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Iguchi A, Cho Y, Yabe H, Kato S, Kato K, Hara J, Koh K, Takita J, Ishihara T, Inoue M, Imai K, Nakayama H, Hashii Y, Morimoto A, Atsuta Y, Morio T. Long-term outcome and chimerism in patients with Wiskott-Aldrich syndrome treated by hematopoietic cell transplantation: a retrospective nationwide survey. Int J Hematol 2019; 110:364-369. [PMID: 31187438 DOI: 10.1007/s12185-019-02686-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/22/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
We analyzed the outcomes of allogeneic stem cell transplantation (SCT) and risk factors for chimerism in 108 patients with Wiskott-Aldrich syndrome (WAS) who were registered with The Japan Society for Hematopoietic Cell Transplantation between January 1985 and December 2016. A preparative conditioning regimen consisting of myeloablative conditioning (MAC) was provided to 76 patients, and reduced-intensity conditioning was provided to 30 patients. Fifty-one patients received prophylaxis against graft-versus-host disease (GVHD) with cyclosporine, and 51 patients received tacrolimus (Tac). Chimerism analyses had been performed in 91 patients. Neutrophil engraftment was achieved in 91 patients (84.3%). The engraftment rate was significantly higher in patients who received Tac for GVHD prophylaxis (p = 0.028). Overall survival rate (OS) was significantly higher in patients with complete chimerism than in patients with mixed chimerism (88.2 ± 6.1% and 66.7 ± 9.9%, respectively, p = 0.003). Multivariate analysis showed that the rate of complete chimerism in patients who received MAC including cyclophosphamide (CY) at a dose of 200 mg/kg was significantly higher (p = 0.021) than that in patients who received other conditioning. Thus, MAC including CY at a dose of 200 mg/kg and Tac for GVHD prophylaxis were optimal conditions of SCT for patients with WAS under existing study.
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Affiliation(s)
- Akihiro Iguchi
- Department of Pediatrics, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8638, Japan.
| | - Yuko Cho
- Department of Pediatrics, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiromasa Yabe
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Shunichi Kato
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Junichi Hara
- Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Junko Takita
- Department of Cell Therapy and Transplantation Medicine (Pediatrics), The University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Ishihara
- Department of Pediatrics, Nara Medical University Hospital, Nara, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Kohsuke Imai
- Department of Pediatrics, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideki Nakayama
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yoshiko Hashii
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Morimoto
- Children's Medical Center Tochigi, Jichi Medical University, Shimotsuke, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiro Morio
- Department of Pediatrics, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
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Imataki O, Matsumoto K, Uemura M. Low-dose anti-thymocyte globulin reduce severe acute and chronic graft-versus-host disease after allogeneic stem cell transplantation. J Cancer Res Clin Oncol 2017; 143:709-15. [PMID: 28062916 DOI: 10.1007/s00432-016-2329-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/22/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anti-thymocyte globulin (ATG) administered at 5-10 mg/kg can prevent graft-versus-host disease (GVHD). We sought to investigate the potential for lower doses of ATG to decrease non-relapse mortality (NRM). METHODS We consecutively compared the outcomes of patients with hematological diseases who received allogeneic stem cell transplants from allogeneic related or unrelated donors before February 2010 and were not administered ATG (reference arm), with those administered 2.5 mg/kg ATG after March 2010 (treatment arm). RESULTS We recruited 19 patients into each arm (median age 49 years, range 19-64). 16 patients received myeloablative preparation regimens and 22 patients received toxicity-reduced preparation regimens. All but one patient achieved engraftment, and one secondary graft failure was observed. Overall incidence of acute and chronic GVHD were 63.2 and 15.8%, respectively, in the ATG arm (21.1% grade II to IV, and 0.0% grade III/IV acute GVHD), and 57.9 and 47.4%, respectively, in the reference arm (31.6% grade II to IV, and 21.1% grade III/IV acute GVHD). The estimated probability of overall survival (OS) at 6 years and relapse rate 3 years after transplantation were 49.2 and 26.3% for the ATG arm, respectively, and 54.2 and 21.1% for the reference arm, respectively. The rate of NRM was 10.5% in the ATG arm and 26.3% in the reference arm. No patients died as a result of acute or chronic GVHD. CONCLUSIONS Low-dose ATG may suppress severe acute GVHD and chronic GVHD without increasing NRM, and can be used safely for Japanese patients receiving transplants from HLA-matched donors.
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