally, we propose potential paths to optimize GVM through selecting for class II mismatching and augmenting NK cell activity.
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Affiliation(s)
- Shannon R McCurdy
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Leo Luznik
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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9
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Kapoor R, Yanamandra U, Kumar R, Pramanik SK. Successful T replete haploidentical HSCT with post-transplant cyclophosphamide in two patients with Wiskott-Aldrich syndrome. Med J Armed Forces India 2023; 79:722-725. [PMID: 37981926 PMCID: PMC10654355 DOI: 10.1016/j.mjafi.2023.08.015] [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: 08/06/2023] [Accepted: 08/27/2023] [Indexed: 11/21/2023] Open
Abstract
We describe two young patients with Wiskott-Aldrich Syndrome (WAS) who were treated by T-replete hematopoietic stem cell transplantation (HSCT) from the HLA haploidentical father according to a modified Baltimore protocol. Whereas similar protocols have been successfully used in various malignant and non-malignant diseases, this is the first report for this particular disease. The data being presented pertains to the report about two successful haploidentical transplants with post transplant cyclophosphamide (PTCY) after busulfan-based conditioning.
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Affiliation(s)
- Rajan Kapoor
- Professor & Head (Hematology), Army Hospital (Research & Referral), Delhi Cantt, India
| | - Uday Yanamandra
- Professor, Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Rajiv Kumar
- Senior Advisor (Medicine) & Clinical Hematologist, Army Hospital (R&R), New Delhi, India
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10
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Salas MQ, Rodríguez-Lobato LG, Charry P, Suárez-Lledó M, Pedraza A, Solano MT, Arcarons J, Cid J, Lozano M, Rosiñol L, Esteve J, Carreras E, Fernández-Avilés F, Martínez C, Rovira M. Applicability and validation of different prognostic scores in allogeneic hematopoietic cell transplant (HCT) in the post-transplant cyclophosphamide era. Hematol Transfus Cell Ther 2023:S2531-1379(23)00162-1. [PMID: 37891074 DOI: 10.1016/j.htct.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/21/2023] [Indexed: 10/29/2023] Open
Abstract
We investigated the predictive capacity of six prognostic indices [Karnofsky Performance Status (KPS), Hematopoietic Cell Transplant-Specific Comorbidity Index (HCT-CI), Disease Risk Index (DRI), European Bone Marrow Transplantation (EBMT) and Revised Pre-Transplantation Assessment of Mortality (rPAM) Scores and Endothelial Activation and Stress Index (EASIX)] in 205 adults undergoing post-transplant cyclophosphamide (PTCy)-based allo-HCT. KPS, HCT-CI, DRI and EASIX grouped patients into higher and lower risk strata. KPS and EASIX maintained appropriate discrimination for OS prediction across the first 2 years after allo-HCT [receiver operating characteristic curve (area under the curve (AUC) > 55 %)]. The discriminative capacity of DRI and HCT-CI increased during the post-transplant period, with a peak of prediction at 2 years (AUC of 61.1 % and 61.8 %). The maximum rPAM discriminative capacity was at 1 year (1-year AUC of 58.2 %). The predictive capacity of the EBMT score was not demonstrated. This study validates the discrimination capacity for OS prediction of KPS, HCT-CI, DRI and EASIX in PTCy-based allo-HCT.
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Affiliation(s)
- María Queralt Salas
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Luis Gerardo Rodríguez-Lobato
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paola Charry
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Suárez-Lledó
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Alexandra Pedraza
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Teresa Solano
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Arcarons
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Cid
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain
| | - Miquel Lozano
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain; University of Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain
| | - Francesc Fernández-Avilés
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain; University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain; University of Barcelona, Barcelona, Spain
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11
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Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is commonly utilized in the management of leukemia across multiple subtypes. Graft versus leukemia (GVL) is a critical component of successful transplantation and involves donor cells eradicating residual leukemia within the recipient. Graft versus host disease (GVHD) by contrast is a common complication of the transplantation process in which donor cells identify the recipient's various organ systems as foreign, thereby leading to a multitude of organ toxicities that can be described as autoimmune in nature. As both GVL and GVHD are mediated by a similar mechanism, these processes are felt to occur in tandem with one another. Here, we review the allogeneic HCT process in the context of GVL.
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Affiliation(s)
- Zane Chiad
- 1021 Morehead Medical Drive, Building 2, Charlotte, NC, 28204, USA.
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12
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Yao JM, Otoukesh S, Kim H, Yang D, Mokhtari S, Samara Y, Blackmon A, Arslan S, Agrawal V, Pourhassan H, Amanam I, Ball B, Koller P, Salhotra A, Becker P, Curtin P, Artz A, Aldoss I, Ali H, Stewart F, Smith E, Stein A, Marcucci G, Forman SJ, Nakamura R, Al Malki MM. Tocilizumab for Cytokine Release Syndrome Management After Haploidentical Hematopoietic Cell Transplantation With Post-Transplantation Cyclophosphamide-Based Graft-Versus-Host Disease Prophylaxis. Transplant Cell Ther 2023; 29:515.e1-515.e7. [PMID: 37182736 PMCID: PMC10527340 DOI: 10.1016/j.jtct.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
Cytokine release syndrome (CRS) is a common complication after haploidentical hematopoietic cell transplantation (HaploHCT). Severe CRS after haploHCT leads to higher risk of non-relapse mortality (NRM) and worse overall survival (OS). Tocilizumab (TOCI) is an interleukin-6 receptor inhibitor and is commonly used as first-line for CRS management after chimeric antigen receptor T cell therapy, but the impact of TOCI administration for CRS management on Haplo HCT outcomes is not known. In this single center retrospective analysis, we compared HCT outcomes in patients treated with or without TOCI for CRS management after HaploHCT with post-transplantation cyclophosphamide- (PTCy-) based graft-versus-host disease (GvHD) prophylaxis. Of the 115 patients eligible patients who underwent HaploHCT at City of Hope between 2019 to 2021 and developed CRS, we identified 11 patients who received tocilizumab for CRS management (TOCI). These patients were matched with 21 patients who developed CRS but did not receive tocilizumab (NO-TOCI) based on age at the time of HCT (≤64 years or >65 years or older), conditioning intensity (myeloablative versus reduced-intensity/nonmyeloablative), and CRS grading (1, 2, versus 3-4). Instead of 22 controls, we chose 21 patients because there was only 1 control matched with 1 TOCI treatment patient in 1 stratum. With only 11 patients in receiving tocilizumab for CRS treatment, matching with 21 patients who developed CRS but did not receive tocilizumab, we had 80% power to detect big differences (hazard ratio [HR] = 3.4 or higher) in transplantation outcomes using a 2-sided 0.05 test. The power would be reduced to about 20% to 30% if the difference was moderate (HR = 2.0) using the same test. No CRS-related deaths were recorded in either group. Median time to neutrophil engraftment was 21 days (range 16-43) in TOCI and 18 days (range 14-23) in NO-TOCI group (HR = 0.55; 95% confidence interval [CI] = 0.28-1.06, P = .08). Median time to platelet engraftment was 34 days (range 20-81) in TOCI and 28 days (range 12-94) in NO-TOCI group (HR = 0.56; 95% CI = 0.25-1.22, P = .19). Cumulative incidences of day 100 acute GvHD grades II-IV (P = .97) and grades III-IV (P = .47) were similar between the 2 groups. However, cumulative incidence of chronic GvHD at 1 year was significantly higher in patients receiving TOCI (64% versus 24%; P = .05). Rates of NRM (P = .66), relapse (P = .83), disease-free survival (P = .86), and overall survival (P = .73) were similar at 1 year after HCT between the 2 groups. Tocilizumab administration for CRS management after HaploHCT appears to be safe with no short-term adverse effect and no effect on relapse rate. However, the significantly higher cumulative incidence of chronic GvHD, negates the high efficacy of PTCy on GvHD prophylaxis in this patient population. Therefore using tocilizumab for CRS management in the HaploHCT population with PTCy maybe kept only for patients with severe CRS. The impact on such approach on long term outcome in HaploHCT with PTCy will need to be evaluated in a larger retrospective study or a prospective manner.
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Affiliation(s)
- Janny M Yao
- Department of Pharmacy, City of Hope National Medical Center, Duarte, California
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Hanna Kim
- Department of Pharmacy, City of Hope National Medical Center, Duarte, California
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, Division of Biostatistics, City of Hope National Medical Center, Duarte, California
| | - Sally Mokhtari
- Department of Clinical and Translational Project Development, City of Hope National Medical Center, Duarte, California
| | - Yazeed Samara
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Amanda Blackmon
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Vaibhav Agrawal
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Hoda Pourhassan
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Idoroenyi Amanam
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Brian Ball
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Paul Koller
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Pamela Becker
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Peter Curtin
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Andrew Artz
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Haris Ali
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Forrest Stewart
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Eileen Smith
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Anthony Stein
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Guido Marcucci
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic cell transplantation, City of Hope National Medical Center, Duarte, California.
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13
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Bakhtiari T, Ahmadvand M, Yaghmaie M, Sadeghi A, Mousavi SA, Rostami T, Ganjalikhani-Hakemi M. Investigation of KIR/HLA relationship and other clinical variables after T-cell-replete haploidentical bone marrow transplantation in patients with acute myeloid leukemia (AML). BMC Immunol 2023; 24:10. [PMID: 37340345 DOI: 10.1186/s12865-023-00548-1] [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: 11/05/2022] [Accepted: 06/07/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND KIR/HLA mismatch in hematopoietic stem cell transplantation (HSCT), particularly in patients with acute myeloid leukemia (AML), was related to decreased recurrence rates, improved engraftment, and a reduction in graft-versus-host disease, according to recent research (GVHD). Uncertainty exists about the impact of KIR/HLA mismatch on haploidentical-HSCTs treated with post-transplant cyclophosphamide (PTCy). We attempted to analyze the effects of KIR/HLA mismatch on clinical outcomes on transplant outcomes using the cohort of 54 AML patients who received a haplo-HSCT with PTCy. RESULTS In contrast to KIR/HLA match, our findings showed that donor KIR/HLA mismatch was substantially associated with superior OS (HR, 2.92; (P = 0.04)). Moreover, donor KIR/HLA mismatch (KIR2DS1D/C2+ R and KIR2DS2D/C1+ R mismatch versus KIR2DL1D/C2- R mm, KIR2DL2/3D/C1- R mm and KIR3DL1D/Bw4- mm) was correlated with the improvements in OS (HR, 0.74; P = 0.085) and activating. KIR/HLA mismatch versus KIR/HLA match was significantly correlated with improvements in OS (HR, .46; P = 0.03) and inhibitory. KIR/HLA mismatch versus KIR/HLA match was enhancement in the OS (HR, .93; P = 0.06). Despite a higher rate of aGvHD (grade I-IV) in the patients with KIR/HLA mismatch compared to KIR/HLA matched (57% vs. 33% (p = 0.04). However, the KIR/HLA mismatch group saw a decreased relapse rate (3.2% vs. 23%, p = 0.04). CONCLUSION This analysis shows the significance of KIR/HLA Incompatibility, other clinical variables like CMV, the relationship between donor/recipient and donor age, and the relationship between donor/recipient and donor age in the haplo-donor selection process. It also suggests that KIR and HLA mismatching between donor and recipient could be routinely performed for haplo-donor selection and may improve clinical outcomes after haplo-HSCTs with PTCy.
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Affiliation(s)
- Tahereh Bakhtiari
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ahmadvand
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Marjan Yaghmaie
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sadeghi
- Department of Internal Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seied Asadollah Mousavi
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Rostami
- Hematologic Malignancies Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mazdak Ganjalikhani-Hakemi
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Immunology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey.
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14
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Mussetti A, Kanate AS, Wang T, He M, Hamadani M, Finel H, Boumendil A, Glass B, Castagna L, Dominietto A, McGuirk J, Blaise D, Gülbas Z, Diez-Martin J, Marsh SGE, Paczesny S, Gadalla SM, Dreger P, Zhang MJ, Spellman SR, Lee SJ, Bolon YT, Sureda A. Haploidentical Versus Matched Unrelated Donor Transplants Using Post-Transplantation Cyclophosphamide for Lymphomas. Transplant Cell Ther 2023; 29:184.e1-184.e9. [PMID: 36577482 PMCID: PMC10316698 DOI: 10.1016/j.jtct.2022.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/26/2022]
Abstract
When using post-transplantation cyclophosphamide (PTCy) graft-versus-host disease (GVHD) prophylaxis for lymphoma patients, it is currently unknown whether a matched unrelated donor (MUD) or a haploidentical related donor is preferable if both are available. In this study we wanted to test whether using a haploidentical donor has the same results of a MUD. A total of 2140 adults (34% Center for International Blood and Marrow Transplant Research, 66% European Society for Blood and Marrow Transplantation registry) aged ≥18 years who received their first haploidentical hematopoietic cell transplantation (haplo-HCT) or MUD-HCT (8/8 match at HLA-loci A, B, C, and DRB1) for lymphoma using PTCy-based GVHD prophylaxis from 2010 to 2019 were retrospectively analyzed. The majority of both MUD and haploidentical HCTs received reduced intensity/nonmyeloablative conditioning (74% and 77%, respectively) and used a peripheral blood stem cell graft (91% and 60%, respectively) and a 3-drug GVHD prophylaxis (PTCy + calcineurin inhibitor + MMF in 54% and 90%, respectively). Haploidentical HCT has less favorable results versus MUD cohort in terms of overall mortality (hazard ratio [HR= = 1.69; 95% confidence interval [CI], 1.30-2.27; P < .001), progression-free survival (HR=1.39; 95% CI, 1.10-1.79; P = .008), nonrelapse mortality (HR = 1.93; 95% CI, 1.21-3.07; P = .006), platelet engraftment (HR = 0.69; 95% CI, 0.59-0.80; P < .001), acute grade 2-4 GVHD incidence (HR = 1.65; 95% CI, 1.28-2.14; P < .001), and chronic GVHD (HR = 1.79; 95% CI, 1.30-2.48, P < .001). No significant differences were observed in terms of relapse and neutrophil engraftment. Adjusting for propensity score yielded similar results. Whenever MUD is available in a timely manner, it should be preferred over a haploidentical donor when using PTCy-based GVHD prophylaxis for patients with lymphoma.
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Affiliation(s)
- Alberto Mussetti
- Hematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain.
| | | | - Tao Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Meilun He
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hervé Finel
- Lymphoma Working Party, EBMT Central Registry Office, Paris, France
| | - Ariane Boumendil
- Lymphoma Working Party, EBMT Central Registry Office, Paris, France
| | - Bertram Glass
- Lymphoma Working Party, EBMT Central Registry Office, Paris, France
| | - Luca Castagna
- IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Alida Dominietto
- Department of Haematology, IRCCS Ospedale Policlinico San Martino Genova, Genoa, Italy
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas Cancer Center, Kansas City, Kansas
| | - Didier Blaise
- Transplant and Cellular Immunotherapy Program, Department of Hematology, Aix-Marseille University (AMU), Management Sport Cancer laboratoire (MSC), Institut Paoli Calmettes, Marseille, France
| | - Zafer Gülbas
- Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - Jose Diez-Martin
- Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain
| | - Steven G E Marsh
- Anthony Nolan Research Institute, London, United Kingdom; University College London Cancer Institute, University College London, London, United Kingdom
| | - Sophie Paczesny
- Department of Microbiology and Immunology, Medical University of South Carolina College of Medicine, Charleston, South Carolina
| | - Shahinaz M Gadalla
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Peter Dreger
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Mei-Jie Zhang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen R Spellman
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Stephanie J Lee
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, Wisconsin; Fred Hutchinson Cancer Center, Seattle, Washington
| | - Yung-Tsi Bolon
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Anna Sureda
- Hematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
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15
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Baron F, Labopin M, Tischer J, Raiola AM, Vydra J, Blaise D, Chiusolo P, Stölzel F, Fanin R, Chevallier P, Nagler A, Ciceri F, Mohty M. GVHD occurrence does not reduce AML relapse following PTCy-based haploidentical transplantation: a study from the ALWP of the EBMT. J Hematol Oncol 2023; 16:10. [PMID: 36782226 PMCID: PMC9923893 DOI: 10.1186/s13045-023-01403-x] [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: 12/05/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023] Open
Abstract
The association between graft-versus-host disease (GVHD) occurrence and acute myeloid leukemia (AML) relapse in patients treated with HLA-haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) with post-transplant cyclophosphamide (PTCy)-based GVHD prophylaxis has remained debated. Here, we addressed this issue in patients with active AML at transplantation. 2-year cumulative incidences of relapse and leukemia-free survival (LFS) were 49% and 32.3%, respectively. There were no associations between acute nor chronic GVHD of any grade and lower relapse incidence. However, grade I acute GVHD was associated with better LFS (HR = 0.71, 95% CI 0.51-0.99, P = 0.04). In contrast, grade III-IV acute (HR = 3.09, 95% CI 1.87-5.12, P < 0.0001) as well as extensive chronic (HR = 3.3, 95% CI 1.81-6.04, P = 0.0001) GVHD correlated with higher nonrelapse mortality leading to lower LFS (HR = 1.36, 95% CI 0.99-1.86, P = 0.056 and HR = 1.97, 95% CI 1.35-2.89, P = 0.0004, respectively). In conclusion, these data suggest a dissociation of graft-versus-leukemia effects from GVHD in patients with active AML treated with PTCy-based Haplo-HCT.
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Affiliation(s)
- Frédéric Baron
- Laboratory of Hematology, GIGA-I3, University of Liege and CHU of Liège, Sart-Tilman, 4000, Liège, Belgium.
| | - Myriam Labopin
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Department of Hematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Sorbonne University, Paris, France
| | - Johanna Tischer
- Department of Internal Medicine III, LMU, University Hospital of Munich, Campus Grosshadern, Munich, Germany
| | | | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Didier Blaise
- Programme de Transplantation et d'immunothérapie Cellulaire, Management Sport Cancer Lab, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Friedrich Stölzel
- University Hospital Dresden, Medizinische Klinik und Poliklinik, TU Dresden, Dresden, Germany.,University Hospital Schleswig-Holstein, Kiel, Germany
| | - Renato Fanin
- Division of Hematology, Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | | | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Fabio Ciceri
- Haematology and BMT, Ospedale San Raffaele S.R.L., Milan, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Department of Hematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Sorbonne University, Paris, France
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16
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Terakura S. [Selection strategy for graft source in 2023]. Rinsho Ketsueki 2023; 64:1152-1157. [PMID: 37899195 DOI: 10.11406/rinketsu.64.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) grafts have expanded from related human leukocyte antigens (HLA)-matched donors to unrelated HLA-matched donors and umbilical cord blood. Either one of these grafts is now available for almost all patients who need allo-HSCT. Furthermore, an allo-HSCT from an HLA one haplo-mismatched donor can be safely performed with cyclophosphamide administration after transplantation. Graft-versus-host disease (GVHD) and graft-versus-leukemia effects are inextricably linked in allo-HSCT, and a transplant with more GVHD-associated complications is not necessarily a worse transplant as a graft selection indicator. Transplants with severe GVHD have fewer relapses, which offset the negative effects. This study presents data to guide graft selection by comparing transplant outcomes from different donor sources. The current position of post-transplant cyclophosphamide haplo from HLA-one haplo mismatched donor is also discussed based on data presented to date.
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Affiliation(s)
- Seitaro Terakura
- Department of Hematology and Oncology, Nagoya University Hospital
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17
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Okada N, Yamamoto R, Maruoka H, Himeno M, Hiramoto N, Ishikawa T. Haploidentical Stem Cell Transplantation Using Post-Transplant Cyclophosphamide for T-Cell Prolymphocytic Leukemia after Alemtuzumab Induction Therapy: A Case Report. Case Rep Oncol 2023; 16:604-612. [PMID: 37900793 PMCID: PMC10601731 DOI: 10.1159/000531471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 10/31/2023] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a rare aggressive disease with a poor prognosis. Allogeneic stem cell transplantation (allo-SCT) followed by alemtuzumab administration is the most promising treatment for T-PLL but is associated with a high risk of infections as alemtuzumab strongly suppresses cellular immunity, leading to high transplant-related mortality and unsatisfactory survival rates. In addition, for patients without human leukocyte antigen-matched donors, haploidentical stem cell transplantation (haplo-SCT) using post-transplant cyclophosphamide (PTCy) has been used because of the ready availability of donors and achievement of results comparable to those of transplantation with human leukocyte antigen-matched donors. However, there are no reports on the efficacy and safety, including infectious complications, of haplo-SCT with PTCy after alemtuzumab therapy in patients with. Here, we describe a 66-year-old Japanese male patient with T-PLL treated successfully with haplo-SCT after induction therapy of alemtuzumab for T-PLL. Approximately 3 months after the achievement of complete remission with alemtuzumab for T-PLL, haplo-SCT with reduced-intensity conditioning and PTCy was performed. Infectious complications were improved by early therapeutic interventions, and peripheral T cell counts gradually recovered. The patient was alive for more than 16 months after allo-SCT with no signs of relapse. Thus, haplo-SCT using PTCy should be considered as an option after alemtuzumab treatment for T-PLL.
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Affiliation(s)
- Naoki Okada
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryusuke Yamamoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hayato Maruoka
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mayuko Himeno
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
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18
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Luo R, Zhang X, Wang Y, Man Q, Gu W, Tian Z, Wang J. Post-transplant cyclophosphamide for GVHD prophylaxis in pediatrics with chronic active Epstein-Barr virus infection after haplo-HSCT. Orphanet J Rare Dis 2022; 17:422. [PMID: 36461028 PMCID: PMC9716678 DOI: 10.1186/s13023-022-02585-2] [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: 01/06/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Chronic active Epstein-Barr virus infection (CAEBV) is a rare but life-threatening progressive disease. Human leukocyte antigen (HLA)-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is the best choice as sometimes HLA-matched donor is not accessible. However, graft-versus-host-disease (GVHD) following transplantation remains a major cause of treatment failure and elevated mortality. Post-transplant cyclophosphamide (PTCy) has recently emerged for effective GVHD prophylaxis in a haploidentical setting in many hematologic malignancies. Here, we report the performance of PTCy for GVHD prophylaxis in a series of CEABV patients treated with haplo-HSCT. METHODS Consecutive pediatric CAEBV patients who were treated with haplo-HSCT and give PTCy for GVHD prophylaxis were analyzed. 1-year GVHD and relapse-free survival (GRFS), overall survival (OS) and cumulative incidence of moderate-to-severe chronic GVHD (cGVHD) were estimated. RESULTS A total of 8 patients ranging from 2 to 15 years old were included. Among them, 4 patients had early complications after haplo-HSCT. Counts of T-cell subsets increased within 6 months post transplantation, indicating an immune reconstitution. Only 1 patient developed grade II acute GVHD, and 2 patients had moderate cGVHD. One patient died from diffuse alveolar hemorrhage within the first year after transplantation. The 1-year GRFS rate, OS rate and cumulative incidence of moderate-to-severe cGVHD were 62.5%, 87.5% and 25.0%, respectively. CONCLUSION Our findings suggest that, among CAEBV patients treated with haplo-HSCT, PTCy may be an alternative choice for the prevention of GVHD.
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Affiliation(s)
- Rongmu Luo
- grid.464204.00000 0004 1757 5847Department of Hematology, Aerospace Center Hospital, No. 15, Yuquan Road, Haidian District, Beijing, 100049 China
| | - Xiaomei Zhang
- grid.464204.00000 0004 1757 5847Department of Hematology, Aerospace Center Hospital, No. 15, Yuquan Road, Haidian District, Beijing, 100049 China
| | - Ya Wang
- grid.414252.40000 0004 1761 8894Department of Hematology, Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, 100700 China
| | - Qihang Man
- grid.464204.00000 0004 1757 5847Department of Hematology, Aerospace Center Hospital, No. 15, Yuquan Road, Haidian District, Beijing, 100049 China
| | - Wenjing Gu
- grid.464204.00000 0004 1757 5847Department of Hematology, Aerospace Center Hospital, No. 15, Yuquan Road, Haidian District, Beijing, 100049 China
| | - Zhengqin Tian
- grid.464204.00000 0004 1757 5847Department of Hematology, Aerospace Center Hospital, No. 15, Yuquan Road, Haidian District, Beijing, 100049 China
| | - Jingbo Wang
- grid.464204.00000 0004 1757 5847Department of Hematology, Aerospace Center Hospital, No. 15, Yuquan Road, Haidian District, Beijing, 100049 China
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Salas MQ, Charry P, Pedraza A, Martínez-Cibrian N, Solano MT, Domènech A, Suárez-Lledó M, Nomdedeu M, Cid J, Lozano M, de-LLobet N, Arcarons J, Rosiñol L, Gutiérrez-García G, Carreras E, Esteve J, Urbano-Ispizua Á, Fernández-Avilés F, Rovira M, Martínez C. PTCY and Tacrolimus for GVHD Prevention for Older Adults Undergoing HLA-Matched Sibling and Unrelated Donor AlloHCT. Transplant Cell Ther 2022:S2666-6367(22)01277-5. [PMID: 35577323 DOI: 10.1016/j.jtct.2022.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/20/2022] [Accepted: 05/09/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The use of PTCY for graft-versus-host disease (GHVD) prevention is becoming prevalent in the transplant community when HLA-identical sibling (MSD) and 10/10 HLA-matched (MUD) and 9/10 mismatched (MMUD) unrelated donors are selected for alloHSCT. However, reported evidence on outcomes from elderly receiving PTCY-containing GVHD prophylaxis remains limited. OBJECTIVES This study aims to compare the outcomes of PTCY-TK prophylaxis and conventional GVHD prophylaxis in patients aged >50 years undergoing peripheral blood alloHSCT from a single institution. STUDY DESIGN A total of 161 consecutive patients aged >50 years undergoing alloHSCT between Jan-2014 and Feb-2021 were included. Data was collected retrospectively and updated in December 2021. Patients received grafts from HLA-identical sibling (MSD), and from 10/10 and 9/10 HLA matched and mismatched unrelated donors (UD). RESULTS Overall, median age was 60 years and 91 (54.8%) received PTCY-TK for GVHD prevention. Time to neutrophil and platelet engraftment was longer in the PTCY-TK group (20 vs. 16 days and 19 vs. 11 days, P< 0.001). The cumulative incidences of grade II-IV and III-IV aGVHD at day +100 and moderate/severe cGVHD at 2 years were 18.2%, 5.7% and 9.5% for patients receiving PTCY-TK, and 26.0%, 9.6% and 39.5% for those that did not. The multivariate analysis showed that PTCY-TK reduced the probability of grade II-IV aGVHD (HR 0.41, p=0.035), of cGVHD [any grade: HR 0.43 (p=0.014), and of moderate/severe cGVHD (HR 0.15 (p<0.001)]. At 2-years, the overall survival (65.4% vs. 65.6%, p=0.472), non-relapse mortality (17.4% vs. 13.7%, p=0.967), and cumulative incidence of relapse rates (24.2% vs. 27.5%, p=0.712) were comparable between both cohorts; GVHD-Free/Relapse-free survival (GRFS) was higher in the PTCY-TK group (2-years: 50.2% vs. 21.8%; HR 0.42, p=0.001). In patients aged ≥50 years, Conclusion: PTCY-TK was safe and a more effective drug combination than non-PTCY containing GVHD prophylaxis, even with the use of matched and mismatched UD, and resulted in comparable relapse rates and better GRFS.
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20
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Little JS, Shapiro RM, Aleissa MM, Kim A, Chang JBP, Kubiak DW, Zhou G, Antin JH, Koreth J, Nikiforow S, Cutler CS, Romee R, Issa NC, Ho VT, Gooptu M, Soiffer RJ, Baden LR. Invasive Yeast Infection After Haploidentical Donor Hematopoietic Cell Transplantation Associated with Cytokine Release Syndrome. Transplant Cell Ther 2022; 28:508.e1-508.e8. [PMID: 35526780 PMCID: PMC9357112 DOI: 10.1016/j.jtct.2022.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Use of haploidentical donor hematopoietic cell transplantation (haploHCT) has expanded but recent reports raise concern for increased rates of infectious complications. The incidence and risk factors for invasive fungal disease (IFD) after haploHCT have not been well elucidated. OBJECTIVE The objective of this study is to evaluate the incidence and risk factors for IFD after haploHCT. The identification of key risk factors will permit targeted prevention measures and may explain elevated risk for other infectious complications after haploHCT. STUDY DESIGN We performed a single-center retrospective study of all adults undergoing haploHCT between May 2011 and May 2021 (n=205). The 30-day and one-year cumulative incidence of proven or probable IFD and one-year non-relapse mortality (NRM) were assessed. Secondary analysis evaluated risk factors for invasive yeast infection (IYI) using univariate and multivariable Cox regression models. RESULTS Twenty-nine patients (14%) developed IFD following haploHCT. Nineteen (9.3%) developed IYI in the first year, 13 of which occurred early with a 30-day cumulative incidence of 6.3% (95% CI 2.9 - 9.6%) and increased NRM in patients with IYI (53.9% versus 10.9%). The majority of yeast isolates (17/20; 85%) were fluconazole susceptible. The incidence of IYI in the first 30 days after haploHCT was 10% among the 110 (54%) patients who developed cytokine release syndrome (CRS) and 21% among the 29 (14%) who received tocilizumab. On multivariable analysis, AML (HR 6.24; 1.66 - 23.37; p=0.007) and CRS (HR 4.65; 1.00 - 21.58; p=0.049) were associated with an increased risk of early IYI after haploHCT. CONCLUSION CRS after haploHCT is common and is associated with increased risk of early IYI. The identification of CRS as a risk factor for IYI raises questions about its potential association with other infections after haploHCT. Recognition of key risk factors for infection may permit individualized strategies for prevention and intervention and minimize potential side effects.
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Affiliation(s)
- Jessica S Little
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA.
| | - Roman M Shapiro
- Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA; Department of Pharmacy, Brigham and Women's Hospital, Boston, USA
| | - Muneerah M Aleissa
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - Austin Kim
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA
| | - Jun Bai Park Chang
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA
| | - David W Kubiak
- Harvard Medical School, Boston, USA; Department of Pharmacy, Brigham and Women's Hospital, Boston, USA
| | - Guohai Zhou
- Harvard Medical School, Boston, USA; Center for Clinical Investigation, Brigham and Women's Hospital, Boston, USA
| | - Joseph H Antin
- Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - John Koreth
- Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - Sarah Nikiforow
- Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - Corey S Cutler
- Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - Rizwan Romee
- Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - Nicolas C Issa
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - Vincent T Ho
- Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - Mahasweta Gooptu
- Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - Robert J Soiffer
- Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, USA; Center for Clinical Investigation, Brigham and Women's Hospital, Boston, USA.
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21
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Okamoto K, Osone S, Matsuura A, Asazuma M, Matsuoka T, Kanayama T, Imamura T, Hosoi H. [HLA-mismatched bone marrow transplantation with post-transplant cyclophosphamide for pediatric patients with aplastic anemia]. Rinsho Ketsueki 2022; 63:45-50. [PMID: 35135951 DOI: 10.11406/rinketsu.63.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Post-transplant cyclophosphamide (PTCy) has improved the efficacy of HLA-mismatched hematopoietic cell transplantation (HCT) by decreasing the risk of graft-versus-host disease (GVHD) and nonrelapse mortality. If an HLA-matched donor is not available, GVHD prophylaxis with PTCy can also be used for HLA-mismatched HCT in patients with pediatric aplastic anemia (AA). We report two cases of pediatric AA that were treated with HLA-mismatched HCT with reduced-intensity conditioning and PTCy. We administered 50 mg/kg/day Cy for GVHD prophylaxis on days 3 and 4, and tacrolimus and mycophenolate mofetil (or methotrexate) were initiated from day 5. In both the cases, the time to engraftment was favorable and GVHD and infection were controllable. PTCy probably allows us to expand donor candidates in pediatric AA when an HLA-matched donor is not available; however, further studies regarding optimal conditioning regimens and late complications are required.
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Affiliation(s)
- Kenji Okamoto
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Shinya Osone
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Amane Matsuura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Masamichi Asazuma
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Taro Matsuoka
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Takuyo Kanayama
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center
| | - Toshihiko Imamura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Hajime Hosoi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
- Department of Nursing, Doshisha Women's College of Liberal Arts
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22
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Furumoto T, Makiyama J, Toriyama E, Niino D, Hata T, Moriuchi Y, Miyazaki Y. [Successful treatment of myelodysplastic syndromes complicated by myeloid sarcoma with haploidentical allogeneic hematopoietic stem cell transplantation using post-transplant cyclophosphamide]. Rinsho Ketsueki 2022; 63:341-346. [PMID: 35662155 DOI: 10.11406/rinketsu.63.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Using post-transplant cyclophosphamide (PTCy-haplo), haploidentical allogeneic hematopoietic stem cell transplantation has shown a surge in popularity in recent years. There are, however, only a few reports of PTCy-haplo being used to treat myelodysplastic syndromes (MDS) that have been complicated by myeloid sarcoma (MS). An immuno-suppressive therapy was given to a 25-year-old man who was diagnosed with low-risk MDS in September 2007. After an ileocecal ulcer biopsy that revealed MS in July 2019, a chromosomal analysis of the bone marrow cells in August 2019 revealed loss of chromosome 7, which is associated with poor prognosis. Because the patient lacked an HLA-matched sibling donor, he underwent PTCy-haplo in December 2019. On day 33, complete remission and donor chimerism was achieved. Ileocecal ulcer scarring was discovered by a colonoscopy on day 54. Grade I cutaneous acute graft-versus-host disease was discovered approximately on day 30 and treated with topical steroids. PTCy-haplo may be an effective treatment for MS.
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Affiliation(s)
| | | | - Eo Toriyama
- Department of Hematology, Sasebo City General Hospital
| | - Daisuke Niino
- Department of Pathology, Sasebo City General Hospital
| | - Tomoko Hata
- Department of Clinical Laboratory, Nagasaki Harbor Medical Center
| | | | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University
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23
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Swaminathan VV, Uppuluri R, Meena SK, Varla H, Chandar R, Ramakrishnan B, Jayakumar I, Raj R. Treosulfan-Based Conditioning in Matched Family, Unrelated and Haploidentical Hematopoietic Stem Cell Transplantation for Genetic Hemophagocytic Lymphohistiocytosis: Experience and Outcomes over 10 Years from India. Indian J Hematol Blood Transfus 2022; 38:84-91. [PMID: 35125715 PMCID: PMC8804033 DOI: 10.1007/s12288-021-01422-z] [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: 01/16/2021] [Accepted: 02/24/2021] [Indexed: 01/03/2023] Open
Abstract
We aimed to analyze data in children with primary hemophagocytic lymphohistiocytosis (HLH) who underwent hematopoietic stem cell transplantation (HSCT). We performed a retrospective study where children up to 18 years, with primary HLH and who underwent HSCT from January 2011 to December 2019, were included. Twenty-five children with genetic HLH underwent HSCT, including variants (Griscelli syndrome (GS2) 7, Chediak-Higashi syndrome (CHS) 2, XIAP mutation 2). Donors were matched family 8 (32%), umbilical cord blood unit 3 (12%), matched unrelated 2 (8%), haploidentical HSCT 12 (48%), (TCR alpha/beta depletion 2 and post-transplant cyclophosphamide 10). With treosulfan-based conditioning, engraftment was achieved in 23/25 (92%) transplants (100% in haplo-HSCT), with sustained complete chimerism in 87%. Disease-free survival was noted in 2/3 children with stable mixed chimerism. Graft-versus-host disease (GVHD) of grade I/II was noted in 6 (24%), grade III in 3 (13%); chronic limited skin GVHD in 2 (12%) children. Overall survival was 72% (87.5% in matched donor, 66.7% in the haplo-HSCT), 71% in GS2, 50% in CHS, 100% in XIAP. HSCT is curative in primary HLH with acceptable disease-free survival with mixed chimerism. Haplo-HSCT is a viable option for those without matched family or unrelated donors.
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Affiliation(s)
- Venkateswaran Vellaichamy Swaminathan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Satish Kumar Meena
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Harika Varla
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Rumesh Chandar
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | | | - Indira Jayakumar
- Department of Pediatric Critical Care, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, 320, Padma Complex, Anna Salai, Teynampet, Chennai, 600035 India
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Uygun V, Özsan N, Daloğlu H, Öztürkmen S, Yalçın K, Karasu G, Yeşilipek A. Epstein-Barr virus-related lymphoproliferative disorders in T-cell repleted haploidentical transplantation with post-transplant cyclophosphamide. Int J Hematol 2021; 115:600-604. [PMID: 34826107 DOI: 10.1007/s12185-021-03267-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
EBV-associated lymphoproliferative disorders (LPDs) are common in hematopoietic stem cell transplantation (HSCT) with T-cell-depleted grafts, but are extremely rare in HSCT patients with T-cell-replete grafts with post-transplant cyclophosphamide (PTCy). Here we present the cases of two pediatric patients who developed EBV-related LPD after T-cell-replete haplo-HSCT with PTCy. One of these is the first reported case of EBV-positive mucocutaneous ulcer (EBVMCU) developing after PTCy. EBV-related diseases are rare in T-cell-replete haplo-HSCT patients with PTCy. However, in patients with risk factors, it is reasonable to screen for EBV viremia for LPD.
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Affiliation(s)
- Vedat Uygun
- Department of Pediatric Bone Marrow Transplantation Unit, Faculty of Medicine, İstinye University, MedicalPark Antalya Hospital, Fener Mah. Tekelioğlu Cad. No:7 Lara, Antalya, Turkey.
| | - Nazan Özsan
- Department of Pathology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Hayriye Daloğlu
- Department of Pediatric Bone Marrow Transplantation Unit, Faculty of Health Sciences, MedicalPark Antalya Hospital, Antalya Bilim University, Antalya, Turkey
| | - Seda Öztürkmen
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Antalya, Turkey
| | - Koray Yalçın
- Department of Pediatric Bone Marrow Transplantation Unit, Faculty of Medicine, MedicalPark Göztepe Hospital, Bahçeşehir University, İstanbul, Turkey
| | - Gülsün Karasu
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Göztepe Hospital, İstanbul, Turkey
| | - Akif Yeşilipek
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Antalya, Turkey
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Hashem H, Najjar R, Abu-Shanap M, Khattab E, Rihani R, Tbakhi A, Sultan I. Haploidentical Hematopoietic Cell Transplantation Using Post-transplant Cyclophosphamide for Children with Non-malignant Diseases. J Clin Immunol 2021. [PMID: 34355352 DOI: 10.1007/s10875-021-01113-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/25/2021] [Indexed: 12/22/2022]
Abstract
Haploidentical hematopoietic cell transplantation (HCT) is a valuable curative option for children with non-malignant diseases. Haploidentical HCT using post-transplant cyclophosphamide (PTCy) is a readily available option in the absence of an HLA-matched donor. We conducted a retrospective single-center study on the outcome of haploidentical HCT in children with non-malignant diseases. We gathered data from 44 patients underwent HCT in the period 2015 to 2020. The indications for HCT were bone marrow failure, primary immunodeficiency, metabolic disorders, and hemoglobinopathy. Median age at HCT was 4 years (range 0.7-20). The conditioning regimens were myeloablative (n = 17) or reduced intensity (n = 27). After a median follow-up of 20 months (range 4-71), 2-year overall survival was 89% and 2-year GvHD-free relapse-free survival (GRFS) was 66%. Incidence of primary graft failure was 13.6%. Cumulative incidence of grade II-IV acute and moderate/severe chronic GvHD were 20% and 6.4%, respectively. Younger age at HCT (< 4 years) and primary immunodeficiency were significantly associated with better GRFS (p < 0.05). In conclusion, haploidentical HCT using PTCy is feasible and curative in children with non-malignant diseases lacking an HLA-matched donor. Early diagnosis and referral in addition to timely treatment can further improve outcomes.
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Sanz J, Galimard JE, Labopin M, Afanasyev B, Sergeevich MI, Angelucci E, Kröger N, Koc Y, Ciceri F, Diez-Martin JL, Arat M, Sica S, Rovira M, Aljurf M, Tischer J, Savani B, Ruggeri A, Nagler A, Mohty M. Post-transplant cyclophosphamide containing regimens after matched sibling, matched unrelated and haploidentical donor transplants in patients with acute lymphoblastic leukemia in first complete remission, a comparative study of the ALWP of the EBMT. J Hematol Oncol 2021; 14:84. [PMID: 34049582 PMCID: PMC8161915 DOI: 10.1186/s13045-021-01094-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no information on the impact of donor type in allogeneic hematopoietic stem cell transplantation (HCT) using homogeneous graft-versus-host (GVHD) prophylaxis with post-transplant cyclophosphamide (PTCy) in acute lymphoblastic leukemia (ALL). METHODS We retrospectively analyzed outcomes of adult patients with ALL in CR1 that had received HCT with PTCy as GVHD prophylaxis from HLA-matched sibling (MSD) (n = 78), matched unrelated (MUD) (n = 94) and haploidentical family (Haplo) (n = 297) donors registered in the EBMT database between 2010 and 2018. The median follow-up period of the entire cohort was 2.2 years. RESULTS Median age of patients was 38 years (range 18-76). Compared to MSD and MUD, Haplo patients received peripheral blood less frequently. For Haplo, MUD, and MSD, the cumulative incidence of 100-day acute GVHD grade II-IV and III-IV, and 2-year chronic and extensive chronic GVHD were 32%, 41%, and 34% (p = 0.4); 13%, 15%, and 15% (p = 0.8); 35%, 50%, and 42% (p = 0.01); and 11%, 17%, and 21% (p = 0.2), respectively. At 2 years, the cumulative incidence of relapse and non-relapse mortality was 20%, 20%, and 28% (p = 0.8); and 21%, 18%, and 21% (p = 0.8) for Haplo, MUD, and MSD, respectively. The leukemia-free survival, overall survival and GVHD-free, relapse-free survival for Haplo, MUD, and MSD was 59%, 62%, and 51% (p = 0.8); 66%, 69%, and 62% (p = 0.8); and 46%, 44%, and 35% (p = 0.9), respectively. On multivariable analysis, transplant outcomes did not differ significantly between donor types. TBI-based conditioning was associated with better LFS. CONCLUSIONS Donor type did not significantly affect transplant outcome in patient with ALL receiving SCT with PTCy.
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Affiliation(s)
- Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
- CIBERONC, Instituto Carlos III, Madrid, Spain.
| | - Jacques-Emmanuel Galimard
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Boris Afanasyev
- RM Gorbacheva Research Institute, Pavlov University, Lva Tolstogo 6/8, 197022, Saint-Petersburg, Russian Federation
| | - Moiseev Ivan Sergeevich
- RM Gorbacheva Research Institute, Pavlov University, Lva Tolstogo 6/8, 197022, Saint-Petersburg, Russian Federation
| | - Emanuele Angelucci
- Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nicolaus Kröger
- Bone Marrow Transplantation Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Yener Koc
- Medicana International, Istanbul, Turkey
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milan, Italy
| | - J L Diez-Martin
- Hematology Department, Hospital GU Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense Madrid, Madrid, Spain
| | - Mutlu Arat
- Florence Nightingale Sisli Hospital, Hematopoietic SCT Unit, Istanbul, Turkey
| | - Simona Sica
- Istituto di Ematologia, Universita Cattolica S. Cuore, Rome, Italy
| | - Montserrat Rovira
- Department of Hematology, Hospital Clinic, Institute of Hematology and Oncology, Barcelona, Spain
- August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre Oncology (Section of Adult Haematolgy/BMT), Riyadh, Saudi Arabia
| | - Johanna Tischer
- Department of Internal Medicine III, Grosshadern, LMU, University Hospital of Munich, Munich, Germany
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mohamad Mohty
- Department of Hematology, and INSERM UMRs 938, Hopital Saint Antoine, Sorbonne University, Paris, France
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Dholaria B, Labopin M, Sanz J, Ruggeri A, Cornelissen J, Labussière-Wallet H, Blaise D, Forcade E, Chevallier P, Grassi A, Zubarovskaya L, Kuball J, Ceballos P, Ciceri F, Baron F, Savani BN, Nagler A, Mohty M. Allogeneic hematopoietic cell transplantation with cord blood versus mismatched unrelated donor with post-transplant cyclophosphamide in acute myeloid leukemia. J Hematol Oncol 2021; 14:76. [PMID: 33941226 PMCID: PMC8094558 DOI: 10.1186/s13045-021-01086-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation (allo-HCT) using a mismatched unrelated donor (MMUD) and cord blood transplantation (CBT) are valid alternatives for patients without a fully human leukocyte antigen (HLA)-matched donor. Here, we compared the allo-HCT outcomes of CBT versus single-allele-mismatched MMUD allo-HCT with post-transplant cyclophosphamide (PTCy) in acute myeloid leukemia. METHODS Patients who underwent a first CBT without PTCy (N = 902) or allo-HCT from a (HLA 9/10) MMUD with PTCy (N = 280) were included in the study. A multivariate regression analysis was performed for the whole population. A matched-pair analysis was carried out by propensity score-based 1:1 matching of patients (177 pairs) with known cytogenetic risk. RESULTS The incidence of grade II-IV and grade III-IV acute graft-versus-host disease (GVHD) at 6 months was 36% versus 32% (p = 0.07) and 15% versus 11% (p = 0.16) for CBT and MMUD cohorts, respectively. CBT was associated with a higher incidence of graft failure (11% vs. 4%, p < 0.01) and higher 2-year non-relapse mortality (NRM) (30% vs. 16%, p < 0.01) compared to MMUD. In the multivariate analysis, CBT was associated with a higher risk of, NRM (HR = 2.09, 95% CI 1.46-2.99, p < 0.0001), and relapse (HR = 1.35, 95% CI 1-1.83, p = 0.05), which resulted in worse leukemia-free survival (LFS) (HR = 1.68, 95% CI 1.34-2.12, p < 0.0001), overall survival (OS) (HR = 1.7, 95% CI 1.33-2.17, p < 0.0001), and GVHD-free, relapse-free survival (GRFS) (HR = 1.49, 95% CI 1.21-1.83, p < 0.0001) compared to MMUD. The risk of grade II-IV acute GVHD (p = 0.052) and chronic GVHD (p = 0.69) did not differ significantly between the cohorts. These results were confirmed in a matched-pair analysis. CONCLUSIONS CBT was associated with lower LFS, OS, and GRFS due to higher NRM, compared to MMUD allo-HCT with PTCy. In the absence of a fully matched donor, 9/10 MMUD with PTCy may be preferred over CBT.
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Affiliation(s)
- Bhagirathbhai Dholaria
- Department of Hematology-Oncology, Vanderbilt University Medical Center, 220 Pierce Ave, 777 Preston Research Building, Nashville, TN, 37232, USA.
| | | | - Jaime Sanz
- Hematology Department, University Hospital La Fe, Valencia, Spain
| | - Annalisa Ruggeri
- Department of Pediatric Hematology and Oncology IRCCS, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Jan Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | | | | | - Anna Grassi
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ludmila Zubarovskaya
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian Federation
| | - Jürgen Kuball
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Patrice Ceballos
- Département d'Hématologie Clinique, CHU Lapeyronie, Montpellier, France
| | - Fabio Ciceri
- Ospedale San Raffaele S.R.L., Haematology and BMT, Milan, Italy
| | | | - Bipin N Savani
- Department of Hematology-Oncology, Vanderbilt University Medical Center, 220 Pierce Ave, 777 Preston Research Building, Nashville, TN, 37232, USA
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel
- ALWP Office Hôpital Saint-Antoine, Paris, France
| | - Mohamad Mohty
- EBMT ALWP Office, Hôpital Saint-Antoine, Paris, France
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, UMRs 938, AP-HP, Sorbonne University, and INSERM, Paris, France
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Terao T, Tsushima T, Fukumoto A, Kuzume A, Miura D, Narita K, Takeuchi M, Matsue K. EBV-PTLD in a patient after haploidentical stem-cell transplantation with post-transplant cyclophosphamide. Int J Hematol 2021; 114:136-40. [PMID: 33675520 DOI: 10.1007/s12185-021-03111-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 12/18/2022]
Abstract
Here, we describe the case of a male patient with Epstein-Barr virus post-transplantation lymphoproliferative disorder (EBV-PTLD), which developed 18 months after a haploidentical hematopoietic stem cell transplantation (haplo-HSCT) and the administration of post-transplant cyclophosphamide (PTCy). Of note, no anti-thymoglobulin was used in the entire clinical course. Prior to the onset of EBV-PTLD, the patient had pulmonary chronic graft-versus-host disease and was treated with prednisolone and tacrolimus. After stopping immunosuppressive therapy, he was diagnosed with EBV-positive infectious mononucleosis PTLD, and EBV-associated hemophagocytic syndrome; therefore, dexamethasone and rituximab monotherapies were administered. After four courses of rituximab, EBV-DNA was no longer detected in the peripheral blood, and the patient's laboratory data improved. Overall, this study highlights the need to predict the risk factors associated with the development of EBV-PTLD in transplanted patients after haplo-HSCT with PTCy.
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Salas MQ, Atenafu EG, Law AD, Lam W, Pasic I, Chen C, Dong Hwan Kim D, Michelis FV, Gerbitz A, Lipton JH, Mattsson J, Kumar R, Viswabandya A. Experience Using Anti-Thymocyte Globulin With Post-Transplantation Cyclophosphamide for Graft-Versus-Host Disease Prophylaxis in Peripheral Blood Haploidentical Stem Cell Transplantation. Transplant Cell Ther 2021; 27:428.e1-428.e9. [PMID: 33965185 DOI: 10.1016/j.jtct.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
Haploidentical hematopoietic cell transplantation (HaploHCT) is an alternative treatment option for patients without a suitable 10/10 HLA matched donor. We share an updated experience at our center of using in vivo dual T-cell depletion with anti-thymocyte globulin (ATG) and post-transplantation cyclophosphamide (PTCy) in peripheral blood haploHCT and report the impact of reducing the dose of ATG from 4.5 mg/kg to 2 mg/kg on post-transplantation complications and outcomes. Ninety-five consecutive adults underwent haploHCT at our center between August 2016 and February 2020, all of whom were included in the study. Nine (9.5%) patients received myeloablative conditioning, and 86 (90.5%) patients underwent reduced-intensity haploHCT. All patients received thymoglobulin, PTCy and cyclosporine (CsA) for graft-versus-host disease (GVHD) prophylaxis: Sixty (63.2%) patients received 4.5 mg/kg, and 35 (36.8%) patients received 2 mg/kg of ATG. Clinical information was collected retrospectively and updated in June 2020. The median age was 57 (18-73), and acute myeloid leukemia was the most prevalent diagnosis (58.9%). The day 100 cumulative incidence of grade II-IV and grade III-IV aGVHD, and 1-year moderate/severe cGVHD were 22.3%, 11.1%, and 20.2%, respectively. Those patients who received 2 mg/kg of ATG had higher incidence of grade III-IV aGVHD (23.9% vs 3.5%, P = .006) and comparable moderate/severe cGVHD (1-year 20.6% vs 19.8%, P = .824) than those patients who received 4.5 mg/kg. Overall, the 18-month overall survival (OS), relapse-free survival (RFS), and non-relapse mortality (NRM) were 43.8%, 38.4%, and 40.2%, respectively. The reduction of the ATG dose did not have a significant impact in OS (hazard ratio [HR] 1.06, P = .847), RFS (HR 0.984, P = .955), and in NRM (HR 1.38; P = .348). The reduction of the ATG resulted in a negative impact on aGVHD without conferring any benefit in OS, RFS, and NRM. Consequently, the ATG dose used at our institution in combination with PTCy and CsA for haploHCT continues to be 4.5 mg/kg.
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Affiliation(s)
- Maria Queralt Salas
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Eshetu G Atenafu
- Department of Biostatistics, Princes Margaret Cancer Centre, University Health Network. Toronto, Ontario, Canada
| | - Arjun Datt Law
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Wilson Lam
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ivan Pasic
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Carol Chen
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dennis Dong Hwan Kim
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Fotios V Michelis
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Armin Gerbitz
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey Howard Lipton
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jonas Mattsson
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajat Kumar
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Auro Viswabandya
- Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
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Kurita N, Sakamoto T, Kato T, Kusakabe M, Yokoyama Y, Nishikii H, Sakata-Yanagimoto M, Obara N, Hasegawa Y, Chiba S. Early administration of cyclosporine may reduce the incidence of cytokine release syndrome after HLA-haploidentical hematopoietic stem-cell transplantation with post-transplant cyclophosphamide. Ann Hematol 2021; 100:1295-1301. [PMID: 33580280 DOI: 10.1007/s00277-021-04439-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
Cytokine release syndrome (CRS), occurring in more than 70% of HLA-haploidentical hematopoietic stem-cell transplantations with post-transplant cyclophosphamide (PT/CY-haplo), can lead to hemodynamic instability and worsen clinical outcomes. A calcineurin inhibitor is initiated after cyclophosphamide administration in the commonly used PT/CY regimens. Here, we conducted a phase I/II, prospective, single-center trial of PT/CY-haplo to evaluate the safety and efficacy of cyclophosphamide on days 3 and 5 along with cyclosporin and mycophenolate mofetil started from day - 1. Thirty-five adults with hematologic malignancies were enrolled. Myeloablative and reduced-intensity conditioning were used in 25 and 10 patients, respectively. Graft sources were bone marrow in 11 patients and mobilized peripheral blood stem cells in 24 patients. Disease-free survival on day 100, the primary endpoint, was 86% (95% confidence interval (CI), 69-94), which was over the predefined threshold of 50%. Unexpectedly, only 20% (95% CI, 8.4-37) of patients developed fever of > 38 °C early after graft infusion, all CRS grade 1, and all of which resolved just after cyclophosphamide administration. The cumulative incidences of grades II-IV acute graft-versus-host disease (GVHD), III-IV acute GVHD, and moderate-severe chronic GVHD were 23% (95% CI, 11-38), 6% (95% CI, 1-17), and 11% (95% CI, 4-25), respectively. The 3-year overall survival rate was 49% (95% CI, 31-64). Our results suggest that administration of cyclosporine and mycophenolate mofetil prior to PT/CY can reduce the frequency and severity of CRS without increasing GVHD. UMIN Clinical Trial Registry numbers: 000006631 and 000015694.
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Affiliation(s)
- Naoki Kurita
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tatsuhiro Sakamoto
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takayasu Kato
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Manabu Kusakabe
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuhisa Yokoyama
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hidekazu Nishikii
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Mamiko Sakata-Yanagimoto
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naoshi Obara
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuichi Hasegawa
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shigeru Chiba
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan.
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31
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Gao F, Zhang J, Hu J, Lin L, Xu Y. Post-transplant cyclophosphamide versus antithymocyte globulin in allogeneic hematopoietic cell transplantation: a meta-analysis. Ann Hematol 2021; 100:529-540. [PMID: 33420575 DOI: 10.1007/s00277-021-04399-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/03/2021] [Indexed: 12/23/2022]
Abstract
Graft-versus-host disease (GVHD) prophylaxis based on post-transplant cyclophosphamide (PTCy) or antithymocyte globulin (ATG) is widely used in allogeneic hematopoietic stem cell transplantations (allo-HCT). The differential impacts of PTCy and ATG on transplantation outcomes are not well characterized. Here we report a meta-analysis of PTCy versus ATG in allo-HCT. Ten studies were eligible, and a total of 1871 patients were included. The incidence of II-IV aGVHD, III-IV aGVHD, and NRM were significantly lower in PTCy arm (HR = 0.63, 95% CI 0.45-0.89; HR = 0.35, 95% CI 0.16-0.77; HR = 0.59, 95% CI 0.48-0.73). PTCy was associated with a better OS and PFS (HR = 0.62, 95% CI = 0.53-0.73; HR = 0.76, 95% CI 0.62-0.93). The relapse rate and cGVHD incidence were not significantly different between PTCy and ATG (HR = 0.85, 95% CI 0.68-1.07; HR = 0.65, 95% CI 0.38-1.12). Thus, compared with ATG, PTCy has a better aGVHD control and OS benefit, without increasing relapse risk, which needs further validation in prospective randomized trials.
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Affiliation(s)
- Feiqiong Gao
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jiawei Zhang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jianlai Hu
- Department of Prosthodontics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Liming Lin
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yang Xu
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China. .,Zhejiang Provincial Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, 310058, China. .,National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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Shirane S, Hamano Y, Furuya C, Honda T, Sasaki M, Komatsu N. [Multiple myeloma treated with haploidentical hematopoietic stem cell transplantation with the administration of post-transplant cyclophosphamide]. Rinsho Ketsueki 2021; 62:85-90. [PMID: 33678775 DOI: 10.11406/rinketsu.62.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We report the case of a 58-year-old woman with multiple myeloma who relapsed after the first autologous peripheral blood stem cell transplantation. She was refractory to new drugs and underwent a haploidentical allogeneic hematopoietic stem cell transplantation (haplo-HSCT) by administering post-transplantation cyclophosphamide (PTCy) after the second autologous peripheral blood stem cell transplantation. Neutrophil and platelet engraftment were achieved on days 22 and 55, respectively. Grade II cutaneous acute graft-versus-host disease was observed, which was resolved by systemic steroid treatment. Post-transplant bone marrow examination confirmed donor chimerism replacement and immunophenotypic complete response, and the patient is alive and disease-free. Although haplo-HSCT using PTCy for multiple myeloma has not been reported in Japan, it could be performed safely. Here, we report our results with literature review.
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Affiliation(s)
- Shuichi Shirane
- Department of Hematology, Juntendo University School of Medicine
| | - Yasuharu Hamano
- Department of Hematology, Juntendo University School of Medicine
| | - Chiho Furuya
- Department of Hematology, Juntendo University School of Medicine
| | - Tadahiro Honda
- Department of Hematology, Juntendo University School of Medicine
| | - Makoto Sasaki
- Department of Hematology, Juntendo University School of Medicine
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine
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Messmer M, Wake L, Tsai HL, Jones RJ, Varadhan R, Wagner-Johnston N. Large Granular Lymphocytosis With Cytopenias After Allogeneic Blood or Marrow Transplantation: Clinical Characteristics and Response to Immunosuppressive Therapy. Transplant Cell Ther 2021; 27:260.e1-6. [PMID: 33781530 DOI: 10.1016/j.jtct.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022]
Abstract
Large granular lymphocytosis (LGL)-or LGL leukemia-is a T- or NK-cell lymphoproliferative disorder that often results in cytopenias and autoimmune phenomena. Several studies have described LGL in a subset of patients after allogeneic blood or marrow transplantation (alloBMT), almost exclusively in the setting of asymptomatic lymphocytosis. Some have suggested an association with improved transplant-related outcomes. In contrast, clinically significant LGL after alloBMT is only described in small case reports. This study sought to assess the characteristics, significance, and response to treatment of LGL associated with unexplained anemia, thrombocytopenia, or neutropenia after alloBMT. We performed a retrospective analysis of 150 patients who were evaluated for LGL by peripheral blood flow cytometry (LGL flow) for unexplained cytopenias following initial engraftment after alloBMT from January 1 2012 to July 1, 2019. We identified patients with abnormally increased populations of LGL cells (LGL+) as assessed by Johns Hopkins Hematopathology. We collected demographic, transplantation, and LGL treatment information from electronic medical records. We compared LGL+ patients to patients with unexplained cytopenias with negative flow cytometry for LGL (LGL-) in this cohort. We also assessed change in blood counts after 4 weeks of immunosuppressive therapy in LGL+ patients. Cytopenias occurred at a median of 5.7 months (range 1-81) after alloBMT. The majority of the transplants were nonmyeloablative from haploidentical donors, and all patients received post-transplantation cyclophosphamide for graft-versus-host disease prophylaxis, consistent with the overall alloBMT characteristics at our center. We identified 70 patients with LGL and cytopenias, representing 47% of those evaluated by flow cytometry. There were no significant demographic or transplant-related differences between LGL+ patients and LGL- patients. The median age was 59, and 63% were male. LGL+ patients were more likely to have had cytomegalovirus (CMV) viremia (73% versus 28%, P < .0001), but not acute or chronic graft-versus-host disease. LGL+ patients had higher absolute lymphocyte counts (1500 versus 485/ mm3, P < .0001), a trend toward lower absolute neutrophil count (660 versus 965/mm3, P = .17), and lower neutrophil to lymphocyte ratio (0.39 versus 1.71, P < .001). There were no differences in overall survival or relapse-free survival. Of those with T-cell LGL, 45 were assessed for T-cell receptor clonality. In all, 22% were clonal, 53% oligoclonal, 4% polyclonal, and 20% indeterminate. Thirty (43%) LGL+ patients received immunosuppressive therapy (IST) for cytopenias. First-line treatment was corticosteroids for 25 (83%). Among those treated, there was an increase in median absolute neutrophil count from 720 before treatment to 1990/mm3 after 4 weeks (P = .0017). Thrombocytopenia and anemia showed at most a mild improvement with IST. LGL was a common association with otherwise unexplained cytopenias after alloBMT, almost always after prior CMV infection. LGL in the setting of cytopenias did not predict improved transplantation outcomes compared to those with cytopenias without presence of LGL. IST was effective at improving neutropenia associated with LGL after alloBMT.
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Bailén R, Kwon M, Pascual-Cascón MJ, Ferrà C, Sanz J, Gallardo-Morillo A, García-Sola A, Torrent A, Jiménez-Lorenzo MJ, Piñana JL, Montoro J, Oarbeascoa G, Dorado N, Gómez-Centurión I, Muñoz C, Martínez-Laperche C, Anguita J, Buño I, Díez-Martín JL; Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH). Post-transplant cyclophosphamide for GVHD prophylaxis compared to ATG-based prophylaxis in unrelated donor transplantation. Ann Hematol 2021; 100:541-53. [PMID: 33140137 DOI: 10.1007/s00277-020-04317-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022]
Abstract
Post-transplant cyclophosphamide (PTCY) effectively prevents graft-versus-host disease after unmanipulated HLA-haploidentical HSCT. The use of PTCY in the unrelated donor HSCT setting is less explored. We conducted a retrospective study of 132 consecutive patients undergoing a matched or 9/10 mismatched unrelated donor HSCT in 4 centers in Spain, 60 with anti-thymocyte globulin (ATG)-based prophylaxis combined with MTX-CsA, and 72 using a PTCY-based regimen. Peripheral blood stem cells were used as graft in most patients (111 patients, 84%); mMUD donors were balanced between groups. Cumulative incidences of grades II-IV and III-IV acute GVHD at 100 days were lower in the PTCy group (46% vs. 67%, p = 0.008; 3% vs. 34%, p = 0.003), without statistically significant differences in the 2-year cumulative incidence of chronic moderate-severe GVHD. At 2 years, no significant differences were observed in overall survival, event-free survival, cumulative incidence of relapse, and non-relapse mortality. GVHD was the most frequent cause of NRM in the ATG group. No differences were observed between groups in the composite endpoint of GVHD-free and relapse-free survival. In this study, PTCy combined with additional immunosuppression after MUD/mMUD HSCT showed a reduction of aGVHD rate with safety results comparable to those obtained with the ATG-based prophylaxis.
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Uppuluri R, Swaminathan VV, Ramanan KM, Meena S, Varla H, Ramakrishnan B, Jayakumar I, Raj R. Haploidentical Stem Cell Transplantation with Post-Transplant Cyclophosphamide in Fanconi Anemia: Improving Outcomes with Improved Supportive Care in India. Biol Blood Marrow Transplant 2020; 26:2292-2298. [PMID: 32835780 DOI: 10.1016/j.bbmt.2020.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022]
Abstract
Fanconi anemia is the most common inherited bone marrow failure syndrome, and hematopoietic stem cell transplantation (HSCT) is the only curative option. Post-transplant cyclophosphamide (PTCy) is challenging in this group of children, given their increased sensitivity to chemotherapy. We performed a retrospective analysis of the data on children diagnosed with Fanconi anemia who underwent a haploidentical HSCT with PTCy from January 2014 to December 2019. Nineteen children (male/female, 0.75:1) underwent 21 haplo-HSCTs with PTCy. Fludarabine, low-dose cyclophosphamide, and 200 centi-gray total body irradiation were included in the conditioning regimen with 25 mg/kg PTCy on days +3 and +4. Haplo-graft was from a sibling in 38% and father in 57% of transplants. The source of stem cells was peripheral blood stem cells in 81% and bone marrow in 19% of transplants, with a median CD34 dose of 5.0 × 106/kg. We documented engraftment in 84% and primary graft failure in 10% of transplants. N-acetylcysteine (NAC) was infused concomitantly during cyclophosphamide in 13 children. Grade 2 and 3 mucositis was lower among those who received NAC as compared to those who did not (30% and 15% versus 33% and 50%), while transaminitis was higher among those who did not receive the infusion. The incidence of acute graft-versus-host disease (GVHD) was 68%, and 81% of these were steroid responsive (grade I/II). We documented chronic GVHD in 25% children, predominantly involving the skin and mouth, which responded to low-dose steroids and ruxolitinib. Serum ferritin was monitored twice weekly as a surrogate marker for cytokine release syndrome due to nonavailability of IL-6 levels. A 1- or 2-log increase in the titers of ferritin associated with clinical features guided the early addition of steroids in the periengraftment period. The mean survival was found to be less among those with high serum ferritin (>10,000 ng/dL) in the periengraftment period as compared to those with ferritin <10,000 ng/dL (mean survival of 25 ± 10 months versus 50 ± 6 months, respectively). The overall survival in our cohort was 68.4%, with a mean survival time of 41.5 months (95% confidence interval, 29.3 to 53.8 months), with a statistically significant correlation between inferior outcome and having received over 15 transfusions before HSCT (P = .01). PTCy can be considered a viable option in children with Fanconi anemia, particularly in resource-limited settings given the high costs of HSCTs. Focused interventions in this subset of children help improve survival outcomes. Early identification of cytokine release syndrome and risk-adapted steroid therapy during engraftment helps prevent mortality. The concomitant use of NAC during cyclophosphamide infusion helps reduce oxygen free radical related tissue damage and regimen-related toxicity.
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Affiliation(s)
- Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India.
| | | | - Kesavan Melarcode Ramanan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Satishkumar Meena
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Harika Varla
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Balasubramaniam Ramakrishnan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
| | - Indira Jayakumar
- Department of Pediatric Critical Care, Apollo Hospitals, Chennai, India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, India
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Patil S, Potter V, Mohty M. Review of conditioning regimens for haplo-identical donor transplants using post-transplant cyclophosphamide in recipients of G-CSF mobilised peripheral stem cell. Cancer Treat Rev 2020; 89:102071. [PMID: 32717620 DOI: 10.1016/j.ctrv.2020.102071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
Haplo-identical transplant is being increasingly used in patients who do not have a readily available matched related or unrelated donor. Post-transplant cyclophosphamide's use due to its simplicity and documented efficacy has made this approach readily employable across diverse transplant centres across the globe. The outcomes of regimens used for conditioning in recipients of bone marrow are at times in variance to that from more commonly employed G-CSF mobilised peripheral stem cell (PBSC). This review highlights various conditioning regimens used in PBSC recipients, with emphasis on toxicities, practicalities and transplant related outcomes of relapse, non-relapse mortality and graft versus host disease.
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Affiliation(s)
- Sushrut Patil
- Alfred Hospital and Monash University, Melbourne, Australia.
| | | | - Mohamad Mohty
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
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Brissot E, Labopin M, Moiseev I, Cornelissen JJ, Meijer E, Van Gorkom G, Rovira M, Ciceri F, Griskevicius L, Blaise D, Forcade E, Mistrik M, Mielke S, Bulabois CE, Niittyvuopio R, Deconinck E, Ruggeri A, Sanz J, Spyridonidis A, Savani B, Giebel S, Nagler A, Mohty M. Post-transplant cyclophosphamide versus antithymocyte globulin in patients with acute myeloid leukemia in first complete remission undergoing allogeneic stem cell transplantation from 10/10 HLA-matched unrelated donors. J Hematol Oncol 2020; 13:87. [PMID: 32620146 PMCID: PMC7333262 DOI: 10.1186/s13045-020-00923-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 05/18/2020] [Accepted: 06/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Graft-versus-host disease (GVHD) remains a major contributor to mortality and morbidity after allogeneic stem-cell transplantation (allo-HSCT). The updated recommendations suggest that rabbit antithymocyte globulin or anti-T-lymphocyte globulin (ATG) should be used for GVHD prophylaxis in patients undergoing matched-unrelated donor (MUD) allo-HSCT. More recently, using post-transplant cyclophosphamide (PTCY) in the haploidentical setting has resulted in low incidences of both acute (aGVHD) and chronic GVHD (cGVHD). Therefore, the aim of our study was to compare GVHD prophylaxis using either PTCY or ATG in patients with acute myeloid leukemia (AML) who underwent allo-HSCT in first remission (CR1) from a 10/10 HLA-MUD. METHODS Overall, 174 and 1452 patients from the EBMT registry receiving PTCY and ATG were included. Cumulative incidence of aGVHD and cGVHD, leukemia-free survival, overall survival, non-relapse mortality, cumulative incidence of relapse, and refined GVHD-free, relapse-free survival were compared between the 2 groups. Propensity score matching was also performed in order to confirm the results of the main analysis RESULTS: No statistical difference between the PTCY and ATG groups was observed for the incidence of grade II-IV aGVHD. The same held true for the incidence of cGVHD and for extensive cGVHD. In univariate and multivariate analyses, no statistical differences were observed for all other transplant outcomes. These results were also confirmed using matched-pair analysis. CONCLUSION These results highlight that, in the10/10 HLA-MUD setting, the use of PTCY for GVHD prophylaxis may provide similar outcomes to those obtained with ATG in patients with AML in CR1.
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Affiliation(s)
- Eolia Brissot
- Sorbonne Université, AP-HP, INSERM UMRs938, Paris, France.
- Service d'Hématologie clinique et de Thérapie cellulaire, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint Antoine, 75012, Paris, France.
| | - Myriam Labopin
- European Society for Blood and Marrow Transplantation Paris Study Office/CEREST-TC, Paris, France
| | - Ian Moiseev
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russian Federation
| | - J J Cornelissen
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ellen Meijer
- Amsterdam University Medical Center, VU Medical Center, Department of Hematology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Gwendolyn Van Gorkom
- Dept. Internal Medicine, Hematology/Oncology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Montserrat Rovira
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Laimonas Griskevicius
- Hematology, Oncology & Transfusion Center, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Didier Blaise
- Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | | | - Martin Mistrik
- Department of Haematology and Transfusion Medicine, University Hospital and Comenius University, Bratislava, Slovak Republic
| | - Stephan Mielke
- Department of Internal Medicine II, University Hospital of Würzburg, Oberdürrbacher Str. 6, D-97080, Würzburg, Germany
| | | | - Riitta Niittyvuopio
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Eric Deconinck
- Service d'Hématologie, Hopital Jean Minjoz, Besançon, France
| | - Annalisa Ruggeri
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Jaime Sanz
- Department of Haematology, University Hospital La Fe, University of Valencia, Valencia, Spain
- Department of Haematology, Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Alexandros Spyridonidis
- Department of Internal Medicine, Bone Marrow Transplantation Unit, University Hospital of Patras, Patras, Greece
| | - Bipin Savani
- Long Term Transplant Clinic, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cencer Center and Institute of Oncology, Gliwice, Poland
| | - Arnon Nagler
- Hematology Division, BMT and Cord Blood Bank, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- Sorbonne Université, AP-HP, INSERM UMRs938, Paris, France
- Service d'Hématologie clinique et de Thérapie cellulaire, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint Antoine, 75012, Paris, France
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Alanazi W, Chen S, Lipton JH, Kim DD, Viswabandya A, Kumar R, Lam W, Law AD, Al-Shaibani Z, Mattsson J, Michelis FV. Post-Transplant Cyclophosphamide Combined with Anti-Thymocyte Globulin as Graft-versus-Host Disease Prophylaxis for Allogeneic Hematopoietic Cell Transplantation in High-Risk Acute Myeloid Leukemia and Myelodysplastic Syndrome. Acta Haematol 2020; 144:66-73. [PMID: 32428903 DOI: 10.1159/000507536] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) is curative for high-risk acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) but with significant non-relapse mortality (NRM) and relapse. We compared the combination of anti-thymocyte globulin (ATG; 4.5 mg/kg) and post-transplant cyclophosphamide (PTCy; 50 mg/kg on day +3 and +4) with other graft-versus-host disease (GvHD) prophylaxis regimens used for these patients. METHODS We retrospectively analyzed 159 patients, aged 22-73 (median 56) years, having undergone transplantation for high-risk AML (n = 120) or MDS (n = 39). The donors were matched related (33%), unrelated (55%) and haploidentical (12%). Almost all patients used peripheral blood stem cells. Conditioning was myeloablative (34%) or reduced intensity (66%). ATG + PTCy was used in 69 patients (43%), and other GvHD prophylaxis regimens in 90 patients (57%). RESULTS Grade III-IV acute GvHD occurred in 4% of the ATG + PTCy patients versus 20% of those using other regimens (p = 0.004), and chronic GvHD in 19% of the ATG + PTCy patients versus 41% of those using other regimens (p = 0.003). Two-year GvHD-free relapse-free survival (GRFS) was 30% with ATG + PTCy versus 18% with other regimens (p = 0.04). Multivariable analysis demonstrated that while ATG + PTCy had no significant influence on overall survival, cumulative incidence of relapse or NRM, there was a significant influence on GRFS in favor of ATG + PTCy (HR = 0.69, 95% CI 0.45-0.99, p = 0.04). CONCLUSIONS We conclude that the ATG + PTCy combination significantly improved GRFS in allogeneic HCT for high-risk AML and MDS without influencing other outcomes.
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Affiliation(s)
- Wael Alanazi
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shiyi Chen
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey H Lipton
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dennis D Kim
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Auro Viswabandya
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rajat Kumar
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Wilson Lam
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Arjun D Law
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Zeyad Al-Shaibani
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonas Mattsson
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Fotios V Michelis
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada,
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Sanz J, Galimard JE, Labopin M, Afanasyev B, Angelucci E, Ciceri F, Blaise D, Cornelissen JJ, Meijer E, Diez-Martin JL, Koc Y, Rovira M, Castagna L, Savani B, Ruggeri A, Nagler A, Mohty M. Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT. J Hematol Oncol 2020; 13:46. [PMID: 32375860 PMCID: PMC7201995 DOI: 10.1186/s13045-020-00882-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023] Open
Abstract
Background The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft-versus-host disease (GVHD) in the haploidentical (Haplo) transplant setting and is being increasingly used in matched sibling (MSD) and matched unrelated (MUD) transplants. There is no information on the impact of donor types using homogeneous prophylaxis with PTCy. Methods We retrospectively compared outcomes of adult patients with acute myeloid leukemia (AML) in first complete remission (CR1) who received a first allogeneic stem cell transplantation (SCT) with PTCy as GVHD prophylaxis from MSD (n = 215), MUD (n = 235), and Haplo (n = 789) donors registered in the EBMT database between 2010 and 2017. Results The median follow-up was 2 years. Haplo-SCT carried a significantly increased risk of acute grade II–IV GVHD (HR 1.6; 95% CI 1.1–2.4) and NRM (HR 2.6; 95% CI 1.5–4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5–0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8–1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8–1.3). Interestingly, the use of peripheral blood was associated with an increased risk of acute (HR 1.9; 95% CI 1.4–2.6) and chronic GVHD (HR 1.7; 95% CI 1.2–2.4) but a lower risk of relapse (HR 0.7; 95% CI 0.5–0.9). Conclusions The use of PTCy in patients with AML in CR1 receiving SCT from MSD, MUD, and Haplo is safe and effective. Haplo-SCT had increased risk of acute GVHD and NRM and lower relapse incidence but no significant difference in survival.
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Affiliation(s)
- Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Avinguda Fernando Abril Martorell, 106, 46026, Valencia, Spain. .,CIBERONC, Instituto Carlos III, Madrid, Spain.
| | | | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Department of Hematology, Hopital Saint Antoine, Sorbonne University, Paris, France
| | - Boris Afanasyev
- First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St Petersburg, Russia
| | - Emanuele Angelucci
- Department of Haematology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Ciceri
- Haematology and BMT, Ospedale San Raffaele s.r.l., Milano, Italy
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Jan J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ellen Meijer
- Department of Hematology (Br 250), VU University Medical Center, Amsterdam, The Netherlands
| | - J L Diez-Martin
- Hematology Department, Hospital GU Gregorio Marañon, Instituto de Investigación sanitaria Gregorio Marañon, Universidad Complutense Madrid, Madrid, Spain
| | - Yener Koc
- Stem Cell Transplant Unit, Medical Park Hospitals, Antalya, Turkey
| | - Montserrat Rovira
- Dept. of Hematology, Institute of Hematology & Oncology, Hospital Clinic, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Institut Josep Carreras, University of Barcelona, Barcelona, Spain
| | - Luca Castagna
- Transplantation Unit, Department of Oncology and Haematology, Istituto Clinico Humanitas, Milan, Italy
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Annalisa Ruggeri
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Piazza S.Onofrio, 4, Rome, Italy
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,ALWP of the EBMT office, Saint Antoine Hospital, Paris, France
| | - Mohamad Mohty
- Department of Hematology, Hopital Saint Antoine, Sorbonne University, Paris, France
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Morozova EV, Barabanshikova MV, Moiseev IS, Shakirova AI, Barhatov IM, Ushal IE, Rodionov GG, Moiseev SI, Surkova EA, Lapin SV, Vlasova JJ, Rudakova TA, Darskaya EI, Baykov VV, Alyanski AL, Bondarenko SN, Afanasyev BV. A Prospective Pilot Study of Graft-versus-Host Disease Prophylaxis with Post-Transplantation Cyclophosphamide and Ruxolitinib in Patients with Myelofibrosis. Acta Haematol 2020; 144:158-165. [PMID: 32325461 DOI: 10.1159/000506758] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/24/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This prospective study evaluated a calcineurin inhibitor-free graft-versus-host disease (GVHD) prophylaxis regimen of ruxolitinib in combination with post-transplant cyclophosphamide (PTCy). Patents and Methods: Twenty patients with primary or secondary myelofibrosis were prospectively enrolled. Reduced intensity conditioning was performed, followed by allogeneic stem cell transplantation from related (n = 7) or unrelated (n = 13) donors. GVHD prophylaxis included only PTCy and ruxolitinib (45 mg) from day-7 to day-2, and 15 mg from day+5 to day+100. This trial was registered at www.clinicaltrials.gov as #NCT02806375. RESULTS Primary engraftment was documented in 17 patients. One patient experienced primary graft failure and 2 died before engraftment. Eleven patients demonstrated severe poor graft function (SPGF), which required ruxolitinib dose reduction. The regimen was well tolerated, with grade 3-4 non-haematological toxicity in 30%, viral reactivation in 45%, and severe sepsis in 15% of patients. The incidence of acute GVHD grade II-IV was 25%, grade III-IV GVHD was 15%, and moderate chronic GVHD was 20%, with no severe cases. Only 2 patients required systemic steroids. Haematological relapse was documented in 1 patient. Two-year non-relapse mortality was 15%, 2-year overall survival was 85%, and 2-year event-free survival was 72%. CONCLUSION GVHD prophylaxis with PTCy and ruxolitinib is associated with low toxicity, good acute and chronic GVHD control, and low relapse incidence. However, the relatively high rate of SPGF should be taken into account. SPGF could possibly be mitigated by ruxolitinib dose reduction.
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Affiliation(s)
- Elena Vladislavovna Morozova
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Maria Vladimirovna Barabanshikova
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation,
| | - Ivan Sergeevich Moiseev
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Alena Igorevna Shakirova
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Ildar Munerovich Barhatov
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Inna Edvardovna Ushal
- Nikiforov Russian Center of Emergency and Radiation Medicine, Saint-Petersburg, Russian Federation
| | | | - Sergey Ivanovich Moiseev
- Nikiforov Russian Center of Emergency and Radiation Medicine, Saint-Petersburg, Russian Federation
| | - Elena Arkadjevna Surkova
- Laboratory of Autoimmune Diagnostics, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Sergey Vladimirovich Lapin
- Laboratory of Autoimmune Diagnostics, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Julia Jurjevna Vlasova
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Tatjana Alexandrovna Rudakova
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Elena Igorevna Darskaya
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Vadim Valentinovich Baykov
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Alksandr Leonidovich Alyanski
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Sergey Nikolaevich Bondarenko
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - Boris Vladimirovich Afanasyev
- R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
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Mallhi KK, Srikanthan MA, Baker KK, Frangoul HA, Torgerson TR, Petrovic A, Geddis AE, Carpenter PA, Baker KS, Sandmaier BM, Thakar MS, Skoda-Smith S, Kiem HP, Storb R, Woolfrey AE, Burroughs LM. HLA-Haploidentical Hematopoietic Cell Transplantation for Treatment of Nonmalignant Diseases Using Nonmyeloablative Conditioning and Post-Transplant Cyclophosphamide. Biol Blood Marrow Transplant 2020; 26:1332-1341. [PMID: 32234377 DOI: 10.1016/j.bbmt.2020.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 01/08/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 01/25/2023]
Abstract
Allogeneic hematopoietic cell transplant (HCT) is often the only curative therapy for patients with nonmalignant diseases; however, many patients do not have an HLA-matched donor. Historically, poor survival has been seen after HLA-haploidentical HCT because of poor immune reconstitution, increased infections, graft-versus-host disease (GVHD), and graft failure. Encouraging results have been reported using a nonmyeloablative T cell-replete HLA-haploidentical transplant approach in patients with hematologic malignancies. Here we report the outcomes of 23 patients with various nonmalignant diseases using a similar approach. Patients received HLA-haploidentical bone marrow (n = 17) or granulocyte colony-stimulating factor-mobilized peripheral blood stem cell (n = 6) grafts after conditioning with cyclophosphamide 50 mg/kg, fludarabine 150 mg/m2, and 2 or 4 Gy total body irradiation. Postgrafting immunosuppression consisted of cyclophosphamide, mycophenolate mofetil, tacrolimus, ± sirolimus. Median patient age at HCT was 10.8 years. Day 100 transplant-related mortality (TRM) was 0%. Two patients died at later time points, 1 from intracranial hemorrhage/disseminated fungal infection in the setting of graft failure and 1 from infection/GVHD. The estimated probabilities of grades II to IV and III to IV acute GVHD at day 100 and 2-year National Institutes of Health consensus chronic GVHD were 78%, 26%, and 42%, respectively. With a median follow-up of 2.5 years, the 2-year overall and event-free rates of survival were 91% and 78%, respectively. These results are encouraging and demonstrate favorable disease-specific lineage engraftment with low TRM in patients with nonmalignant diseases using nonmyeloablative conditioning followed by T cell-replete HLA-haploidentical grafts. However, additional strategies are needed for GVHD prevention to make this a viable treatment approach for patients with nonmalignant diseases.
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Affiliation(s)
- Kanwaldeep K Mallhi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Meera A Srikanthan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Kelsey K Baker
- Clinical Biostatistics, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Haydar A Frangoul
- Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, Tennessee
| | - Troy R Torgerson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Immunology, Seattle Children's Hospital, Seattle, Washington
| | - Aleksandra Petrovic
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Immunology, Seattle Children's Hospital, Seattle, Washington
| | - Amy E Geddis
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, Washington
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Brenda M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Monica S Thakar
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Suzanne Skoda-Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Immunology, Seattle Children's Hospital, Seattle, Washington
| | - Hans-Peter Kiem
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Rainer Storb
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Ann E Woolfrey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Lauri M Burroughs
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, Washington.
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Oltolini C, Greco R, Galli L, Clerici D, Lorentino F, Xue E, Lupo Stanghellini MT, Giglio F, Uhr L, Ripa M, Scarpellini P, Bernardi M, Corti C, Peccatori J, Castagna A, Ciceri F. Infections after Allogenic Transplant with Post-Transplant Cyclophosphamide: Impact of Donor HLA Matching. Biol Blood Marrow Transplant 2020; 26:1179-1188. [PMID: 32004700 DOI: 10.1016/j.bbmt.2020.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
Incidence and outcome of infections after allogeneic hematopoietic stem cell transplantation (HSCT) with post-transplant cyclophosphamide (PT-Cy) as graft-versus-host disease (GVHD) prophylaxis are largely unknown. Study aims were to estimate the incidence of pre-engraftment bloodstream infections (PE-BSIs) and viral infections (VIs; cytomegalovirus [CMV], adenovirus [ADV], human herpes virus 6 [HHV6], and BK-polyomavirus hemorrhagic-cystitis [BKPyV-HC]), their predictive factors, and infection-related mortality (IRM) after HSCT with PT-Cy. We analyzed 235 patients: 62%, 21%, and 17% received haploidentical (haplo), matched-unrelated donor (MUD), and matched-related donor, respectively. Overall, 72 patients had 77 PE-BSI episodes at a median time of 13 days after HSCT: cumulative incidence function (CIF) at 28 days was 32%, without differences among donor types (P = .988). By multivariate analysis, CIF of PE-BSI was higher in patients with severe neutropenia before HSCT (adjusted hazard ratio [AHR] = 2.90) and in multidrug-resistant Gram-negative bacteria rectal carriers (AHR = 2.68). IRM at 30 days was 5%, without differences by donor type (P = .106). Overall, 208 patients experienced ≥1 VIs (first occurrence among CMV, HHV6, ADV, BKPyV-HC) at a median time of 20 days after HSCT: CIF at 90 days was 91%, significantly higher in MUD and haplo (P = .0089). By multivariate analysis, also acute GVHD grade ≥2 (AHR = 1.32) and host/donor CMV-serology mismatch (positive/positive versus negative/negative: AHR = 2.95, positive/negative versus negative/negative: AHR = 2.41, negative/positive versus negative/negative: AHR = 2.35) affected VIs occurrence. IRM at 180 days was 8%, without differences among donor types (P = .106). In conclusion, study results did not show a significant impact of donor type on PE-BSI incidence; conversely, MUD and haploidentical transplants retained a higher occurrence of VIs in the early phase after HSCT.
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Affiliation(s)
- Chiara Oltolini
- Clinic of Infectious Diseases, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Greco
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Clinic of Infectious Diseases, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Clerici
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Lorentino
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Xue
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Fabio Giglio
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lina Uhr
- Clinic of Infectious Diseases, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Clinic of Infectious Diseases, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Scarpellini
- Clinic of Infectious Diseases, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Bernardi
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Consuelo Corti
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jacopo Peccatori
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Clinic of Infectious Diseases, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
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Tegla C, Choi J, Abdul-Hay M, Cirrone F, Cole K, Al-Homsi AS. Current Status and Future Directions in Graft- Versus-Host Disease Prevention Following Allogeneic Blood and Marrow Transplantation in Adults. Clin Hematol Int 2020; 2:5-12. [PMID: 34595437 PMCID: PMC8432335 DOI: 10.2991/chi.d.200115.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/07/2020] [Indexed: 12/22/2022] Open
Abstract
Graft-versus-host disease (GvHD) in its acute and chronic forms continues to represent a significant barrier to the success and wide-applicability of blood and marrow transplantation as a potentially curative treatment modality for a number of benign and malignant blood conditions. Presently, calcineurin inhibitor (CNI)-based regimens remain the most commonly used prevention strategy, although post-transplant cyclophosphamide is emerging as an alternative approach, and is providing a backbone for innovative CNI-free combinations. In this paper, we review the current strategies used for the prevention of GvHD, and highlight some of the developing and promising combinations.
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Affiliation(s)
- Cosmin Tegla
- Division of Hematology and Medical Oncology, New York University Langone Health, New York, NY, USA
| | - Jun Choi
- Division of Hematology and Medical Oncology, New York University Langone Health, New York, NY, USA
| | - Maher Abdul-Hay
- Blood and Marrow Transplantation Program, New York University Langone Health, New York, NY, USA
| | - Frank Cirrone
- Blood and Marrow Transplantation Program, New York University Langone Health, New York, NY, USA
| | - Kelli Cole
- Blood and Marrow Transplantation Program, New York University Langone Health, New York, NY, USA
| | - A Samer Al-Homsi
- Blood and Marrow Transplantation Program, New York University Langone Health, New York, NY, USA
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Jones RJ. Is post-transplant cyclophosphamide a true game-changer in allogeneic transplantation: The struggle to unlearn. Best Pract Res Clin Haematol 2019; 32:101112. [PMID: 31779984 DOI: 10.1016/j.beha.2019.101112] [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] [Indexed: 10/25/2022]
Abstract
Close HLA matching of donors and recipients has been the dogma for successful allogeneic blood or marrow transplantation (BMT), to limit the complications of graft rejection and graft-versus-host disease (GVHD). However, many patients in need, especially those in certain racial and ethnic groups such as African-Americans and Hispanics, are unable to find matches despite increased availability of unrelated donors. Unfortunately, despite many early attempts to develop safe, related haploidentical allogenic BMT, mortality rates exceeding 50% from severe GVHD led most centers to steer away from such transplants by the mid-1990s. However, recent advances based largely on the development of high-dose post-transplant cyclophosphamide GVHD prophylaxis, now yield results with haploidentical related donors that approach those with matched donors. With emerging data that younger donor age may be the most important donor selection criterion, HLA-mismatched donors may even have advantages over matched donors in certain situations. Although the exact role that haploidentical donors should play in donor selection strategies is still being defined, the lack of an HLA-matched donor should no longer ever be an exclusion for allogeneic BMT. Unfortunately, this progress in donor availability has not yet been fully recognized by the medical community. Such a discordance between new advances and their clinical translation highlights that changing standard practice is difficult and takes longer than it should, at least in part because it requires "unlearning" long-standing behaviors.
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Affiliation(s)
- Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, United States.
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Wang Y, Wu DP, Liu QF, Xu LP, Liu KY, Zhang XH, Yu WJ, Xu Y, Huang F, Huang XJ. Low-dose post-transplant cyclophosphamide and anti-thymocyte globulin as an effective strategy for GVHD prevention in haploidentical patients. J Hematol Oncol 2019; 12:88. [PMID: 31481121 PMCID: PMC6724335 DOI: 10.1186/s13045-019-0781-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Low-dose post-transplant cyclophosphamide (PTCy) in conjunction with anti-thymocyte globulin (ATG) appears as a potentially effective graft-versus-host disease (GVHD) prevention strategy in haploidentical hematopoietic cell transplant (haplo-HCT). Our study aims to assess the efficacy of this regimen. METHODS We extended our prospective study in patients treated with low-dose PTCy (14.5 mg/kg on days 3 and 4) in ATG/granulocyte colony-stimulating factor (G-CSF)-based regimen and compared the results to the contemporary cohort of patients without low-dose PTCy (ATG cohort). Both study cohort and control are transplanted from maternal donor or collateral relatives. RESULTS We identified 239 consecutive patients (ATG-PTCy cohort = 114; ATG cohort = 125). All patients but one in ATG cohort achieved myeloid engraftment by day 30 post-HCT. We found that both the cumulative incidence of 100-day grade III-IV aGvHD and non-relapse-mortality (NRM) in the ATG-PTCy cohort was significantly reduced than that in the ATG group (5% vs 18%; P = 0.003; and 6% vs 15%; P= 0.045); the 2-year cumulative incidences of relapse and overall survival were comparable between the two cohorts (13% vs 14%; P = 0.62; and 83% vs 77%; P = 0.18, respectively). Furthermore, GVHD-free, relapse-free survival (GRFS) was significantly improved in the ATG-PTCy arm (63% vs 48%; P = 0.039). In multivariate analysis, the joint treatment resulted in lower grade II-IV acute GVHD (HR 0.58; P = 0.036), grade III-IV aGvHD (HR 0.28; P = 0.006), chronic GVHD (HR 0.60; P = 0.047), NRM (HR 0.26; P = 0.014), and higher GRFS (HR 0.59; P = 0.021) but slower myeloid and platelet recovery (HR 0.29 and 0.30; both P < 0.001). CONCLUSIONS These results suggested that ATG/PTCy (low-dose) can reduce both acute and chronic GVHD as compared with standard ATG-based prophylaxis using maternal donor or collateral relatives at particular high GVHD risk.
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Affiliation(s)
- Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - De-Pei Wu
- The first affiliated hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Qi-Fa Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China
| | - Wen-Jing Yu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yang Xu
- The first affiliated hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Fen Huang
- Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No.11, Xizhimen South Street, Xicheng District, Beijing, 100044, China.
- Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China.
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Solomon SR, Solh M, Zhang X, Morris LE, Holland HK, Bashey A. Fludarabine and Total-Body Irradiation Conditioning before Ablative Haploidentical Transplantation: Long-Term Safety and Efficacy. Biol Blood Marrow Transplant 2019; 25:2211-2216. [PMID: 31247313 DOI: 10.1016/j.bbmt.2019.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
Although myeloablative conditioning (MAC) before haploidentical donor transplant (HIDT) with post-transplant cyclophosphamide is being increasingly used, the optimal preparative regimen remains unclear. In our initial trial, the feasibility of HIDT following a MAC preparative regimen using fludarabine and 12 Gy of total-body irradiation was demonstrated in 30 patients. We now present long-term outcome results, including an additional 52 patients, now with 47 months (16 to 96) median follow-up. Median patient age was 42 (19 to 61) years. The most common diagnoses were acute myelogenous leukemia (51%) and acute lymphoblastic leukemia (33%), and 39% had a high/very high disease risk index (DRI). Engraftment was universal with no cases of primary or secondary graft failure. Grade 3 to 4 acute graft-versus-host disease (GVHD) and moderate to severe chronic GVHD occurred in 17% and 23%, respectively. Nonrelapse mortality (NRM) was 7% at 1 year and 13% at 4 years. Estimated 4-year overall survival (OS), disease-free survival, and cumulative incidence of relapse (CIR) were 67%, 60%, and 27%, respectively. CIR was significantly higher in patients with high/very high- versus low/intermediate-risk DRI (38% versus 20%, P= .032), which led to inferior 4-year OS (50% versus 77%, P = .001). Median time to systemic immunosuppressive therapy (IST) discontinuation was 7.8 months, with 84% of patients off IST at 2 years post-transplant. Current GHVD-free, relapse-free survival (CGRFS) at 2, 3, and 4 years was 60%, 57%, and 60%, respectively. This approach to MAC HIDT results in universal engraftment; low rates of NRM, infection, and clinically significant GVHD; and relatively rapid IST discontinuation, resulting in high rates of CGRFS and survival.
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Affiliation(s)
- Scott R Solomon
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
| | - Melhem Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Xu Zhang
- School of Public Health, University of Texas, Houston, Texas
| | - Lawrence E Morris
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - H Kent Holland
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Asad Bashey
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
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47
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Salas MQ, Law AD, Lam W, Al-Shaibani Z, Loach D, Kim DDH, Michelis FV, Thyagu S, Kumar R, Lipton JH, Mattsson J, Viswabandya A. Safety and Efficacy of Haploidentical Peripheral Blood Stem Cell Transplantation for Myeloid Malignancies Using Post-transplantation Cyclophosphamide and Anti-thymocyte Globulin as Graft- versus-Host Disease Prophylaxis. Clin Hematol Int 2019; 1:105-113. [PMID: 34595418 PMCID: PMC8432390 DOI: 10.2991/chi.d.190316.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022] Open
Abstract
Haploidentical stem cell transplantation (haploSCT) has greatly improved access to curative treatment for myeloid malignancies in patients without suitable matched sibling/unrelated donors. We investigated the safety and efficacy of haploSCT after reduced intensity conditioning (RIC) with anti-thymocyte globulin (ATG), post-transplant cyclophosphamide (PTCy), and cyclosporine to prevent rejection and graft-versus-host disease (GVHD). In this study, 47 patients received RIC using fludarabine, busulfan, and total body irradiation (200 cGy). Unmanipulated peripheral blood grafts were used. GVHD prophylaxis included ATG (4.5 mg/kg day−3 to −1), PTCy (50 mg/kg/day day +3, +4), and cyclosporine from day +5. The median follow-up was 15 months (range 3–27). Thirty one (66%) patients had acute myeloid leukemia (AML), 10 (21%) had high-risk myelodysplastic syndrome, and 6 (13%) had a myeloproliferative neoplasia. Median age was 60 years (range 22–73). The d+100 cumulative incidences of grade II–IV and III–IV acute GVHD were 17% (95% confidence interval (CI) 7.9–29.1) and 6.4% (1.6–15.9), respectively. The cumulative incidence of moderate-severe chronic GVHD at 1 year was 15.2% (95% CI 6.5–27.1). Overall survival (OS) and relapse-free survival (RFS) were 55.2% (95% CI 39.5–68.4) and 49.5% (95% CI 34.2–63), respectively. Nonrelapse mortality (NRM) for all patients at 1 year was 37.1% (95% CI 23.2–51.1). Infection was the main cause of death (26%). For AML, 1-year OS, RFS, and NRM were 64.1% (95% CI 43.3–78.9), 54.5 (95% CI 34.6–70.7), and 26.8% (95% CI 12.3–43.6), respectively. In conclusion, unmanipulated haploidentical peripheral blood stem cells (PBSC) transplantation following RIC and dual in vivo T-cell depletion results in a low incidence of acute and chronic GVHD for patients diagnosed with myeloid malignancies.
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Affiliation(s)
- Maria Queralt Salas
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Arjun Datt Law
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Wilson Lam
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Zeyad Al-Shaibani
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - David Loach
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Dennis Dong Hwan Kim
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Fotios V Michelis
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Santhosh Thyagu
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Rajat Kumar
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jeffrey Howard Lipton
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jonas Mattsson
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Auro Viswabandya
- Hans Messner Allogeneic Blood and Marrow Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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48
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Prata PH, Resche-Rigon M, Blaise D, Socié G, Rohrlich PS, Milpied N, Turlure P, Nguyen S, Sirvent A, Bulabois CE, Berceanu A, Charbonnier A, Chevallier P, Bay JO, Neven B, Jubert C, Mohty M, Rubio MT, Peffault de Latour R. Outcomes of Salvage Haploidentical Transplant with Post-Transplant Cyclophosphamide for Rescuing Graft Failure Patients: a Report on Behalf of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2019; 25:1798-1802. [PMID: 31129355 DOI: 10.1016/j.bbmt.2019.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/26/2019] [Accepted: 05/12/2019] [Indexed: 01/27/2023]
Abstract
Prognosis of patients with graft failure is dismal, and retransplantation is the sole option for long-term survival. To address the interest of haploidentical transplantation as a salvage option in this context, we analyzed data from 24 patients with graft failure or loss retransplanted with a haploidentical donor who received post-transplant cyclophosphamide (PTCy) as graft-versus-host disease prophylaxis (GVHD). Fludarabine-based reduced-intensity conditioning was used in 23 patients and the Baltimore regimen in 14 patients. The median delay between previous and salvage transplantation for graft failure was 63 days (range, 39 to 98). In addition to PTCy, all patients received cyclosporine, and 22 patients also received mycophenolate mofetil for GVHD prophylaxis. With a median follow-up of 353 days (range, 16 to 2010), 1-year overall survival (OS) was 56% (95% confidence interval, 38% to 81%). Transplant complications accounted for 80% of deaths. The cumulative incidence of neutrophil engraftment at day +30 was 79%. Cumulative incidence of grades II to IV acute GVHD at day 100 was 14%, and 1-year cumulative incidence of chronic GVHD was 31%. One-year cumulative incidence of relapse was 13%. Stem cell source did not impact on engraftment, GVHD, relapse, or OS. Salvage haploidentical transplant with PTCy for rescuing graft failure patients leads to an acceptable 1-year OS and might be a valid option in this poor situation.
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Affiliation(s)
- Pedro H Prata
- Bone Marrow Transplant Unit, Saint Louis Hospital, Paris, France.
| | | | - Didier Blaise
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Gérard Socié
- Bone Marrow Transplant Unit, Saint Louis Hospital, Paris, France
| | | | - Noel Milpied
- Department of Hematology, Haut-Leveque Hospital, Bordeaux, France
| | - Pascal Turlure
- Department of Hematology, CHU de Limoges, Limoges, France
| | - Stephanie Nguyen
- Department of Hematology, Pitié Salpêtrière Hospital, Paris, France
| | - Anne Sirvent
- Department of Pediatric Onco-Hematology, CHU de Montpellier, Montpellier, France
| | | | - Ana Berceanu
- Department of Hematology, CHU Jean Minjoz, Besançon, France
| | | | | | - Jacques-Olivier Bay
- Department of Hematology and Cell Therapy, CHU Estaing, Clermont Ferrand, France
| | - Benedicte Neven
- Department of Pediatric Immunology and Hematology, Necker Hospital, Paris, France
| | - Charlotte Jubert
- Department of Pediatric Onco-Hematology, Pellegrin Hospital, Bordeaux, France
| | - Mohamad Mohty
- Department of Hematology, Saint Antoine Hospital, Paris, France
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49
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Abstract
Haploidentical donors are a readily available source for mismatched hematopoietic bone marrow transplantation. The application of this regimen is constantly increasing with the advent of methods that overcome T-cell alloreactions that occur due to human-leukocyte-antigen disparity between host and donor. One successful method to overcome both graft rejection and graft-vs-host disease is transplantation of large numbers T-cell-depleted (TCD) haploidentical stem cell grafts (haploSCT), after myeloablative conditioning. The success of stem cell dose escalation is attributed to a unique immunoregulatory cell-property, termed "veto-activity." However, engraftment of mismatched hematopoietic stem cells following reduced-intensity conditioning still represents a major challenge. Here, we describe how the addition of post-transplant high-dose cyclophosphamide can promote immune tolerance induction after megadose TCD haploSCT, following nonmyeloablative conditioning. We also discuss ways of harnessing the immune regulatory properties of adoptively transferred "veto" cells to support mixed chimerism further and confer tolerance to cell-therapies, such as CAR-T cells. These approaches will soon be tested in phase 1-2 clinical studies and may prove to be a safe and efficacious treatment for many disorders such as hemoglobinopathies, autoimmune diseases, and as a prelude for organ tolerance. Moreover, this approach could pave the way for "off-the-shelf" cell-therapy agents, making them cheaper and easily obtainable.
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Affiliation(s)
- Yair Reisner
- Stem Cell Research, Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, TX.
| | - Noga Or-Geva
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Interdepartmental Program in Immunology, Stanford, TX
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50
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Kanate AS, Szabo A, Raj RV, Bower K, Grulke R, Shah N, Ross KG, Cumpston A, Craig M, Pasquini MC, Shah N, Hari P, Hamadani M, Chhabra S. Comparison of Graft Acquisition and Early Direct Charges of Haploidentical Related Donor Transplantation versus Umbilical Cord Blood Transplantation. Biol Blood Marrow Transplant 2019; 25:1456-1464. [PMID: 30878605 DOI: 10.1016/j.bbmt.2019.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/10/2019] [Indexed: 11/18/2022]
Abstract
Alternative donor allogeneic hematopoietic cell transplants (HCTs), such as double umbilical cord blood transplants (dUCBT) and haploidentical related donor transplants (haplo-HCT), have been shown to be safe and effective in adult patients who do not have an HLA-identical sibling or unrelated donor available. Most transplant centers have committed to 1 of the 2 alternative donor sources, even with a lack of published randomized data directly comparing outcomes and comparative data on the cost-effectiveness of dUCBT versus haplo-HCT. We conducted a retrospective study to evaluate and compare the early costs and charges of haplo-HCT and dUCBT in the first 100 days at 2 US transplant centers. Forty-nine recipients of haplo-HCT (at 1 center) and 37 with dUCBT (at another center) were included in the analysis. We compared graft acquisition, inpatient/outpatient, and total charges in the first 100 days. The results of the analysis showed a significantly lower cost of graft acquisition and lower total charges (for 100-day HCT survivors) in favor of haplo-HCT. Importantly, to control for the obvious shortcomings of comparing costs at 2 different transplant centers, adjustments were made based on the current (2018) local wage index and inflation rate. In the absence of further guidance from a prospective study, the cost analysis in this study suggests that haplo-HCT may result in early cost savings over dUCBT and may be preferred by transplant centers and for patients with more limited resources.
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Affiliation(s)
- Abraham S Kanate
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Aniko Szabo
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Renju V Raj
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathryn Bower
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Rachel Grulke
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nilay Shah
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Kelly G Ross
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Aaron Cumpston
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Michael Craig
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Marcelo C Pasquini
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nirav Shah
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran Hari
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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