1
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Takahashi T, Watkins B, Bratrude B, Neuberg D, Hebert K, Betz K, Yu A, Choi SW, Davis J, Duncan C, Giller R, Grimley M, Harris AC, Jacobsohn D, Lalefar N, Farhadfar N, Pulsipher MA, Shenoy S, Petrovic A, Schultz KR, Yanik GA, Blazar BR, Horan JT, Langston A, Kean LS, Qayed M. The Adverse Event Landscape of Stem Cell Transplant: Evidence for aGVHD Driving Early Transplant Associated Toxicities. Transplant Cell Ther 2024:S2666-6367(24)00317-8. [PMID: 38583802 DOI: 10.1016/j.jtct.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
Although unrelated-donor (URD) hematopoietic cell transplantation (HCT) is associated with many toxicities, a detailed analysis of adverse events, as defined by the Common Terminology Criteria for Adverse Events (CTCAE), has not previously been curated. This represents a major unmet need, especially as it relates to assessing the safety of novel agents. We analyzed a detailed AE database from the "ABA2" randomized, double-blind, placebo-controlled clinical trial of abatacept for acute graft-versus-host disease (aGVHD) prevention, for which the FDA mandated a detailed AE assessment through Day +180, and weekly neutrophil and platelet counts through Day +100. These were analyzed for their relationship to key transplant outcomes, with a major focus on the impact of aGVHD on the development/severity of AEs. A total of 2102 AEs and 1816 neutrophil/platelet counts were analyzed from 142 8/8-HLA-matched URD HCT recipients on ABA2 (placebo cohort, n = 69, abatacept cohort, n = 73). This analysis resulted in 2 major observations. (1) Among graft source, conditioning intensity, age, and Grade 2 to 4 aGVHD, only aGVHD impacted Grade 3 to 5 AE acquisition after the first month post-transplant. (2) The development of Grade 3 to 4 aGVHD was associated with thrombocytopenia. We have created a detailed resource for the transplant community by which to contextualize clinical toxicities after transplant. It has identified aGVHD as a major driver of post-HCT Grade 3 to 5 AEs, and underscored a link between aGVHD and thrombocytopenia. This establishes a critical safety framework upon which the impact of novel post-transplant aGVHD therapeutics should be evaluated. This trial was registered at www.clinicaltrials.gov (#NCT01743131).
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Affiliation(s)
- Takuto Takahashi
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Benjamin Watkins
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, Georgia
| | - Brandi Bratrude
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna Neuberg
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kyle Hebert
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kayla Betz
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alison Yu
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Jeffrey Davis
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christine Duncan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Roger Giller
- Center for Cancer and Blood Disorders, Children Hospital of Colorado, University of Colorado, Aurora, Colorado
| | - Michael Grimley
- University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew C Harris
- Memorial Sloan Kettering Cancer Center, New York City, New York
| | - David Jacobsohn
- Children's National Health System, Washington, District of Columbia
| | - Nahal Lalefar
- University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | | | - Michael A Pulsipher
- Spencer Fox Eccles School of Medicine at the University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, Utah
| | - Shalini Shenoy
- Washington University School of Medicine, St Louis, Missouri
| | - Aleksandra Petrovic
- Seattle Children's Hospital and Fred Hutch Cancer Center, Seattle, Washington
| | - Kirk R Schultz
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - John T Horan
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amelia Langston
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Leslie S Kean
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, Georgia
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2
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Hammami MB, Verceles JA, Goldfinger M, Shah N, Sica RA, Mantzaris I, Kornblum N, Konopleva M, Shastri A, Shapiro LC, Feldman EJ, Gritsman K, Verma A, Cooper DL. Improving Unrelated Donor Equity: Assessing Mismatched Donor Opportunities with Real-World Data in a Minority-Predominant Cohort. Transplant Cell Ther 2024:S2666-6367(24)00227-6. [PMID: 38417677 DOI: 10.1016/j.jtct.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
Recent advances in graft-versus-host disease (GVHD) prophylaxis including post-transplant cyclophosphamide (PTCy) and abatacept have significantly improved outcomes following HLA-mismatched allogenic hematopoietic stem cell transplantation (allo-HSCT) and have tremendous potential for reducing racial disparities in donor availability. A recent small study employing bone marrow as the source of stem cells showed similar outcomes after 5/8 versus 7/8 matches and is currently being tested in a larger study using peripheral blood stem cells. In this study, we examine real-world alternative donor HSCT options for a minority-predominant cohort in the Bronx, NY, focusing on the availability of lesser-matched (5/8 to 7/8) donors. Records of patients who underwent HLA typing at Montefiore Medical Center (2019 to 2022) were reviewed. The National Marrow Donor Program registry was queried to evaluate the availability of donors with at least 99% likelihood of HLA match at various levels (5/8, 6/8, 7/8, 8/8). Two hundred forty-one patients were included, 70% were non-White. Although the availability of ≥7/8 donors was less common in non-White patients, 100% of patients from each group had at least one or more 5/8 and 6/8 HLA-matched donors and more than 80% of these patients had >100 potential 5/8 and 6/8 HLA-matched donors. There was no statistical difference by race or ethnicity in the mean number of donors at 5/8 and 6/8 HLA-match levels. We demonstrate through real-world data that patients from diverse ethnic and racial backgrounds have access to 5/8 and 6/8 HLA-matched donors for allo-HSCT, potentially eliminating disparities in donor availability and allowing prioritization of other donor selection characteristics such as donor age, sex, ABO, and B leader matching. Further work is needed to study whether the use of mismatched donors offers a more potent graft-versus malignancy effect and optimal GVHD prophylaxis.
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Affiliation(s)
- M Bakri Hammami
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Jhannine Alyssa Verceles
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mendel Goldfinger
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Nishi Shah
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - R Alejandro Sica
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Ioannis Mantzaris
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Noah Kornblum
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Marina Konopleva
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Aditi Shastri
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Lauren C Shapiro
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Eric J Feldman
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Kira Gritsman
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Amit Verma
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Dennis L Cooper
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
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3
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Ortí G, Gras L, Koster L, Kulagin A, Byrne J, Apperley JF, Halaburda K, Blau IW, Clark A, Kröger N, Griskevicius L, Carlson K, Collin M, Bloor A, Raiola AM, Blaise D, Aljurf M, López-Corral L, Sakellari I, Beguin Y, Wrobel T, de Rosa L, de Lavallade H, Hayden PJ, McLornan D, Chalandon Y, Yakoub-Agha I. Graft-versus-Host Disease Prophylaxis with Post- Transplantation Cyclophosphamide in Chronic Myeloid Leukemia Patients Undergoing Allogeneic Hematopoietic Cell Transplantation from an Unrelated or Mismatched Related Donor: A Comparative Study from the Chronic Malignancies Working Party of the EBMT (CMWP-EBMT). Transplant Cell Ther 2024; 30:93.e1-93.e12. [PMID: 37783337 DOI: 10.1016/j.jtct.2023.09.019] [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: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
Outcomes following allogeneic hematopoietic cell transplantation (allo-HCT) for chronic myeloid leukemia (CML) with post-transplantation cyclophosphamide (PTCy) using an unrelated donor (UD) or a mismatched related donor (MMRD) remain unknown. We report a retrospective comparison of PTCy-based allo-HCT from a UD, non-PTCy allo-HCT from a UD, and PTCy allo-HCT from an MMRD. Inclusion criteria were adult patients with CML undergoing first allo-HCT between 2012 and 2019 from a UD with either PTCy or non-PTCy graft-versus-host disease (GVHD) prophylaxis or from an MMRD using PTCy. The primary endpoint was GVHD-free/relapse-free survival (GRFS). A total of 1341 patients were included (82% in the non-PTCy UD cohort). With a median follow-up of 34.9 months, the 3-year GRFS was 43% in the non-PTCy cohort, 37% in the PTCy-UD cohort, and 39% PTCy-MMRD cohort (P = .15). Multivariable analyses revealed no significant differences among the 3 cohorts in terms of overall survival (OS), progression-free survival, RI, and nonrelapse mortality. Factors independently associated with worse OS in the overall cohort were Karnofsky Performance Status <90 (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.41 to 2.45; P < .001), older age (HR, 1.24, 95% CI, 1.11 to 1.38; P < .001), and disease stage (compared to chronic phase [CP] 1): blast phase (HR, 2.25; 95% CI, 1.60 to 3.16; P < .001), accelerated phase (HR, 1.63; 95% CI, 1.05 to 2.54; P = .03), and CP >2 (HR, 1.58; 95% CI, 1.15 to 2.17; P = .005). These results suggest that allo-HCT in patients with CML using either a UD or an MMRD with PTCy-based GVHD prophylaxis are feasible transplantation, platforms and that the disease stage at allo-HCT remains a major prognostic factor, highlighting the importance of closely monitoring CML patients and proposing transplantation when indicated when still in CP1.
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Affiliation(s)
- Guillermo Ortí
- Department of Hematology, Vall d`Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
| | - Luuk Gras
- EBMT Statistical Unit, Leiden, the Netherlands
| | | | - Aleksander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, Petersburg, Russian Federation
| | - Jenny Byrne
- Nottingham University, Nottingham, United Kingdom
| | | | | | | | - Andrew Clark
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | | | - Matthew Collin
- Northern Centre for Bone Marrow Transplantation, Newcastle Upon Tyne, United Kingdom
| | - Adrian Bloor
- Christie NHS Trust Hospital, Manchester, United Kingdom
| | | | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Marseille, France
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Lucia López-Corral
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | | | - Yves Beguin
- University of Liege and CHU of Liege, Liege, Belgium
| | | | | | | | | | | | - Yves Chalandon
- Hematology Division and Faculty of Medicine, Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland
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4
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Wang L, Kong P, Zhang C, Gao L, Zhu L, Liu J, Gao S, Chen T, Liu H, Yao H, Liu Y, Feng Y, Zhao L, Li Y, Gao L, Zhang X. Outcomes of patients with hematological malignancies who undergo unrelated donor hematopoietic stem cell transplantation with ATG-Fresenius versus ATG-Genzyme. Ann Hematol 2023; 102:1569-1579. [PMID: 37097455 PMCID: PMC10182153 DOI: 10.1007/s00277-023-05220-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
To compare the outcomes of patients with hematological malignancies who received ATG-Fresenius (ATG-F) 20 mg/kg versus those who received ATG-Genzyme (ATG-G) 10 mg/kg in an unrelated donor hematopoietic stem cell transplantation (HSCT) procedure, a total of 186 patients who underwent their first allogeneic HSCT with an unrelated donor were retrospectively analyzed. One hundred and seven patients received ATG-F, and seventy-nine patients received ATG-G. Multivariate analysis showed that the type of ATG preparation had no effect on neutrophil engraftment (P = 0.61), cumulative incidence of relapse (P = 0.092), nonrelapse mortality (P = 0.44), grade II-IV acute graft-versus-host disease (GVHD) (P = 0.47), chronic GVHD (P = 0.29), overall survival (P = 0.795), recurrence-free survival (P = 0.945) or GVHD-free relapse-free survival (P = 0.082). ATG-G was associated with a lower risk of extensive chronic GVHD and a higher risk of cytomegaloviremia (P = 0.01 and HR = 0.41, P < 0.001 and HR = 4.244, respectively). The results of this study suggest that the preparation of rabbit ATG used for unrelated HSCT should be selected based on the incidence of extensive chronic GVHD of each center, and the posttransplant management strategy should be adjusted according to the ATG preparation.
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Affiliation(s)
- Lu Wang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Peiyan Kong
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Cheng Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lidan Zhu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jia Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shichun Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ting Chen
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Huanfeng Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Han Yao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuqing Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yimei Feng
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lu Zhao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuxia Li
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lei Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
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5
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Hamada M, Muramatsu H, Torii Y, Suzuki K, Narita A, Yoshida T, Imaya M, Yamamori A, Wakamatsu M, Miwata S, Narita K, Kataoka S, Kawashima N, Taniguchi R, Nishikawa E, Nishio N, Ito Y, Kojima S, Takahashi Y. Human leukocyte antigen 7/8-matched unrelated bone marrow transplantation using anti-thymocyte globulin in children. Int J Hematol 2023:10.1007/s12185-023-03571-5. [PMID: 36881377 DOI: 10.1007/s12185-023-03571-5] [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: 10/03/2022] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
Human leukocyte antigen (HLA) mismatched unrelated donor transplantation is associated with an increased risk of graft-versus-host disease, graft failure, and infection, which increases post-transplant morbidity and mortality. In this single-center retrospective study, outcomes were evaluated in 30 consecutive children who underwent bone marrow transplantation (BMT) from HLA 1 allele-mismatched (HLA 7/8-matched) unrelated donors with rabbit anti-thymocyte globulin (rATG) as graft-versus-host disease (GVHD) prophylaxis. The 3-year overall survival (OS), event-free survival (EFS), and GVHD-relapse-free survival rates were 91.7% (95% CI 70.5%-91.9%), 88.3% (95% CI 67.5%-96.1%), and 73.9% (95% CI 52.4%-86.8%), respectively. Grade II-IV and III-IV acute GVHD occurred in 10 (33%) and 2 (7.0%) patients, respectively. The 3-year cumulative incidence of chronic GVHD was 7.8%. No fatal viral infections occurred. The study results show the feasibility of HLA 7/8-matched unrelated BMT with ATG to achieve favorable outcomes and acceptable GVHD, especially for patients who lack a fully matched donor.
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Affiliation(s)
- Motoharu Hamada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Kyogo Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Atsushi Narita
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Taro Yoshida
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Masayuki Imaya
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Ayako Yamamori
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Manabu Wakamatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Shunsuke Miwata
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Kotaro Narita
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Shinsuke Kataoka
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Nozomu Kawashima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Rieko Taniguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Eri Nishikawa
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Nobuhiro Nishio
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.,Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
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6
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Davis E, Archer A, Flynn J, Nhaissi M, Rapoport C, Suri B, Wells D, Papadopoulos E, Politikos I, Fingrut WB, Scaradavou A, Barker JN. An Optimized Search Prognosis Tool to Predict 8/8 HLA Allele-Matched Unrelated Donor Procurement. Transplant Cell Ther 2023; 29:312.e1-312.e5. [PMID: 36822475 PMCID: PMC10149615 DOI: 10.1016/j.jtct.2023.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
For patients in need of allogeneic transplantation who lack an HLA-identical sibling, an 8/8 HLA allele-matched unrelated donor (URD) is a standard alternative. However, delays in URD procurement can adversely impact patient care. Recipient genotype and search assessment (MSKv1.0)-based tools can predict search prognosis for many, but both tools have lower performance in non-European ancestry patients. Using the MSKv1.0 tool, we analyzed searches from 1530 potential allograft recipients (including 863 who underwent transplantation) with the aim of creating an optimized MSKv2.0 search prognosis tool that can classify a URD search as either Good or Poor with a high level of accuracy while also limiting an ambiguous Fair search prognosis regardless of patient ancestry. By MSKv2.0, the 8/8 URD search prognosis distribution was 57% Good, 21% Fair, and 22% Poor in Europeans and 15% Good, 21% Fair, and 63% Poor in non-Europeans. Importantly, compared to MSKv1.0, the likelihood of Fair categorization was reduced to <25% with comparable Fair rates (P = .847) in both European and non-European groups. Moreover, all patients with an MSKv2.0 Good prognosis had an 8/8 URD identified, and almost all of those who underwent transplantation had an 8/8 URD (Europeans, 99%; non-Europeans, 98%; P = .504). The MSKv2.0 tool also was highly accurate at classifying Poor searches, with <10% identifying an 8/8 URD, and almost all patients who underwent transplantation (Europeans, 95%; non-Europeans, 96%) receiving an alternative donor. Using preliminary search results, MSKv2.0 accurately classifies patients by likelihood of 8/8 URD procurement, greatly facilitating triage to 8/8 URD (Good prognosis) or alternative donor (Poor prognosis) transplantations.
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Affiliation(s)
- Eric Davis
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Archer
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Nhaissi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Candice Rapoport
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Beth Suri
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah Wells
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Esperanza Papadopoulos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medicine, New York, New York
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medicine, New York, New York
| | - Warren B Fingrut
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andromachi Scaradavou
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medicine, New York, New York.
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7
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Barkhordar M, Kasaeian A, Janbabai G, Mousavi SA, Fumani HK, Tavakoli S, Bahri T, Ghavamzadeh A, Vaezi M. Outcomes of haploidentical peripheral stem cell transplantation with combination of post-transplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG) compared to unrelated donor transplantation in acute myeloid leukemia: A retrospective 10-year experience. Leuk Res 2022; 120:106918. [PMID: 35843087 DOI: 10.1016/j.leukres.2022.106918] [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: 02/01/2022] [Revised: 06/18/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
In the evolution of haploidentical hematopoietic stem cell transplantation (haplo-HSCT), In vivo T-cell modulation with concomitant use of anti-thymocyte globulin (ATG) and high-dose post-transplant cyclophosphamide (PTCy) provides a novel promising method on transplant outcomes; however, the long-term effects of this therapy are mostly unknown. We retrospectively compared the long-term outcomes of adult acute myeloid leukemia (AML) patients undergoing a haplo-HSCT (n = 92) with a new modified combination of ATG and PTCy in the context of peripheral blood stem cell (PBSC) and myeloablative conditioning (MAC) with an otherwise similar group of AML patients who received an unrelated donor (URD) HSCT (n = 57) with ATG protocol from February 2010 to December 2020 at our single-center (HORCSCT). Median follow-up was 3.73 and 4.28 years for haploidentical and URD-HSCT, respectively. In haplo-HSCT, the cumulative incidence of grades II-IV and III-IV acute graft versus host disease (aGvHD) and extensive chronic GvHD (cGvHD) was much lower than in URD (27% versus 56% for grades II-IV, 8.7% versus 24.5% for grades III-IV, and 15.4% versus 34.7% for extensive cGvHD, respectively). Five-year overall survival (OS) was 54.03% for haplo and 54.48% for URD (p = 0.927); GvHD-free relapse-free survival (GRFS) was 44.1% and 29.86% (p = 0.149); relapse incidence was 15.79% and 26.95% (p = 0.72); and non-relapse mortality (NRM) was 29.48% and 26.32% (p = 0.73), respectively. Using multivariable analyses, when compared to Haplo, URD was a significant predictor of relapse (HR=1.80, p = 0.039); however, no difference in OS, GRFS, and NRM was noted between haplo and URD. Therefore, given the favorable results with haplo-HSCT and considering donor availability promptly with low cost, it conservatively suggested that haplo-HSCT with the introduced protocol could be viewed as the first alternative for patients with AML in the absence of matched sibling donors.
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Affiliation(s)
- Maryam Barkhordar
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran; Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Inflammation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ghasem Janbabai
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Seied Asadollah Mousavi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Kamranzadeh Fumani
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Tavakoli
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Tanaz Bahri
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Vaezi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
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Morishima Y, Morishima S, Stevenson P, Kodera Y, Horowitz M, McKallor C, Malkki M, Spellman SR, Gooley T, Petersdorf EW. Race and Survival in Unrelated Hematopoietic Cell Transplantation. Transplant Cell Ther 2022; 28:357.e1-357.e6. [PMID: 35405366 DOI: 10.1016/j.jtct.2022.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/14/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Survival after hematopoietic cell transplantation depends on race/ethnicity and histocompatibility (HLA) between the patient and transplant donor. HLA sequence variation is a genetic construct of continental populations, but its role in accounting for racial disparities of transplant outcome is unknown. To determine disparities in transplant survivorship among patients of diverse race while accounting for patient and donor HLA variation. A total of 26,945 self-described Japanese, U.S. Asian, White, Hispanic, and Black patients received an unrelated donor transplant for the treatment of a life-threatening blood disorder. The risk of mortality with and without adjustment for known HLA risk factors (number and location of donor mismatches; patient HLA-B leader genotype and HLA-DRβ peptide-binding motif) was studied using multivariable models. Survival after HLA-matched transplantation for patients with optimal leader and peptide-binding features was estimated for each race, as was the improvement in survival over calendar-year time by considering year of transplantation as a continuous linear variable. The number, location, and nature of donor HLA mismatches and the frequency of patient HLA-B and HLA-DRB1 sequence motifs differed by race. Japanese patients had superior survival compared to other races without consideration of HLA. After HLA adjustment, three mortality risk strata were identified: Japanese and U.S. Asian (low-risk); White and Hispanic (intermediate-risk), and Black patients (high-risk). Survival for patients with optimal donor and HLA characteristics was superior for Japanese, intermediate for U.S. Asian, White, and Hispanic, and lowest for Black patients. Five-year increments of transplant year were associated with greater decreases in mortality hazards for Black and Hispanic patients than for Japanese, U.S. Asian and White patients. Transplant survivorship disparities are influenced by HLA as a genetic construct of race. A more complete understanding of the factors that influence transplant outcomes provides opportunities to narrow disparities for future patients.
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Affiliation(s)
- Yasuo Morishima
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University, Nagakute Japan; Department of Hematology and Oncology, Nakagami Hospital, Okinawa, Japan.
| | - Satoko Morishima
- Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Second Department of Internal Medicine, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Phil Stevenson
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yoshihisa Kodera
- Japan Marrow Donor Program, Tokyo, Japan; Center for Hematopoietic Stem Cell Transplantation, Aichi Medical University Hospital, Nagakute, Japan
| | - Mary Horowitz
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Caroline McKallor
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mari Malkki
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Ted Gooley
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Effie W Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
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9
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Gener G, Batlle M, Morgades M, Jiménez MJ, Ferrà C, Ribera JM. Outcomes of unrelated donor stem cell transplantation with or without anti-thymocyte globulin used as graft-versus-host disease prophylaxis in patients with acute leukaemia and myelodysplastic syndrome. Med Clin (Barc) 2021; 157:380-384. [PMID: 33160624 DOI: 10.1016/j.medcli.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Graft-versus-host disease (GVHD) and infections are complications after allogeneic stem cell transplantation (alloSCT). Anti-thymocyte globulin (ATG) is a strategy used as prophylaxis for GVHD. The study analyses the outcomes and frequency of infections with or without ATG after an unrelated donor alloSCT in patients with acute leukaemia and myelodysplastic syndrome. PATIENTS AND METHODS Retrospective study of patients receiving an unrelated donor alloSCT between December 2007 and April 2019. The main outcomes were analysed according to use or not of ATG. RESULTS Sixty-six patients were included. No significant differences were found between the ATG group (n=50) vs. no-ATG group (n=16) in overall survival, cumulative incidence of relapse, cumulative incidence of non-relapse mortality or cumulative incidence of acute GVHD or chronic GVHD. There was a greater frequency of infections in the ATG group (60 vs. 19%, P=.004). CONCLUSIONS In this study, no differences were shown in the main outcomes of alloSCT based on the use of ATG, although more infections were documented in the ATG group.
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Affiliation(s)
- Georgina Gener
- Servicio de Hematología Clínica, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia, Josep Carreras, Barcelona, España.
| | - Montserrat Batlle
- Servicio de Hematología Clínica, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia, Josep Carreras, Barcelona, España
| | - Mireia Morgades
- Servicio de Hematología Clínica, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia, Josep Carreras, Barcelona, España
| | - María-José Jiménez
- Servicio de Hematología Clínica, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia, Josep Carreras, Barcelona, España
| | - Christelle Ferrà
- Universitat de Vic, Universitat Central de Catalunya, Vic, España
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10
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Auletta JJ, Novakovich JL, Stritesky GL, Newman J, Fridy-Chesser ST, Hailperin K, Devine SM. Meeting the Demand for Unrelated Donors in the Midst of the COVID-19 Pandemic: Rapid Adaptations by the National Marrow Donor Program and Its Network Partners Ensured a Safe Supply of Donor Products. Transplant Cell Ther 2021; 27:133-41. [PMID: 33830022 DOI: 10.1016/j.jtct.2020.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023]
Abstract
The impact of the coronavirus disease 2019 (COVID-19) pandemic on hematopoietic cell transplant (HCT) donor registries and transplant center (TC) practices is underreported. This article reports on the National Marrow Donor Program (NMDP) Be The Match Registry and its coordinating the provision of unrelated donor (URD) products to domestic and international TCs during the initial 3 months of the COVID-19 pandemic (March through May 2020). Specifically, NMDP data are presented for disease indications for transplant, URD search volumes and availability, graft requests and processing, courier utilization and performance, and conversion rates from formal donor search and workup to graft collection and shipment. Data following the onset of COVID-19 are compared to the immediate 3 months prior to the COVID-19 pandemic (December 2019 through February 2020) and the same quarter 1 year prior to COVID-19 (March through May 2019). During the initial onset of COVID-19 and compared to 1 year prior, TCs requested and the NMDP performed less donor searches. More multiple URD and direct to workup requests were processed by the NMDP, which likely reflected reductions in donor availability. Yet TCs continued to perform allogeneic transplants for acute disease indications like acute leukemia and myelodysplasia, using more cryopreserved grafts than before COVID-19. In comparison to prepandemic patient cycle conversion rates and durations, the NMDP was able to convert patient cycles at nearly the same or higher rates and in similar or shorter periods of time. Last, despite significant challenges caused by the pandemic, including interruptions in domestic courier services and travel restrictions, graft products were delivered to and received by TCs in similar periods of time than before COVID-19. Taken together, these data show that NMDP service line operations continued to function effectively during the early phases of the COVID-19 pandemic, ensuring requests for and delivery of URD products to domestic and international allogeneic HCT recipients.
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11
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Fujiwara SI, Ikeda K, Kino S, Tanaka A, Hasegawa Y, Fujino K, Makino S, Matsumoto M, Yokohama A, Takeshita A, Muroi K. Clinical significance of autologous blood transfusions in bone marrow harvest from unrelated donors. Int J Hematol 2020; 111:833-9. [PMID: 32172447 DOI: 10.1007/s12185-020-02851-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/01/2020] [Accepted: 03/01/2020] [Indexed: 12/31/2022]
Abstract
In the Japan Marrow Donor Program (JMDP), autologous blood is collected from most unrelated bone marrow (BM) donors. We retrospectively evaluated 5772 donors who underwent BM harvest between 2010 and 2015 through the JMDP. Autologous blood was collected in 96.8% of the donors; the wastage rate was 0.6%. Allogeneic blood transfusion was not required. The mean hemoglobin (Hb) levels were 12.1 g/dL after the BM harvest (mean 891 mL) together with autologous blood transfusion (mean 596 mL). Propensity-score matching was used to adjust the backgrounds. Among donors with harvested BM of 100-400 mL, autologous blood transfusion had no impact on Hb levels or complications after BM harvest. Among donors with harvested BM of > 400 mL, more autologous blood transfusion followed by a bleeding volume of ≤ 100 mL did not confer clinical benefit to donors compared with less autologous blood transfusion followed by a bleeding volume of > 300 mL. The findings of the present study suggest that autologous blood transfusion to BM donors is excessive in terms of Hb changes and post-harvest outcomes.
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12
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Hsu JW, Shaw BE, Kim S, Logan BR, Sees JA, Confer DL, Pulsipher MA, Shah N, Switzer GE, Abidi MH, Ahmed IA, Anderlini PN, Bredeson C, Chhabra S, Dandoy CE, Diaz MA, Farhadfar N, Ganguly S, Gergis U, Hale GA, Hematti P, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Murthy HS, Olsson RF, Savani BN, Schears R, Seo S, Solh M, Spitzer T, Steinberg A, Sugrue M, Warkentin P, Wingard JR. Collection of Peripheral Blood Progenitor Cells in 1 Day Is Associated with Decreased Donor Toxicity Compared to 2 Days in Unrelated Donors. Biol Blood Marrow Transplant 2020; 26:1210-1217. [PMID: 32088366 DOI: 10.1016/j.bbmt.2020.02.011] [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: 11/21/2019] [Revised: 01/29/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Abstract
Peripheral blood stem cells (PBSCs) have been increasingly used for allogeneic hematopoietic cell transplantation instead of bone marrow stem cells. Current National Marrow Donor Program policy recommends 5 days of daily filgrastim, followed by either 1 or 2 days of apheresis for unrelated donors, depending on collection center choice. To date, there are no published studies comparing the differences in donor experience between 1 day and 2 days of apheresis. We examined 22,348 adult unrelated donor collections in 184 centers between 2006 and 2016. Of these 22,348 donors, 20,004 (89.5%) had collection on 1 day, and the other 2344 (9.5%) had collection over 2 days. Information on why donors underwent apheresis in 1 day or 2 days was not available. Donors who underwent apheresis in 1 day were more likely to be male (67% versus 46%; P < .001), younger (age <30 years, 48% versus 36%; P < .001), and have a higher body weight (83.0 kg versus 75.9 kg; P< .001) and body mass index (BMI; >30, 30% versus 22%; P < .001). Successful collection of the requested CD34+ cell count was achieved on the first day in 82% of 1-day collections and in 16% of 2-day collections. Despite not administering filgrastim the evening after the first day of collection in patients who underwent 2 days of apheresis, the median concentration of CD34+ cells/L in the product was higher on the second day of apheresis compared with the first day (23.8 × 106 CD34+/L on day 1 versus 28.7 × 106 CD34+/L on day 2; P< .001). Donors who underwent collection in 1 day were less likely to experience citrate toxicity (36% versus 52%; P< .001), hospitalization (1% versus 6%; P< .001), and other side effects related to apheresis (Modified Toxicity Criteria incidence: 20% versus 26%; P < .001). Female sex, older age, collection via central lines, and higher BMI were factors associated with greater likelihood for the development of toxicity, whereas less toxicity was noted in those with higher CD34+ counts and more blood processed on the first day of collection. We conclude that although unrelated donors can be successfully collected in 1 day or 2 days, 1-day apheresis procedures were associated with less overall toxicity, and thus we recommend single-day collections, especially if the requested number of cells have been collected in 1 day.
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Affiliation(s)
- Jack W Hsu
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida.
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Soyoung Kim
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer A Sees
- Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | - Nirali Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Galen E Switzer
- University of Pittsburgh Medical Center- Cancer Center University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Muneer H Abidi
- Hematology and Oncology, Spectrum Health Hospital Group, Grand Rapids, Michigan
| | - Ibrahim A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Paulo N Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Nosha Farhadfar
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Gregory A Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Kimberly A Kasow
- Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jane L Liesveld
- Department of Medicine, Strong Memorial Hospital-University of Rochester Medical Center, Rochester, New York
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Raquel Schears
- Department of Emergency Medicine, Mayo Medical School, Rochester, Minnesota
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Melhern Solh
- Northside Hospital Blood and Marrow Transplant and Leukemia Program, The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Thomas Spitzer
- Cellular Therapy and Transplantation Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - John R Wingard
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida
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13
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Seif AE, Li Y, Monos DS, Heidemann SC, Aplenc R, Barrett DM, Casper JT, Freedman JL, Grupp SA, Margolis DA, Olson TS, Teachey DT, Keever-Taylor CA, Wang Y, Talano JAM, Bunin NJ. Partially CD3 +-Depleted Unrelated and Haploidentical Donor Peripheral Stem Cell Transplantation Has Favorable Graft-versus-Host Disease and Survival Rates in Pediatric Hematologic Malignancy. Biol Blood Marrow Transplant 2019; 26:493-501. [PMID: 31765697 DOI: 10.1016/j.bbmt.2019.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 11/12/2022]
Abstract
Most children who may benefit from stem cell transplantation lack a matched related donor. Alternative donor transplantations with an unrelated donor (URD) or a partially matched related donor (PMRD) carry an increased risk of graft-versus-host-disease (GVHD) and mortality compared with matched related donor transplantations. We hypothesized that a strategy of partial CD3+/CD19+ depletion for URD or PMRD peripheral stem cell transplantation (PSCT) would attenuate the risks of GVHD and mortality. We enrolled 84 pediatric patients with hematologic malignancies at the Children's Hospital of Philadelphia and the Children's Hospital of Wisconsin between April 2005 and February 2015. Two patients (2.4%) experienced primary graft failure. Relapse occurred in 23 patients (27.4%; cumulative incidence 26.3%), and 17 patients (20.2%) experienced nonrelapse mortality (NRM). Grade III-IV acute GVHD was observed in 18 patients (21.4%), and chronic GVHD was observed and graded as limited in 24 patients (35.3%) and extensive in 8 (11.7%). Three-year overall survival (OS) was 61.8% (95% confidence interval [CI], 50.2% to 71.4%) and event-free survival (EFS) was 52.0% (95% CI, 40.3% to 62.4%). Age ≥15 years was associated with decreased OS (P= .05) and EFS (P= .05). Relapse was more common in children in second complete remission (P = .03). Partially CD3+-depleted alternative donor PSCT NRM, OS, and EFS compare favorably with previously published studies of T cell-replete PSCT. Historically, T cell-replete PSCT has been associated with a higher incidence of extensive chronic GVHD compared with limited chronic GVHD, which may explain the comparatively low relapse and NRM rates in our study cohort despite similar overall rates of chronic GVHD. Partial T cell depletion may expand donor options for children with malignant transplantation indications lacking a matched related donor by mitigating, but not eliminating, chronic GVHD.
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Affiliation(s)
- Alix E Seif
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yimei Li
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dimitri S Monos
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie C Heidemann
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard Aplenc
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David M Barrett
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James T Casper
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jason L Freedman
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephan A Grupp
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Margolis
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy S Olson
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David T Teachey
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carolyn A Keever-Taylor
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yongping Wang
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie-An M Talano
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nancy J Bunin
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
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14
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Fürst D, Neuchel C, Tsamadou C, Schrezenmeier H, Mytilineos J. HLA Matching in Unrelated Stem Cell Transplantation up to Date. Transfus Med Hemother 2019; 46:326-336. [PMID: 31832058 DOI: 10.1159/000502263] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/13/2019] [Indexed: 12/27/2022] Open
Abstract
Unrelated hematopoietic stem cell transplantation (HSCT) has evolved from an experimental protocol to a potentially curative first-line treatment in certain disease instances. Factors enabling this transformation were the optimization of treatment protocols and supportive care as well as the availability of a large number of donors worldwide along with the higher quality and reliability of HLA typing. The main criterion for donor selection is HLA compatibility. In this review we discuss the current clinical evidence of HLA matching in unrelated HSCT. In this context, we address methodical aspects of transplantation immunobiology research and discuss the impact of locus and resolution of HLA differences. Furthermore, we address special constellations such as unidirectional mismatches or the presence of nonexpressed alleles as well as HLA alloimmunization and describe the perspective for HLA typing and matching strategies in the future, given the implementation of novel complete or near-complete gene typing approaches using next-generation sequencing short read technology, which are now entering the standard of clinical care.
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Affiliation(s)
- Daniel Fürst
- Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Christine Neuchel
- Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Chrysanthi Tsamadou
- Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Hubert Schrezenmeier
- Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Joannis Mytilineos
- Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, and University Hospital Ulm, Ulm, Germany.,Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
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15
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Yao JF, Zhang GX, Shen YY, Zhang RL, He Y, Wei JL, Jiang EL, Yang DL, Feng SZ, Han MZ. [HLA-10/10 matched unrelated donor versus sibling donor hematopoietic stem cell transplantation for adult acute myeloid leukemia]. Zhonghua Xue Ye Xue Za Zhi 2019; 40:460-6. [PMID: 31340617 DOI: 10.3760/cma.j.issn.0253-2727.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
目的 观察人类白细胞抗原(HLA)匹配的无关供者造血干细胞移植(MUD-HSCT)治疗成人急性髓系白血病(AML)的疗效。 方法 回顾性分析2008年1月至2017年4月接受MUD-HSCT的成人AML病例资料,并以同期同胞全相合供者移植(MSD-HSCT)病例为对照,分析两组患者总生存(OS)率、无病生存(DFS)率、复发率、非复发死亡率(NRM)、植活率及急慢性移植物抗宿主病(aGVHD、cGVHD)发生率的差异。 结果 共247例连续性病例入组,MUD组46例,MSD组201例。除1例MSD组患者早期死亡外,两组患者均获粒细胞植活,但MUD组中位植活时间长于MSD组(15 d对14 d,P=0.017),血小板累积植活率差异无统计学意义(93.5%对98.0%,P=0.128)。两组患者aGVHD、cGVHD累积发生率差异无统计学意义(50.0%对46.3%,P=0.421;37.8%对43.0%,P=0.581)。与MSD组相比,MUD组患者3年累积NRM显著升高(22.0%对10.4%,P=0.049),但累积复发率差异无统计学意义(20.5%对28.3%,P=0.189)。两组患者3年OS率和DFS率差异均无统计学意义(61.6%对63.3%,P=0.867;57.5%对61.6%,P=0.760)。经多因素分析发现,患者年龄≥45岁、移植前第2次完全缓解(CR2)及以上或未缓解状态、有髓外浸润病史及Ⅲ~Ⅳ度aGVHD是影响生存的独立危险因素。 结论 与MSD-HSCT相比,MUD-HSCT治疗成人AML的NRM较高,粒细胞植活中位时间较长,但GVHD发生率、复发率、OS率及DFS率并无显著差异,是缺乏MSD的成人AML患者的理想替代移植方案。
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16
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Zhang Y, Wu L, Mo W, Zhou M, Li Y, Chen X, Wang C, Pan S, Xu S, Zhou W, Zhou R, Wang S. Comparable Outcomes of First-Line Hematopoietic Stem Cell Transplantation from Unrelated and Matched Sibling Donors in Adult Patients with Aplastic Anemia: A Retrospective Single-Center Study. Biol Blood Marrow Transplant 2019; 25:1567-1575. [PMID: 30926448 DOI: 10.1016/j.bbmt.2019.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/19/2019] [Indexed: 12/20/2022]
Abstract
To explore the feasibility of upfront unrelated donor (URD) hematopoietic stem cell transplantation (HSCT) in the treatment of adult aplastic anemia (AA), we conducted a retrospective, single-center study and compared the outcomes of adult patients who underwent first-line URD HSCT or matched sibling donor (MSD) HSCT between August 2012 and June 2018. In all, 23 URD HSCT recipients had an increased cumulative incidence of grade II acute graft-versus-host disease (aGVHD) (21.7% versus 3.4%; P =.007), but similar rates of secondary graft failure (8.7 ± 6.0% versus 6.9 ± 3.4%; P = .764), chronic GVHD (cGVHD) (18.2% versus 8.8%; P = .285), extensive cGVHD (9.1% versus 3.5%; P = .328), 5-year estimated overall survival (87.0% versus 94.2%; P = .501), and 5-year estimated failure-free survival (82.0% versus 89.3%; P = .404) compared with 58 MSD HSCT recipients treated during the same period. After using propensity score matching to reduce the influence of potential confounders, the 2 groups were well balanced in terms of pretransplantation clinical factors. The median survival time was similar, and no significant differences in the aforementioned outcomes were observed between the 2 groups. Our results suggest that URD HSCT may be an effective and feasible option for first-line therapy in adult AA patients who lack an MSD.
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Affiliation(s)
- Yuping Zhang
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liangliang Wu
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wenjian Mo
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ming Zhou
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yumiao Li
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaowei Chen
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Caixia Wang
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shiyi Pan
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shilin Xu
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Zhou
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ruiqing Zhou
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shunqing Wang
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
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17
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Murata M, Takenaka K, Uchida N, Ozawa Y, Ohashi K, Kim SW, Ikegame K, Kanda Y, Kobayashi H, Ishikawa J, Ago H, Hirokawa M, Fukuda T, Atsuta Y, Kondo T. Comparison of Outcomes of Allogeneic Transplantation for Primary Myelofibrosis among Hematopoietic Stem Cell Source Groups. Biol Blood Marrow Transplant 2019; 25:1536-1543. [PMID: 30826464 DOI: 10.1016/j.bbmt.2019.02.019] [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: 11/29/2018] [Accepted: 02/19/2019] [Indexed: 12/15/2022]
Abstract
The choice of alternative donor is a major issue in allogeneic hematopoietic stem cell transplantation (HSCT) for patients with primary myelofibrosis (PMF) without an HLA-matched related donor. We conducted this retrospective study using the Japanese national registry data for 224 PMF patients to compare the outcomes of first allogeneic HSCT from HLA-matched related donor bone marrow (Rtd-BM), HLA-matched related donor peripheral blood stem cells (Rtd-PB), HLA-matched unrelated donor bone marrow (UR-BM), unrelated umbilical cord blood (UR-UCB), and other hematopoietic stem cell grafts. Nonrelapse mortality (NRM) rates at 1 year after Rtd-BM, Rtd-PB, UR-BM, UR-UCB, and other transplantations were 16%, 36%, 30%, 41%, and 48%, respectively. Multivariate analysis identified UR-UCB transplantation, other transplantation, frequent RBC transfusion before transplantation, and frequent platelet (PLT) transfusion before transplantation as predictive of higher NRM. Relapse rates at 1 year after Rtd-BM, Rtd-PB, UR-BM, UR-UCB, and other transplantation were 14%, 17%, 11%, 14%, and 15%, respectively. No specific factor was associated with the incidence of relapse. Overall survival (OS) at 1 and 4 years after Rtd-BM, Rtd-PB, UR-BM, UR-UCB, and other transplantation were 81% and 71%, 58% and 52%, 61% and 46%, 48% and 27%, and 48% and 41%, respectively. Multivariate analysis identified older patient age, frequent RBC transfusion before transplantation, and frequent PLT transfusion before transplantation as predictive of lower OS. In conclusion, UR-UCB transplantation, as well as UR-BM transplantation, can be selected for PMF patients without an HLA-identical related donor. However, careful management is required for patients after UR-UCB transplantation because of the high NRM. Further studies including more patients after HLA-haploidentical related donor and HLA-mismatched unrelated donor transplantation would provide more valuable information for patients with PMF when making decisions regarding the choice of alternative donor.
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Affiliation(s)
- Makoto Murata
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuto Takenaka
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Toon, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Aichi, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Sung-Won Kim
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhiro Ikegame
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroatsu Ago
- Department of Hematology and Oncology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Makoto Hirokawa
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Kondo
- Department of Hematology, Aiiku Hospital, Sapporo, Japan
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18
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Prokopishyn NL, Logan BR, Kiefer DM, Sees JA, Chitphakdithai P, Ahmed IA, Anderlini PN, Beitinjaneh AM, Bredeson C, Cerny J, Chhabra S, Daly A, Diaz MA, Farhadfar N, Frangoul HA, Ganguly S, Gastineau DA, Gergis U, Hale GA, Hematti P, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Murthy HS, Norkin M, Olsson RF, Papari M, Savani BN, Szer J, Waller EK, Wirk B, Yared JA, Pulsipher MA, Shah NN, Switzer GE, O'Donnell PV, Confer DL, Shaw BE. The Concentration of Total Nucleated Cells in Harvested Bone Marrow for Transplantation Has Decreased over Time. Biol Blood Marrow Transplant 2019; 25:1325-1330. [PMID: 30716454 PMCID: PMC6615955 DOI: 10.1016/j.bbmt.2019.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
Bone marrow (BM) is an essential source of hematopoietic stem cell grafts for many allogeneic hematopoietic cell transplant (HCT) recipients, including adult patients (for specific diseases and transplantation strategies) and the majority of pediatric recipient. However, since the advent of granulocyte colony-stimulating factor-mobilized peripheral blood stem cell (PBSC) grafts, there has been a significant decrease in the use of BM in HCT, thought to be due mainly to the increased logistical challenges in harvesting BM compared with PBSCs, as well as generally no significant survival advantage of BM over PBSCs. The decreased frequency of collection has the potential to impact the quality of BM harvests. In this study, we examined >15,000 BM donations collected at National Marrow Donor Program centers between 1994 and 2016 and found a significant decline in the quality of BM products, as defined by the concentration of total nucleated cells (TNCs). The mean TNC concentration in BM donations dropped from 21.8 × 106 cells/mL in the earliest era (1994 to 1996) to 18.7 × 106 cells/mL in the most recent era (2012 to 2016) (means ratio, .83; P < .001). This decline in BM quality was seen despite the selection of more donors perceived to be optimal (eg, younger and male). Multivariate regression analysis showed that higher-volume centers (performing >30 collections per era) had better-quality harvests with higher concentrations of TNCs collected. In conclusion, we have identified a significant decrease in the quality of BM collections over time, and lower-volume collection centers had poorer-quality harvests. In this analysis, we could not elucidate the direct cause for this finding, suggesting the need for further studies to investigate the key factors responsible and to explore the impact on transplant recipients.
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Affiliation(s)
- Nicole L Prokopishyn
- Department of Pathology and Laboratory Medicine,University of Calgary, Calgary, Alberta, Canada
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Jennifer A Sees
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Ibrahim A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Paolo N Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Haydar A Frangoul
- Division of Pediatric-Hematology and Oncology, The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, Tennessee
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | | | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Gregory A Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Kimberly A Kasow
- Department of Pediatrics in the Division of Hematology-Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jane L Liesveld
- Strong Memorial Hospital-University of Rochester Medical Center, Rochester, New York
| | - Hemant S Murthy
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Maxim Norkin
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Mona Papari
- ITxM Clinical Services Cord Blood Lab, Rosemont, Illinois
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey Szer
- Clinical Haematology at Peter MacCalluma Cancer Centre and The Royal Melbourne Hospital, Victoria, Australia
| | - Edmund K Waller
- Department of Hematology and Meidcal Oncology, Emory University Hospital, Atlanta, Georgia
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul V O'Donnell
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Yang SH, Wan HL, Gu MH, Wang TF. Janus kinase 2 V617F mutation in an unrelated peripheral blood stem cell donor. Tzu Chi Med J 2019; 31:60-62. [PMID: 30692834 PMCID: PMC6334566 DOI: 10.4103/tcmj.tcmj_189_17] [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] [Indexed: 11/05/2022] Open
Abstract
Polycythemia vera (PV) is relatively uncommon in early adulthood, and evidence about the prevalence of the Janus kinase 2 (JAK2) V617F mutation in the general population is limited. Here, we report a previously healthy volunteer peripheral blood stem cell (PBSC) donor who developed symptomatic PV with the JAK2 V617F mutation 2 years after PBSC mobilization and harvest. The characteristic mutation was identified retrospectively in the blood sample of the donor at the confirmation typing stage, which was before granulocyte colony-stimulating factor injection. This report presents a safety issue for both donor and recipient of hematopoietic stem cell transplantation. Clinicians should be aware of this during health workup and postdonation follow-up of unrelated PBSC donors. Any abnormal and/or equivocal laboratory data, especially during the donor workup stage, should not be overlooked.
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Affiliation(s)
- Shang-Hsien Yang
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Buddhist Tzu Chi Stem Cells Center, Hualien, Taiwan
| | - Hsiang-Lin Wan
- Department of Hematology and Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Ming-Hui Gu
- Department of Laboratory Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tso-Fu Wang
- Buddhist Tzu Chi Stem Cells Center, Hualien, Taiwan.,Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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20
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Vazirabad I, Chhabra S, Nytes J, Mehra V, Narra RK, Szabo A, Jerkins JH, Dhakal B, Hari P, Anderson MW. Direct HLA Genetic Comparisons Identify Highly Matched Unrelated Donor-Recipient Pairs with Improved Transplantation Outcome. Biol Blood Marrow Transplant 2018; 25:921-931. [PMID: 30537549 DOI: 10.1016/j.bbmt.2018.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/03/2018] [Indexed: 12/01/2022]
Abstract
HLA matching by allele-level genotyping is largely based on genetic similarity between a few exons that encode the antigen recognition domain (ARD) of the HLA protein. Next-generation sequencing (NGS) can identify HLA genetic polymorphisms in non-ARD-encoding exons, introns, and untranslated regions, but the impact of these polymorphisms on hematopoietic cell transplantation (HCT) outcome is unclear. We performed NGS-based sequencing of 11 HLA loci on a well-characterized retrospective cohort of 166 unrelated donor-recipient HCT pairs. Genetic differences between HCT pairs were identified and visualized using a novel bioinformatics approach that directly compares phased full-length HLA sequences. Our approach was able to correctly classify HCT pairs without known HLA allele-level mismatches and also to identify a subset of HLA allele-matched HCT pairs with very few to no genetic differences in the sequenced HLA regions. This highly HLA genetically matched unrelated HCT group shows improved overall survival and reduced acute graft-versus-host disease compared with HCT pairs with HLA allele-level mismatches. These results suggest that direct genetic matching of HLA loci may offer an additional means of HCT donor selection beyond traditional HLA allele comparisons and suggests that genetic similarity as defined by HLA sequencing may have a novel role in unrelated HCT donor selection. Finally, our approach can enable larger cohort studies with adequate power to detect differences in other HCT outcomes based on genetic similarity within the HLA loci.
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Affiliation(s)
- Ibrahim Vazirabad
- Diagnostic Laboratories and Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James Nytes
- Diagnostic Laboratories and Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | - Vatsal Mehra
- Diagnostic Laboratories and Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | - Ravi K Narra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James H Jerkins
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran Hari
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew W Anderson
- Diagnostic Laboratories and Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin.
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21
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Miyamura K. [Introduction and the current status of unrelated peripheral blood stem cells transplantation in Japan]. Rinsho Ketsueki 2018; 59:2323-2333. [PMID: 30305542 DOI: 10.11406/rinketsu.59.2323] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In other countries, unrelated donor peripheral blood stem cell transplantation (PBSCT) is more prevalent than bone marrow transplantation; however, in Japan, it was introduced in 2010 after confirming the safety of donors. PBSCT does not require blood donation, general anesthesia, or frequent bone marrow aspiration of the donor. After PBSCT, numerous hematopoietic cells can prompt blood recovery and engraftment, which has enabled reduced intensity transplantation in elderly patients and patients with concurrent diseases, such as infection. In addition, GVL effect by a large number of donor lymphocytes is expected, however, chronic GVHD is a major concern. When introducing PBSCT in Japan, manuals were drafted considering the short-term safety of donors, and data were collected on the occurrence of long- and short-term adverse events. A randomized trial reported no difference in the survival rate between bone marrow transplantation and PBSCT at 5 years; however, it revealed that QOL was better in the former. PB is a essential transplant source option, and attempts are being made to overcome chronic GVHD. PBSC contains abundant stem cells, progenitor cells, and immunocompetent cells and is indispensable for the development of cell therapy for blood diseases in the future.
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Affiliation(s)
- Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital
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22
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Rodríguez-Arbolí E, Márquez-Malaver FJ, Rodríguez-Torres N, Caballero-Velázquez T, Escamilla-Gómez V, Calderón-Cabrera C, Falantes-González JF, Solé-Rodríguez M, García-Ramírez P, Moya-Arnao M, Carreras E, Espigado-Tocino I, Pérez-Simón JA. Allocation to Matched Related or Unrelated Donor Results in Similar Clinical Outcomes without Increased Risk of Failure to Proceed to Transplant among Patients with Acute Myeloid Leukemia: A Retrospective Analysis from the Time of Transplant Approval. Biol Blood Marrow Transplant 2018; 25:183-190. [PMID: 30153492 DOI: 10.1016/j.bbmt.2018.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/19/2018] [Indexed: 11/30/2022]
Abstract
Clinical outcomes after allogeneic hematopoietic stem cell transplantation (allo-SCT) from unrelated donors (URDs) approach those of matched related donor (MRD) transplants in patients with acute myeloid leukemia (AML). Yet, available data fail to account for differences in pretransplantation outcomes between these donor selection strategies. In this regard, URD allo-HSCT is associated with longer waiting times to transplantation, potentially resulting in higher probabilities of failure to reach transplant. We retrospectively analyzed 108 AML patients accepted for first allo-HSCT from the time of approval to proceed to transplant. Fifty-eight (54%) patients were initially allocated to MRD, while URD search was initiated in 50 (46%) patients. Time to transplant was longer in patients allocated to a URD when compared with patients assigned to an MRD (median 142 days versus 100 days; p < .001). Forty-three of 58 (74%) patients in the MRD group and 35 of 50 (70%) patients in the URD group underwent transplantation (odds ratio [OR], 1.22; p = .63). Advanced disease status at the time of allo-HSCT approval was the only predictor of failure to reach transplantation in the multivariate analysis (OR, 4.78; p = .001). Disease progression was the most common cause of failure to reach allo-HSCT (66.7%) in both the MRD and URD groups. With a median follow-up from transplantation of 14.5 (interquartile range, 5 to 29) months, the 2-year estimate of overall survival (OS) from allo-HSCT was 46% in the MRD group and 57% in the URD group (p = .54). There were no differences in OS according to donor type allocation in the multivariate analysis (hazard ratio, 1.01; p = .83). When including patients from the time of transplant approval, 2-year OS was 39% in the MRD group versus 42% in the URD group. Our study suggests that allocation of AML patients to URDs may result in comparable clinical outcomes to MRD assignment without a significant increase in the risk of failure to reach transplant.
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Affiliation(s)
- Eduardo Rodríguez-Arbolí
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - Francisco José Márquez-Malaver
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - Nancy Rodríguez-Torres
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - Teresa Caballero-Velázquez
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - Virginia Escamilla-Gómez
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - Cristina Calderón-Cabrera
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - José Francisco Falantes-González
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | | | - Patricia García-Ramírez
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - María Moya-Arnao
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - Enric Carreras
- Spanish Bone Marrow Donor Registry, Foundation and Research Institute Josep Carreras Against Leukemia, Barcelona, Spain
| | - Ildefonso Espigado-Tocino
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - José Antonio Pérez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain.
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23
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Shenoy S, Walters MC, Ngwube A, Soni S, Jacobsohn D, Chaudhury S, Grimley M, Chan K, Haight A, Kasow KA, Parikh S, Andreansky M, Connelly J, Delgado D, Godder K, Hale G, Nieder M, Pulsipher MA, Trachtenberg F, Neufeld E, Kwiatkowski JL, Thompson AA. Unrelated Donor Transplantation in Children with Thalassemia using Reduced-Intensity Conditioning: The URTH Trial. Biol Blood Marrow Transplant 2018; 24:1216-1222. [PMID: 29374585 PMCID: PMC5993578 DOI: 10.1016/j.bbmt.2018.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/03/2017] [Accepted: 01/18/2018] [Indexed: 01/19/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) can cure transfusion-dependent thalassemia (TDT). In a multicenter trial we investigated the efficacy of reduced-intensity conditioning (RIC) before unrelated donor (URD) HSCT in children with TDT. Thirty-three children, ages 1 to 17 years, received bone marrow (BM) or umbilical cord blood (UCB) allografts. Median time to neutrophil engraftment was 13 days (range, 10 to 25) and 24 days (range, 18 to 49) and platelet engraftment 23 days (range, 12 to 46) and 50 days (range, 31 to 234) after BM and UCB allografts, respectively. With a median follow-up of 58 months (range, 7 to 79), overall and thalassemia-free survival was 82% (95% CI, .64% to .92%) and 79% (95% CI, .6% to .9%), respectively. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) after BM and UCB allografts was 24% and 44%; the 2-year cumulative incidence of chronic extensive GVHD was 29% and 21%, respectively; 71% of BM and 91% of UCB recipients discontinued systemic immunosuppression by 2 years. Six patients who had Pesaro risk class 2 (n = 5) and class 3 (n = 1) died of GVHD (n = 3), viral pneumonitis (n = 2) and pulmonary hemorrhage (n = 1). Outcomes after this RIC compared favorably with URD HSCT outcomes for TDT and supported engraftment in 32 of 33 patients. Efforts to reduce GVHD and infectious complications are being pursued further.
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Affiliation(s)
- Shalini Shenoy
- Department of Pediatrics, St. Louis Children's Hospital, Washington University, St. Louis, Missouri.
| | - Mark C Walters
- Department of Pediatrics, UCSF Benioff Children's Hospital, Oakland, California
| | - Alex Ngwube
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona
| | - Sandeep Soni
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - David Jacobsohn
- Department of Pediatrics, Children's National Medical Center, Washington, DC
| | - Sonali Chaudhury
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Michael Grimley
- Department of Pediatrics, Texas Transplant Institute, San Antonio, Texas
| | - Kawah Chan
- Department of Pediatrics, Texas Transplant Institute, San Antonio, Texas
| | - Ann Haight
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Kimberley A Kasow
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Suhag Parikh
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Martin Andreansky
- Department of Pediatrics, University of Miami, Holtz Children's Hospital, Miami, Florida
| | - Jim Connelly
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - David Delgado
- Department of Pediatrics, Riley Children's Hospital, Indianapolis, Indiana
| | - Kamar Godder
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, Florida
| | - Gregory Hale
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Michael Nieder
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Michael A Pulsipher
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Felicia Trachtenberg
- Department of Pediatrics, New England Research Institutes, Boston, Massachusetts
| | - Ellis Neufeld
- Department of Pediatrics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Janet L Kwiatkowski
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexis A Thompson
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
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24
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Shaw BE, Logan BR, Spellman SR, Marsh SGE, Robinson J, Pidala J, Hurley C, Barker J, Maiers M, Dehn J, Wang H, Haagenson M, Porter D, Petersdorf EW, Woolfrey A, Horowitz MM, Verneris M, Hsu KC, Fleischhauer K, Lee SJ. Development of an Unrelated Donor Selection Score Predictive of Survival after HCT: Donor Age Matters Most. Biol Blood Marrow Transplant 2018; 24:1049-56. [PMID: 29454040 DOI: 10.1016/j.bbmt.2018.02.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/08/2018] [Indexed: 12/23/2022]
Abstract
Donor factors, in addition to HLA matching status, have been associated with recipient survival in unrelated donor (URD) hematopoietic cell transplantation (HCT); however, there is no hierarchical algorithm that weights the characteristics of individual donors against each other in a quantitative manner to facilitate donor selection. The goal of this study was to develop and validate a donor selection score that prioritizes donor characteristics associated with better survival in 8/8 HLA-matched URDs. Two separate patient/donor cohorts, the first receiving HCT between 1999 and 2011 (n = 5952, c1), and the second between 2012 and 2014 (n = 4510, c2) were included in the analysis. Both cohorts were randomly spilt, 2:1, into training and testing sets. Despite studying over 10,000 URD transplants, we were unable to validate a donor selection score. The only donor characteristic associated with better survival was younger age, with 2-year survival being 3% better when a donor 10 years younger is selected. These results support previous studies suggesting prioritization of a younger 8/8 HLA-matched donor. This large dataset also shows that none of the other donor clinical factors tested were reproducibly associated with survival, and hence flexibility in selecting URDs based on other characteristics is justified. These data support a simplified URD selection process and have significant implications for URD registries.
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Crisalli LM, Hinkle JT, Walling CC, Sell M, Frey NV, Hexner EO, Loren AW, Luger SM, Stadtmauer EA, Porter DL, Reshef R. Higher Donor Apheresis Blood Volumes Are Associated with Reduced Relapse Risk and Improved Survival in Reduced-Intensity Allogeneic Transplantations with Unrelated Donors. Biol Blood Marrow Transplant 2018; 24:1203-1208. [PMID: 29408506 DOI: 10.1016/j.bbmt.2018.01.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/22/2017] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) with reduced-intensity conditioning (RIC) offers a curative option for patients with hematologic malignancies who are unable to undergo myeloablative conditioning, but its success is limited by high rates of relapse. Several studies have suggested a role for T cell doses in peripheral blood stem cell grafts in RIC HSCT. Because T cell dose is typically not known until after the collection, and apheresis blood volume is easily modifiable, we hypothesized that higher donor apheresis blood volumes would improve transplantation outcomes through an effect on graft composition. Thus, we analyzed the relationships between apheresis volume, graft composition, and transplantation outcomes in 142 consecutive patients undergoing unrelated donor allogeneic RIC HSCT. We found that apheresis volume ≥15 L was associated with a significantly decreased risk of relapse (adjusted hazard ratio [aHR], .48; 95% confidence interval [CI], .28 to .84]; P = .01) and improved relapse-free survival (aHR, .56; 95% CI, .35 to .89; P = .02) and overall survival (aHR, .55; 95% CI, .34 to .91; P = .02). A high apheresis volume was not associated with increased rates of acute or chronic graft-versus-host disease. These results demonstrate that an apheresis volume of at least 15 L is independently predictive of improved transplantation outcomes after RIC allogeneic HSCT.
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Affiliation(s)
- Lisa M Crisalli
- Abramson Cancer Center and the Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joanne T Hinkle
- Abramson Cancer Center and the Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christopher C Walling
- Abramson Cancer Center and the Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mary Sell
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Noelle V Frey
- Abramson Cancer Center and the Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth O Hexner
- Abramson Cancer Center and the Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alison W Loren
- Abramson Cancer Center and the Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Selina M Luger
- Abramson Cancer Center and the Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Edward A Stadtmauer
- Abramson Cancer Center and the Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David L Porter
- Abramson Cancer Center and the Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ran Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY.
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26
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Jorge AS, Suárez-Lledó M, Pereira A, Gutierrez G, Fernández-Avilés F, Rosiñol L, Llobet N, Solano T, Urbano-Ispízua Á, Rovira M, Martínez C. Single Antigen-Mismatched Unrelated Hematopoietic Stem Cell Transplantation Using High-Dose Post-Transplantation Cyclophosphamide Is a Suitable Alternative for Patients Lacking HLA-Matched Donors. Biol Blood Marrow Transplant 2018; 24:1196-1202. [PMID: 29410343 DOI: 10.1016/j.bbmt.2018.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/17/2018] [Indexed: 12/30/2022]
Abstract
The optimal prophylaxis regimen for graft-versus-host disease (GVHD) in the setting of mismatched unrelated donor (MMUD) allogeneic hematopoietic stem cell transplantation (alloHSCT) is not defined. The use of high-dose post-transplant cyclophosphamide (PTCy) in haploidentical transplantation has proven feasible and effective in overcoming the negative impact of HLA disparity on survival. We hypothesized that PTCy could also be effective in the setting of MMUD transplantation. We retrospectively analyzed 86 consecutive adult recipients of alloHSCT in our institution, comparing 2 contemporaneous groups: PTCy MMUD (n = 26) versus matched unrelated donor (MUD) (n = 60). Graft source was primarily peripheral blood (92%). All PTCy MMUD were HLA 7/8 (differences in HLA class I loci in 92% of patients) and received PTCy plus tacrolimus ± mofetil mycophenolate as GVHD prophylaxis. No differences were observed between PTCy MMUD and MUD in the 100-day cumulative incidence of acute GVHD grades II to IV (31% versus 22%, respectively; P = .59) and III to IV (8% versus 10%, P = .67). There was a trend for a lower incidence of moderate to severe chronic GVHD at 1 year after PTCy MMUD in comparison with MUD (22% versus 41%, P = .098). No differences between PTCy MMUD and MUD were found regarding nonrelapse mortality (25% versus 18%, P = .52) or relapse rate (11% versus 19%, P = .18). Progression-free survival and overall survival at 2 years were similar in both cohorts (67% versus 54% [HR, .84; 95% CI, .38 to 1.88; P = .68] and 72% versus 57% [HR, .71; 95% CI, .31 to 1.67; P = .44], respectively). The 2-year cumulative incidence of survival free of moderate to severe chronic GVHD and relapse tended to be higher in the PTCy MMUD group (47% versus 24%; HR, .60; 95% CI, .31 to 1.14; P = .12). We conclude that HLA 7/8 MMUD transplantation using PTCy plus tacrolimus is a suitable alternative for those patients who lack a MUD.
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Affiliation(s)
- Ana Sofia Jorge
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Arturo Pereira
- Hemotherapy and Hemostasis Department, Hospital Clínic, Barcelona, Spain
| | - Gonzalo Gutierrez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Noemí Llobet
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Teresa Solano
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Álvaro Urbano-Ispízua
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain.
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27
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Kawashima N, Nishiwaki S, Shimizu N, Kamoshita S, Watakabe K, Yokohata E, Kurahashi S, Ozawa Y, Miyamura K. Outcomes of strategic alternative donor selection or suspending donor search based on Japan Marrow Donor Program coordination status. Int J Hematol 2018; 107:551-8. [PMID: 29374827 DOI: 10.1007/s12185-018-2413-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 01/16/2023]
Abstract
In allogeneic hematopoietic stem cell transplantation (allo-HSCT) from unrelated donors, delays in donor search are adversely associated with patient outcome. However, the optimal duration for either waiting for an unrelated donor or selecting alternative sources remains undetermined. Using data from the Japan Marrow Donor Program (JMDP) registry, we retrospectively analyzed 349 adult patients who had searched for unrelated donors. Two hundred and three patients received allo-HSCT from JMDP donors (Group A) with a median of 140 days required to identify a donor, 60 received allo-HSCT from alternative sources (Group B) after a median of 111.5 days at which point either all donor candidates had failed or the patient achieved a second or subsequent complete remission, and 77 suspended allo-HSCT (Group C) after a median of 310 days. The 5-year overall survival (OS) rate in Group A was superior to that of Group C (48.6 vs 38.5%, P = 0.001). Although Group B included more patients with high or very high disease risk index (DRI) at the time of allo-HSCT compared with Group A, the 5-year OS was not significantly different between Groups A and B (48.6 vs 40.9%, P = 0.07), indicating that switching to alternative donors may benefit patients with high DRI.
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28
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Tsai SB, Rhodes J, Liu H, Shore T, Bishop M, Cushing MM, Gergis U, Godley L, Kline J, Larson RA, Mayer S, Odenike O, Stock W, Wickrema A, van Besien K, Artz AS. Reduced-Intensity Allogeneic Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome Using Combined CD34-Selected Haploidentical Graft and a Single Umbilical Cord Unit Compared with Matched Unrelated Donor Stem Cells in Older Adults. Biol Blood Marrow Transplant 2017; 24:997-1004. [PMID: 29288821 DOI: 10.1016/j.bbmt.2017.12.794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/22/2017] [Accepted: 12/20/2017] [Indexed: 11/12/2022]
Abstract
Haplo/cord transplantation combines an umbilical cord blood (UCB) graft with CD34-selected haploidentical cells and results in rapid hematopoietic recovery followed by durable UCB engraftment. We compared outcomes of transplants in older patients with acute myeloid leukemia (AML) or high-risk myelodysplastic syndromes (MDS) who received either HLA-matched unrelated donor (MUD) cells or haplo/cord grafts. Between 2007 and 2013, 109 adults ages 50 and older underwent similar reduced-intensity conditioning with fludarabine and melphalan and antibody-mediated T cell depletion for AML (n = 83) or high-risk MDS (n = 26) followed by either a MUD (n = 68) or haplo/cord (n = 41) graft. Patient characteristics were similar for each graft source except for more minority patients receiving a haplo/cord transplant (P = .01). One half of the AML patients were not in remission. Two-year progression-free survival (PFS), overall survival (OS), and graft-versus-host disease-free relapse-free survival were 38%, 48%, and 32.1% for MUD and 33%, 48%, and 33.8% for haplo/cord transplants (P = .62 for PFS; P = .97 for OS; P= .84), respectively. Acute grades II to IV and chronic graft-versus-host-disease rates did not differ at 19.5% and 4.9% in haplo/cord compared with 25% and 7.4% after MUD (P = .53 and P = .62, respectively). Multivariate analysis confirmed no significant differences in transplant outcomes by donor type. Haplo/cord reduced-intensity transplantation achieves similar outcomes relative to MUD in older AML and MDS patients, making this a promising option for those without matched donors.
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Affiliation(s)
- Stephanie B Tsai
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois; Section of Hematology-Oncology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Joanna Rhodes
- Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York
| | - Hongtao Liu
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Tsiporah Shore
- Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York
| | - Michael Bishop
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Melissa M Cushing
- Department of Pathology, Weill-Cornell Medical College, New York, New York
| | - Usama Gergis
- Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York
| | - Lucy Godley
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Justin Kline
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Richard A Larson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sebastian Mayer
- Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York
| | - Olatoyosi Odenike
- Section of Hematology-Oncology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amittha Wickrema
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Koen van Besien
- Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York
| | - Andrew S Artz
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois.
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29
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Rangarajan HG, Abu-Arja R, Pai V, Guilcher GMT, Soni S. Outcomes of Unrelated Donor Stem Cell Transplantion with Post-Transplant Cyclophosphamide for Graft-versus-Host Disease Prophylaxis in Patients with Severe Sickle Cell Disease. Biol Blood Marrow Transplant 2017; 24:413-417. [PMID: 29061531 DOI: 10.1016/j.bbmt.2017.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/02/2017] [Accepted: 10/15/2017] [Indexed: 10/18/2022]
Abstract
Unrelated donor (URD) hematopoietic cell transplantation (HCT) in children with sickle cell disease (SCD) is associated with a high incidence of rejection and graft-versus-host disease (GVHD). We report on the first 4 patients with severe SCD who underwent URD HCT using a novel myeloablative and immunosuppressive regimen composed of busulfan, fludarabine, and antithymocyte globulin with a single dose of post-transplant cyclophosphamide along with tacrolimus and mycophenolate mofetil for GVHD prophylaxis. Three patients engrafted and remain disease-free after a median follow-up period of 2.5 years. One patient had primary graft failure attributed to low stem cell content of the graft. Of interest, none of the engrafted patients developed acute or chronic GVHD. This preparative regimen along with the use of post-transplant cyclophosphamide offers a promising approach for unrelated donor transplants in patients with SCD and needs further corroboration in larger number of patients.
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Affiliation(s)
- Hemalatha G Rangarajan
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Rolla Abu-Arja
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Vinita Pai
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio; Department of Pharmacy, Nationwide Children's Hospital, Columbus, Ohio
| | - Gregory M T Guilcher
- Section of Pediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, Departments of Oncology and Pediatrics, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Sandeep Soni
- Division of Stem Cell Transplant and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
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30
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Goto T, Tanaka T, Sawa M, Ueda Y, Ago H, Chiba S, Kanamori H, Nishikawa A, Nougawa M, Ohashi K, Okumura H, Tanimoto M, Fukuda T, Kawashima N, Kato T, Okada K, Nagafuji K, Okamoto SI, Atsuta Y, Hino M, Tanaka J, Miyamura K. Prospective observational study on the first 51 cases of peripheral blood stem cell transplantation from unrelated donors in Japan. Int J Hematol 2018; 107:211-21. [PMID: 29027623 DOI: 10.1007/s12185-017-2341-y] [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: 07/07/2017] [Revised: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 12/28/2022]
Abstract
The Japan Marrow Donor Program (JMDP) has facilitated unrelated peripheral blood stem cell transplantation (URPBSCT) since 2010. We conducted a prospective multicenter observational study to evaluate the feasibility of such transplantation. Between 2011 and 2014, 51 patients underwent URPBSCT from 8/8 allele-matched donors for hematological malignancies. The median age of the patients was 50 years; 21 had high-risk disease. Myeloablative conditioning regimens were used in 31 patients, and tacrolimus based graft-versus-host disease (GVHD) prophylaxis was used for all patients. The cumulative rate of engraftment was 96%. With a median follow-up period of 610 days for survivors, 100-day and 1-year overall survival rates were 86 and 59%, respectively. The cumulative incidence of non-relapse mortality and relapse at 1 year were 14 and 35%, respectively. The incidence of grade II to IV acute GVHD at 100 days and extensive type of chronic GVHD at 1 year were 25 and 32%, respectively. The probability of overall survival was comparable with that of bone marrow transplantation from HLA matched-unrelated donors in Japan, although the incidence of chronic GVHD was higher. Further follow-up with more patients is clearly warranted to establish the optimal use of URPBSCT together with the approaches of minimizing chronic GVHD.
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Stroncek DF, Shaw BE, Logan BR, Kiefer DM, Savani BN, Anderlini P, Bredeson CN, Hematti P, Ganguly S, Diaz MA, Abdel-Azim H, Ahmed I, Maharaj D, Seftel M, Beitinjaneh A, Seo S, Yared JA, Halter J, O'Donnell PV, Hale GA, DeFilipp Z, Lazarus H, Liesveld JL, Zhou Z, Munshi P, Olsson RF, Kasow KA, Szer J, Switzer GE, Chitphakdithai P, Shah N, Confer DL, Pulsipher MA. Donor Experiences of Second Marrow or Peripheral Blood Stem Cell Collection Mirror the First, but CD34 + Yields Are Less. Biol Blood Marrow Transplant 2017; 24:175-184. [PMID: 28958894 DOI: 10.1016/j.bbmt.2017.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
Abstract
Little is known about the experiences of individuals donating peripheral blood stem cells (PBSCs) or marrow for a second time. To study this, unrelated donors making a second donation through the National Marrow Donor Program between 2004 and 2013 were evaluated. Experiences of second-time donors giving marrow (n = 118: first donation was PBSC in 76 and marrow in 42) were compared with those making only 1 marrow donation (n = 5829). Experiences of second-time donors giving PBSCs (n = 602) (first donation was PBSCs in 362; marrow in 240) were compared to first-time PBSC donors (n = 16,095). For donors giving a second PBSC or marrow donation there were no significant differences in maximum skeletal pain, maximum symptoms measured by an established modified toxicity criteria, and recovery time compared with those who donated only once. Notably, the yield of marrow nucleated cells and PBSC CD34+ cells with second donations was less. As previously noted with single first-time donations, female (PBSCs and marrow) and obese donors (PBSCs) had higher skeletal pain and/or toxicity with a second donation. PBSC donors who experienced high levels of pain or toxicity with the first donation also experienced high levels of these symptoms with their second donation and slower recovery times. In conclusion, for most donors second donation experiences were similar to first donation experiences, but CD34+ yields were less. Knowledge of the donor's first experience and stem cell yields may help centers decide whether second donations are appropriate and institute measures to improve donor experiences.
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Affiliation(s)
- David F Stroncek
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Bronwen E Shaw
- Center for International Blood and Bone Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Brent R Logan
- Center for International Blood and Bone Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Bipin N Savani
- Hematology & Stem Cell Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paolo Anderlini
- Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Christopher N Bredeson
- The Ottawa Hospital Blood & Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Peiman Hematti
- Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Siddhartha Ganguly
- Hematologic Malignancies and Cellular Therapies, University of Kansas Medical Center, Westwood, Kansas
| | - Miguel Angel Diaz
- Unidad de Trasplante Hematopoyetico, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Hisham Abdel-Azim
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Ibrahim Ahmed
- Children's Mercy Hospital-UMKC, Kansas City, Missouri
| | - Dipnarine Maharaj
- South Florida Bone Marrow Transplant/Stem Cell Transplant Institute, Bethesda Health City, Boynton Beach, Florida
| | - Matthew Seftel
- Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Ontario, Canada
| | - Amer Beitinjaneh
- Stem Cell Transplantation and Cell Therapy Program, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sachiko Seo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jean A Yared
- Department of Medicine, Greenbaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Joerg Halter
- Department of Haematology, University Hospital Basel, Basel, Switzerland
| | - Paul V O'Donnell
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory A Hale
- Cancer and Blood Disorders Institute, All Children's Hospital, St. Petersburg, Florida
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hillard Lazarus
- Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jane L Liesveld
- Hematology-Oncology Unit, Department of Medicine, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Zheng Zhou
- University of Massachusetts, Marlboro, Massachusetts
| | - Pashna Munshi
- Georgetown University Hospital, Washington, District of Columbia
| | - Richard F Olsson
- Karolinska Institutet, Division of Therapeutic Immunology, Stockholm, Sweden
| | - Kimberly Anne Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey Szer
- Department of Hematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia
| | - Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pintip Chitphakdithai
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Nirali Shah
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dennis L Confer
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Michael A Pulsipher
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
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32
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Brissot E, Labopin M, Stelljes M, Ehninger G, Schwerdtfeger R, Finke J, Kolb HJ, Ganser A, Schäfer-Eckart K, Zander AR, Bunjes D, Mielke S, Bethge WA, Milpied N, Kalhs P, Blau IW, Kröger N, Vitek A, Gramatzki M, Holler E, Schmid C, Esteve J, Mohty M, Nagler A. Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT. J Hematol Oncol 2017; 10:130. [PMID: 28646908 PMCID: PMC5483262 DOI: 10.1186/s13045-017-0498-8] [Citation(s) in RCA: 35] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/16/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Primary refractory acute myeloid leukemia (PRF-AML) is associated with a dismal prognosis. Allogeneic stem cell transplantation (HSCT) in active disease is an alternative therapeutic strategy. The increased availability of unrelated donors together with the significant reduction in transplant-related mortality in recent years have opened the possibility for transplantation to a larger number of patients with PRF-AML. Moreover, transplant from unrelated donors may be associated with stronger graft-mediated anti-leukemic effect in comparison to transplantations from HLA-matched sibling donor, which may be of importance in the setting of PRF-AML. METHODS The current study aimed to address the issue of HSCT for PRF-AML and to compare the outcomes of HSCT from matched sibling donors (n = 660) versus unrelated donors (n = 381), for patients with PRF-AML between 2000 and 2013. The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. RESULTS HSCT provide patients with PRF-AML a 2-year leukemia-free survival and overall survival of about 25 and 30%, respectively. In multivariate analysis, two predictive factors, cytogenetics and time from diagnosis to transplant, were associated with lower leukemia-free survival, whereas Karnofsky performance status at transplant ≥90% was associated with better leukemia-free survival (LFS). Concerning relapse incidence, cytogenetics and time from diagnosis to transplant were associated with increased relapse. Reduced intensity conditioning regimen was the only factor associated with lower non-relapse mortality. CONCLUSIONS HSCT was able to rescue about one quarter of the patients with PRF-AML. The donor type did not have any impact on PRF patients' outcomes. In contrast, time to transplant was a major prognostic factor for LFS. For patients with PRF-AML who do not have a matched sibling donor, HSCT from an unrelated donor is a suitable option, and therefore, initiation of an early search for allocating a suitable donor is indicated.
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Affiliation(s)
- Eolia Brissot
- Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, 184 rue du faubourg Saint-Antoine, 75571 Paris, Cedex 12 France
| | - Myriam Labopin
- Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, 184 rue du faubourg Saint-Antoine, 75571 Paris, Cedex 12 France
- Acute Leukemia Working Party Office, Hôpital Saint Antoine, APHP, Paris, France
| | - Matthias Stelljes
- Department of Medicine A/Hematology and Oncology, University of Muenster, Muenster, Germany
| | - Gerhard Ehninger
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Dresden, Germany
| | | | - Jürgen Finke
- Faculty of Medicine and Medical Center, Hematology, Oncology and Stem Cell Transplantation, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Axel R. Zander
- Bone Marrow Transplantation Center, University Hospital Eppendorf, Hamburg, Germany
| | - Donald Bunjes
- Klinik fuer Innere Medizin III, Universtätklinikum, Ulm, Germany
| | - Stephan Mielke
- Department of Internal Medicine II, Würzburg University Medical Center, Würzburg, Germany
| | - Wolfgang A. Bethge
- Medical Department, Hematology and Oncology, University of Tuebingen, Tübingen, Germany
| | | | - Peter Kalhs
- Department of Internal Medicine I, Bone Marrow Transplantation Unit, Medical University of Vienna, Vienna, Austria
| | - Igor-Woflgang Blau
- Charite-Campus Benjamin Franklin Universitaetsmedizin Berlin Klinik III- Hematologie u Onkologie, Hindenburgdamm, Berlin, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonin Vitek
- Department of Clinical Hematology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Martin Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
| | - Ernst Holler
- Department of Haematology/Oncology, University Hospital Regensburg, Regensburg, Germany
| | | | - Jordi Esteve
- Hospital Clinic Institut d’investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Mohamad Mohty
- Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, 184 rue du faubourg Saint-Antoine, 75571 Paris, Cedex 12 France
- Acute Leukemia Working Party Office, Hôpital Saint Antoine, APHP, Paris, France
| | - Arnon Nagler
- Acute Leukemia Working Party Office, Hôpital Saint Antoine, APHP, Paris, France
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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33
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Horio T, Mizuno S, Uchino K, Mizutani M, Hanamura I, Espinoza JL, Onizuka M, Kashiwase K, Morishima Y, Fukuda T, Kodera Y, Doki N, Miyamura K, Mori T, Takami A. The recipient CCR5 variation predicts survival outcomes after bone marrow transplantation. Transpl Immunol 2017; 42:34-39. [PMID: 28487238 DOI: 10.1016/j.trim.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/24/2017] [Accepted: 05/05/2017] [Indexed: 12/18/2022]
Abstract
The chemokine receptor CCR5 plays roles in the trafficking of effector cells towards the site of inflammation. We retrospectively examined the impact of the CCR5 variation (rs1800023, -2086A>G) on transplant outcomes in a cohort of 329 patients who underwent unrelated HLA-matched bone marrow transplantation (BMT) for hematologic malignancies through the Japan Marrow Donor Program. A multivariate analysis showed that the recipient CCR5 -2086A/A genotype was significantly associated with a lower relapse rate but not with the development of graft-versus-host disease (GVHD) or transplant-related mortality, thereby resulting in better disease-free and overall survival rates than other variations. The donor CCR5 -2086A/A genotype was associated with a lower incidence of grades 3-4 acute GVHD, which did not improve the survival outcomes. These findings suggest that the recipient CCR5 -2086A/A genotype affects the induction of the graft-versus-tumor effect without augmenting the development of GVHD. CCR5 genotyping in transplant recipients may therefore be a useful tool for evaluating pretransplantation risks.
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Affiliation(s)
- Tomohiro Horio
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Shohei Mizuno
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Kaori Uchino
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Motonori Mizutani
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Ichiro Hanamura
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - J Luis Espinoza
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
| | - Koichi Kashiwase
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan.
| | - Yasuo Morishima
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
| | - Takahiro Fukuda
- Hematopoietic Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo, Japan.
| | - Yoshihisa Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University, Nagoya, Japan.
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Akiyoshi Takami
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
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34
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Shin MK, Shin S, Lee JY, Koh Y. Physicians' preferences and perceptions regarding donor selection in allogeneic stem cell transplantation in Korea when a matched domestic donor is not available. Blood Res 2017; 52:31-36. [PMID: 28401099 PMCID: PMC5383585 DOI: 10.5045/br.2017.52.1.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/24/2016] [Accepted: 01/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background A number of alternative donor options exist for patients who fail to find domestic HLA-matched donors for allogeneic hematopoietic stem cell transplantation (allo-HSCT). We assessed physicians' perspectives on allo-HSCT donor selection when a matched domestic donor is not available. Methods We administered a questionnaire survey to 55 hematologists (response rate: 28%) who attended the annual spring conference of the Korean Society of Haematology in 2015. The questionnaire contained four clinical allo-HSCT scenarios and the respondents were asked to choose the most preferred donor among the given options. Results In all four scenarios, the hematologists preferred a matched international donor over partially mismatched unrelated domestic or haplo-matched family donors. The numbers of hematologists who chose a matched international donor (HLA 8/8) in cases of acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblastic leukemia, and aplastic anemia were 37 (67.3%), 41 (74.6%), 33 (60.0%), and 36 (65.5%), respectively. The important factors that affected donor selection included “expecting better clinical outcomes (40.5%)” and “lower risk of side effects (23.4%).” The majority of participants (80%) responded that allo-HSCT guidelines for donor selection customized for the Korean setting are necessary. Conclusion Although hematologists still prefer perfectly matched foreign donors when a fully matched domestic allo-HSCT donor is not available, we confirmed that there was variation in their responses. For evidence-based clinical practice, it is necessary to provide further comparative clinical evidence on allo-HSCT from haplo-matched family donors and fully matched unrelated international donors.
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Affiliation(s)
- Min Kyung Shin
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sangjin Shin
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ja Youn Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Youngil Koh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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35
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Ruggeri A, Battipaglia G, Labopin M, Ehninger G, Beelen D, Tischer J, Ganser A, Schwerdtfeger R, Glass B, Finke J, Michallet M, Stelljes M, Jindra P, Arnold R, Kröger N, Mohty M, Nagler A. Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study. J Hematol Oncol 2016; 9:89. [PMID: 27639553 PMCID: PMC5027089 DOI: 10.1186/s13045-016-0321-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 07/19/2016] [Accepted: 09/08/2016] [Indexed: 12/02/2022] Open
Abstract
Background Allogeneic stem cell transplantation is the only curative option for patients with acute myeloid leukemia (AML) experiencing relapse. Either matched sibling donor (MSD) or unrelated donor (UD) is indicated. Methods We analyzed 1554 adults with AML transplanted from MSD (n = 961) or UD (n = 593, HLA-matched 10/10, n = 481; 9/10, n = 112). Compared to MSD, UD recipients were older (49 vs 52 years, p = 0.001), transplanted more recently (2009 vs 2006, p = 0.001), and with a longer interval to transplant (10 vs 9 months, p = 0.001). Conditioning regimen was more frequently myeloablative for patients transplanted with a MSD (61 vs 46 %, p = 0.001). Median follow-up was 28 (range 3–157) months. Results Cumulative incidence (CI) of neutrophil engraftment (p = 0.07), grades II–IV acute GVHD (p = 0.11), chronic GVHD (p = 0.9), and non-relapse mortality (NRM, p = 0.24) was not different according to the type of donor. At 2 years, CI of relapse (relapse incidence (RI)) was 57 vs 49 % (p = 0.001). Leukemia-free survival (LFS) at 2 years was 21 vs 26 % (p = 0.001), and overall survival (OS) was 26 vs 33 % (p = 0.004) for MSD vs UD, respectively. Chronic GVHD as time-dependent variable was associated with lower RI (HR 0.78, p = 0.05), higher NRM (HR 1.71, p = 0.001), and higher OS (HR 0.69, p = 0.001). According to HLA match, RI was 57 vs 50 vs 45 %, (p = 0.001) NRM was 23 vs 23 vs 29 % (p = 0.26), and LFS at 2 years was 21 vs 27 vs 25 % (p = 0.003) for MSD, 10/10, and 9/10 UD, respectively. In multivariate analysis adjusted for differences between the two groups, UD was associated with lower RI (HR 0.76, p = 0.001) and higher LFS (HR 0.83, p = 0.001) compared to MSD. Interval between diagnosis and transplant was the other factor associated with better outcomes (RI (HR 0.62, p < 0.001) and LFS (HR 0.67, p < 0.001)). Conclusions Transplantation using UD was associated with better LFS and lower RI compared to MSD for high-risk patients with AML transplanted in first relapse.
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Affiliation(s)
- Annalisa Ruggeri
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.
| | - Giorgia Battipaglia
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.,Department of Hematology and Marrow Transplantation, University Federico II of Naples, Naples, Italy
| | - Myriam Labopin
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France
| | - Gerhard Ehninger
- Medical Clinic and Polyclinic, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital Essen, Essen, Germany
| | - Johanna Tischer
- Department of Internal Medicine III, UH of Munich (LMU), Munich, Germany
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Rainer Schwerdtfeger
- Department of Haematology, Oncology Helios-Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Bertram Glass
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Jurgen Finke
- Department of Hematology/Oncology and Stem Cell Transplantation, University Medical Center, Freiburg, Germany
| | - Mauricette Michallet
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | | | - Pavel Jindra
- Departments of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | | | - Nicolaus Kröger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mohamad Mohty
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.,Hôpital Saint-Antoine, Paris University UPMC, INSERM U938, Paris, France.,Université Pierre and Marie Curie, Paris, France
| | - Arnon Nagler
- Université Pierre and Marie Curie, Paris, France.,Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.,ALWP Office, Hôpital Saint Antoine, AP-HP, Paris, France
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36
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Rubio MT, Savani BN, Labopin M, Polge E, Niederwieser D, Ganser A, Schwerdtfeger R, Ehninger G, Finke J, Renate A, Craddock C, Kröger N, Hallek M, Jindra P, Mohty M, Nagler A. The impact of HLA-matching on reduced intensity conditioning regimen unrelated donor allogeneic stem cell transplantation for acute myeloid leukemia in patients above 50 years-a report from the EBMT acute leukemia working party. J Hematol Oncol 2016; 9:65. [PMID: 27488518 PMCID: PMC4971653 DOI: 10.1186/s13045-016-0295-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 06/06/2016] [Accepted: 07/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background Data comparing fully matched and mismatched-unrelated-donor (M- and mM-URD) allogeneic hematopoietic stem cell transplant (allo-SCT) following reduced intensity conditioning regimens for acute myeloid leukemia are limited. Methods We retrospectively compared the outcome of 3398 patients above the age of 50 years who underwent 10/10 M-URD (n = 2567), 9/10 (n = 723), or 8/10 (n = 108) mM-URD allo-SCT for acute myeloid leukemia after reduced intensity conditioning regimen between 2000 and 2013. The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. Results HLA matching had no impact on engraftment (p = 0.31). In univariate analysis, in comparison to 10/10 M-URD, mM-URD was associated with higher incidence of grade II–IV acute graft-versus-host disease (GVHD) (p = 0.0002), similar rates of chronic GVHD (p = 0.138) but increased incidence of its extensive form (p = 0.047). Compared to 10/10 M-URD, patients transplanted in the first complete remission (CR1) with a 9 or an 8/10 mM-URD had decreased 2-year leukemia free (LFS) (p = 0.005) and overall survivals (OS) (56.7, 46.1, and 50.2 %, respectively, p = 0.005), while outcomes were comparable between all groups for patients transplanted beyond CR1. In multivariate analysis, 9/10 versus 10/10 URD was associated with higher non-relapse mortality (HR 1.34, p = 0.001), similar risk of relapse and chronic GVHD and inferior LFS (HR 1.25, p = 0.0001), and OS (HR 1.27, p = 0.0001). There was no difference in adjusted transplant outcomes between 9/10 and 8/10 mM-URD. Conclusions Reduced intensity conditioned allo-SCT with a 10/10 M-URD remains the preferable option for AML patients above the age of 50 years. The use of a 9/10 or an 8/10 mM-URD in patients not having a fully matched donor represents an alternative therapeutic option that should be compared to other alternative donor transplant strategies. Electronic supplementary material The online version of this article (doi:10.1186/s13045-016-0295-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie T Rubio
- Department of Hematology, Hôpital Brabois, CHRU Nancy, Vandœuvre-lès-Nancy, France. .,CNRS UMR 7365, IMoPA, Nancy, France. .,Université de Lorraine, Nancy, France. .,Acute Leukemia Working Party of EBMT, Paris, France.
| | - Bipin N Savani
- Acute Leukemia Working Party of EBMT, Paris, France. .,Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Myriam Labopin
- Acute Leukemia Working Party of EBMT, Paris, France.,EBMT Paris study office/CEREST-TC, Paris, France.,Department of Haematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Emmanuelle Polge
- Acute Leukemia Working Party of EBMT, Paris, France.,EBMT Paris study office/CEREST-TC, Paris, France.,Department of Haematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Dietger Niederwieser
- Division Hematology, Oncology and Hemostasiology, University Hospital Leipzig, Leipzig, Germany
| | - Arnold Ganser
- Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Gerhard Ehninger
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus der TU Dresden, Dresden, Germany
| | - Jürgen Finke
- Department of Medicine, Hematology, Oncology, University of Freiburg, Freiburg, Germany
| | - Arnold Renate
- MedizinischeKlinik m. S. Hämatologie/Onkologie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Nicolaus Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Michael Hallek
- Department of Medicine, University of Cologne, Cologne, Germany
| | - Pavel Jindra
- Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | - Mohamad Mohty
- Acute Leukemia Working Party of EBMT, Paris, France.,EBMT Paris study office/CEREST-TC, Paris, France.,Department of Haematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Arnon Nagler
- Acute Leukemia Working Party of EBMT, Paris, France.,Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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37
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Altaf SY, Apperley JF, Olavarria E. Matched unrelated donor transplants-State of the art in the 21st century. Semin Hematol 2016; 53:221-229. [PMID: 27788759 DOI: 10.1053/j.seminhematol.2016.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/20/2016] [Indexed: 12/29/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is the therapy of choice in many hematological malignant and non-malignant diseases by using human leukocyte antigen (HLA)-matched siblings as stem cell source but only one third of the patients will have HLA-matched siblings. Hence, physicians rely on the availability of matched unrelated donors (URD). The possibility of finding a matched URD is now more than 70% due to continuous expansion of URD registries around the world. The use of URD in adult patients is steadily increasing and in the last 8 years has superseded the numbers of matched sibling donor transplants and has become the most commonly used stem cell source. There is also an increasing trend to use peripheral blood (PB) stem cells rather than bone marrow (BM) stem cells. Outcomes following URD transplants depend mainly upon the indication and urgency of transplant, age and comorbidities of recipients, cytomegalovirus (CMV) matching/mismatching between donor and the recipient, and degree of HLA matching. In some studies outcome of unrelated stem cell transplants in terms of treatment-related mortality (TRM), disease-free survival (DFS), and overall survival (OS) is comparable to sibling donors.
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Affiliation(s)
- Syed Y Altaf
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jane F Apperley
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Eduardo Olavarria
- Centre for Haematology, Imperial College London, London, United Kingdom.
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38
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Abstract
There are now more than 25 million volunteer donors registered worldwide for patients in need of a life-saving hematopoietic cell transplant to cure blood disorders. Although a human leukocyte antigen (HLA)-matched donor remains the preferred stem cell source for transplantation, the use of a donor with limited HLA mismatching may be considered. Significant advances in clinical and basic research have been instrumental in furthering the understanding of donor-recipient HLA mismatches that are better tolerated than other mismatches. An increased appreciation of the role of regulatory region variation that affects the level of HLA expression provides new approaches for the selection of HLA-mismatched donors.
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Affiliation(s)
- Effie W Petersdorf
- Department of Medicine, University of Washington; Seattle Cancer Care Alliance; Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA.
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39
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Uchino K, Mizuno S, Mizutani M, Horio T, Hanamura I, Espinoza JL, Matsuo K, Onizuka M, Kashiwase K, Morishima Y, Fukuda T, Kodera Y, Doki N, Miyamura K, Mori TMT, Takami A. Toll-like receptor 1 variation increases the risk of transplant-related mortality in hematologic malignancies. Transpl Immunol 2016; 38:60-6. [PMID: 27369862 DOI: 10.1016/j.trim.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 05/31/2016] [Accepted: 06/24/2016] [Indexed: 11/24/2022]
Abstract
Toll-like receptor 1 (TLR1) genetic variant (rs5743551, -7202A>G) has been reported to be associated with susceptibility to various infectious diseases. We retrospectively examined the impact of TLR1 variation on transplant outcomes in a cohort of 320 patients who underwent unrelated HLA-matched bone marrow transplantation (BMT) for hematologic malignancies. A multivariate analysis showed that the G/G genotype in the recipients and the donors was associated with a significantly lower 3-year transplant-related mortality (TRM). The recipient G/G genotype also resulted in a better 3-year progression-free survival. This study suggests that the recipient and donor TLR1 G/G genotypes are comparably associated with a reduced risk of death that was not related to relapse. Thus, TLR1 genotyping may be useful for selecting the donor, managing patients in a risk-adapted manner, and creating therapeutic strategies to prevent complications after hematopoietic stem cell transplantation.
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Affiliation(s)
- Kaori Uchino
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Shohei Mizuno
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Motonori Mizutani
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Tomohiro Horio
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Ichiro Hanamura
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - J Luis Espinoza
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan.
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
| | - Koichi Kashiwase
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan.
| | - Yasuo Morishima
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
| | - Takahiro Fukuda
- Hematopoietic Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo, Japan.
| | - Yoshihisa Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University, Nagoya, Japan.
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
| | | | - Akiyoshi Takami
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
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40
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Kang HJ, Hong KT, Lee JW, Kim H, Park KD, Shin HY, Lee SH, Yoo KH, Sung KW, Koo HH, Lee JW, Chung NG, Cho B, Kim HK, Koh KN, Im HJ, Seo JJ, Jung HJ, Park JE, Lee YH, Lim YT, Lim YJ, Kim SY, Yoo ES, Ryu KH, Lee JH, Park JA, Park SK, Ahn HS. Improved Outcome of a Reduced Toxicity-Fludarabine, Cyclophosphamide, plus Antithymocyte Globulin Conditioning Regimen for Unrelated Donor Transplantation in Severe Aplastic Anemia: Comparison of 2 Multicenter Prospective Studies. Biol Blood Marrow Transplant 2016; 22:1455-1459. [PMID: 27090956 DOI: 10.1016/j.bbmt.2016.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is a curative therapy for severe aplastic anemia (SAA); however, the optimal conditioning regimen for HSCT with an unrelated donor has not yet been defined. A previous study using a fludarabine (FLU), cyclophosphamide (Cy), and antithymocyte globulin (ATG) conditioning regimen (study A: 50 mg/kg Cy once daily i.v. on days -9, -8, -7, and -6; 30 mg/m(2) FLU once daily i.v. on days -5, -4, -3, and -2; and 2.5 mg/kg of ATG once daily i.v. on days -3, -2, and -1) demonstrated successful engraftment (100%) but had a high treatment-related mortality rate (32.1%). Therefore, given that Cy is more toxic than FLU, we performed a new phase II prospective study with a reduced-toxicity regimen (study B: 60 mg/kg Cy once daily i.v. on days -8 and -7; 40 mg/m(2) FLU once daily i.v. on days -6, -5, -4, -3, and -2; and 2.5 mg/kg ATG once daily i.v. on 3 days). Fifty-seven patients were enrolled in studies A (n = 28) and B (n = 29), and donor type hematologic recovery was achieved in all patients in both studies. The overall survival (OS) and event-free survival (EFS) rates of patients in study B was markedly improved compared with those in study A (OS: 96.7% versus 67.9%, respectively, P = .004; EFS: 93.3% versus 64.3%, respectively, P = .008). These data show that a reduced-toxicity conditioning regimen with FLU, Cy, and ATG may be an optimal regimen for SAA patients receiving unrelated donor HSCT.
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Affiliation(s)
- Hyoung Jin Kang
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Won Lee
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyery Kim
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Duk Park
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Young Shin
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo Hyun Lee
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ki Woong Sung
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae Wook Lee
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Nak Gyun Chung
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Bin Cho
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Hack Ki Kim
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Kyung Nam Koh
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ho Joon Im
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong Jin Seo
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyun Joo Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jun Eun Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Ho Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young Tak Lim
- Department of Pediatrics, Pusan National University School of Medicine, Pusan, Republic of Korea
| | - Yeon Jung Lim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sun Young Kim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Eun Sun Yoo
- Department of Pediatrics, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
| | - Kyung Ha Ryu
- Department of Pediatrics, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
| | - Jae Hee Lee
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jeong-A Park
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Pusan, Republic of Korea
| | - Sang Kyu Park
- Department of Pediatrics, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hyo Seop Ahn
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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41
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Abstract
The clinical outcome after allogeneic stem cell transplantation from a human leukocyte antigen (HLA)-matched sibling donor as well as an HLA-matched unrelated donor has clearly improved due in part to the progress made in the domains of HLA-typing techniques. Although HLA-matched sibling transplantation is still held as the "gold standard," transplantation from HLA-A, -B, -C, -DRB1, and -DQB1-matched unrelated donors (so called 10/10) represent the first choice for patients without a suitable related donor. Several studies have shown that unmanipulated marrow transplantation from an HLA allele-matched unrelated donor resulted in similar outcomes to those observed following sibling transplantation. However, incorporating anti-thymocyte globulin (ATG) within graft-versus-host disease (GVHD) prophylaxis should be considered for peripheral blood stem cell grafts in order to decrease the risk of developing chronic GVHD.
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Affiliation(s)
- Ibrahim Yakoub-Agha
- LIRIC, INSERM U995, University Lille 2, Lille, France; UAM allo-CSH, University Hospital of Lille, Lille, France.
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42
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Huang W, Yu L, Cao T, Li Y, Liu Z, Li H, Bo J, Zhao Y, Jing Y, Wang S, Zhu H, Dou L, Wang Q, Gao C. The efficacy and safety of rabbit anti-thymocyte globulin vs rabbit anti-T-lymphocyte globulin in peripheral blood stem cell transplantation from unrelated donors. Leuk Lymphoma 2015; 57:355-363. [PMID: 26118935 DOI: 10.3109/10428194.2015.1045901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The comparative efficacy and safety of antithymocyte globulin (ATG) at fixed doses in patients undergoing allogeneic peripheral blood stem cell transplantation from unrelated donors (UR-PBSCT) has not been evaluated. In this study, the records of 56 patients and 54 patients who received pre-transplant ATG-Thymoglobulin (ATG-T) at a total dose of 10 mg/kg and ATG- Fresenius (ATG-F) at a total dose of 20 mg/kg, respectively, were retrospectively analyzed. ATG-F patients had a significantly lower probability of developing chronic graft-vs-host disease (cGVHD) than those treated with ATG-T (p = 0.04). ATG-F was associated with a non-significant trend towards lower relapse rates and higher survival at 3- and 5-years of follow-up compared with ATG-T. A significantly greater proportion of ATG-T patients experienced chills and high fever than ATG-F patients (p < 0.01). The current findings suggest that ATG-F may more effectively and safely prevent cGVHD without increasing relapse rates in patients undergoing UR-PBSCT.
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Affiliation(s)
- Wenrong Huang
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China.,b Department of Hematology , Hainan Branch of Chinese PLA General Hospital , Hainan province , PR China
| | - Li Yu
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Tingting Cao
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Yanfen Li
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Zhanxiang Liu
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Honghua Li
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Jian Bo
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Yu Zhao
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Yu Jing
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Shuhong Wang
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Haiyan Zhu
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Liping Dou
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Qunshun Wang
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
| | - Chunji Gao
- a Department of Hematology and BMT , Chinese PLA General Hospital , Beijing , PR China
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43
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Pan Z, Yuan X, Li Y, Wu X, Zhu W, Bao X, Zhao Q, He J. Dynamic Detection of Anti-Human Leukocyte Antigen (HLA) Antibodies but not HLA-DP Loci Mismatches Can Predict Acute Graft-versus-Host Disease and Overall Survival in HLA 12/12-Matched Unrelated Donor Allogeneic Hematopoietic Stem Cell Transplantation for Hematological Malignancies. Biol Blood Marrow Transplant 2015; 22:86-95. [PMID: 26283096 DOI: 10.1016/j.bbmt.2015.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 08/08/2015] [Indexed: 11/26/2022]
Abstract
The National Marrow Donor Program and Center for International Blood and Marrow Transplant Research provided guidelines for the use of anti-HLA antibodies and HLA-DP-mismatched loci in unrelated donor hematopoietic stem cell transplantation (HSCT). However, a deeper understanding of other potentially useful biomarkers for predicting clinical outcomes in HLA-A, -B, -C, -DRB1, -DQB1, and -DQA1 (12/12)-matched unrelated donor HSCT is needed to further improve clinical outcomes. We tested HLA genotyping for 123 pairs of patients and donors. Anti-HLA antibodies using the Luminex method was applied to 123, 117, and 106 serum samples collected before and 1 month and 3 months after transplantation. The presences of anti-HLA antibodies at the 3 time points were 37.4% (46 of 123), 40.2% (47 of 117), and 22.6% (24 of 106). Mismatch of HLA-DPB1 and/or DPA1 allele between patient-donor pairs was 83.6% (92 of 110). Patients with anti-HLA antibodies had delayed platelet recovery. The presence of anti-HLA antibodies and their dynamic changes after transplantation were associated with increased occurrence of grades II to IV acute and chronic graft-versus-host disease (GVHD), higher treatment-related mortality, and reduced overall survival (OS) and disease-free survival, especially in acute myeloid leukemia and myelodysplastic syndrome patients. Multivariate analysis showed that presence of anti-HLA antibodies before transplantation was a risk factor for GVHD and OS. Furthermore, HLA-DP loci-matched subgroup showed a trend towards a lower rate of acute GVHD and a higher OS in the anti-HLA Abs-negative group. Our results suggest that dynamic changes of anti-HLA antibodies independently predict for a negative outcome of HSCT, independent of HLA-DP loci mismatches. Routine monitoring for anti-HLA antibody dynamics should be conducted before and after HSCT.
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Affiliation(s)
- Zhijuan Pan
- Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Xiaoni Yuan
- Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Yang Li
- Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Xiaojin Wu
- Department of Hematology, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Wenjuan Zhu
- Department of Hematology, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Xiaojin Bao
- Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Qinqin Zhao
- Department of Hematology, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Jun He
- Department of HLA Laboratory, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
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44
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Nomoto H, Takami A, Espinoza JL, Matsuo K, Mizuno S, Onizuka M, Kashiwase K, Morishima Y, Fukuda T, Kodera Y, Doki N, Miyamura K, Mori T, Nakao S, Ohtake S, Morishita E. A donor thrombomodulin gene variation predicts graft-versus-host disease development and mortality after bone marrow transplantation. Int J Hematol 2015; 102:460-70. [PMID: 26246110 DOI: 10.1007/s12185-015-1852-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
Thrombomodulin, encoded by the THBD gene, is a critical regulator of coagulation and innate immunity. Its gene variant (rs3176123, 2729A>C) in the 3' untranslated region has been reported to be associated with vasculopathies. The present study analyzed the impact of THBD variation on transplant outcomes in a cohort of 317 patients who underwent unrelated HLA-matched bone marrow transplantation (BMT) for hematologic malignancies through the Japan Marrow Donor Program. The donor A/C or C/C genotype vs. the donor A/A genotype resulted in a lower incidence of grades II-IV acute graft-versus-host disease [GVHD; hazard ratio (HR) 0.66; 95 % confidence interval (CI) 0.44-0.99; P = 0.05] according to a multivariate analysis. In patients with grades II-IV acute GVHD, the donor A/C or C/C genotype vs. the donor A/A genotype was associated with significantly better overall survival rates (HR 0.45; 95 % CI 0.21-0.99, P = 0.05), while this effect was absent in other patients. A functional analysis using lymphocytes obtained from healthy individuals revealed that the 2729C allele has a higher level of THBD mRNA than the 2729A allele. These findings suggest the functional relevance of the rs3176123 variation and indicate that higher thrombomodulin expression by individuals with the 2729C allele likely accounts for their decreased risk for acute GVHD development and subsequent mortality.
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Shaw BE, Logan BR, Kiefer DM, Chitphakdithai P, Pedersen TL, Abdel-Azim H, Abidi MH, Akpek G, Diaz MA, Artz AS, Dandoy C, Gajewski JL, Hematti P, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Majhail NS, O'Donnell PV, Olsson RF, Savani BN, Schears RM, Stroncek DF, Switzer GE, Williams EP, Wingard JR, Wirk BM, Confer DL, Pulsipher MA. Analysis of the Effect of Race, Socioeconomic Status, and Center Size on Unrelated National Marrow Donor Program Donor Outcomes: Donor Toxicities Are More Common at Low-Volume Bone Marrow Collection Centers. Biol Blood Marrow Transplant 2015; 21:1830-8. [PMID: 26116089 DOI: 10.1016/j.bbmt.2015.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/14/2015] [Indexed: 11/22/2022]
Abstract
Previous studies have shown that risks of collection-related pain and symptoms are associated with sex, body mass index, and age in unrelated donors undergoing collection at National Marrow Donor Program centers. We hypothesized that other important factors (race, socioeconomic status [SES], and number of procedures at the collection center) might affect symptoms in donors. We assessed outcomes in 2726 bone marrow (BM) and 6768 peripheral blood stem cell (PBSC) donors collected between 2004 and 2009. Pain/symptoms are reported as maximum levels over mobilization and collection (PBSC) or within 2 days of collection (BM) and at 1 week after collection. For PBSC donors, race and center volumes were not associated with differences in pain/symptoms at any time. PBSC donors with high SES levels reported higher maximum symptom levels 1 week after donation (P = .017). For BM donors, black males reported significantly higher levels of pain (OR, 1.90; CI, 1.14 to 3.19; P = .015). No differences were noted by SES group. BM donors from low-volume centers reported more toxicity (OR, 2.09; CI, 1.26 to 3.46; P = .006). In conclusion, race and SES have a minimal effect on donation-associated symptoms. However, donors from centers performing ≤ 1 BM collection every 2 months have more symptoms after BM donation. Approaches should be developed by registries and low-volume centers to address this issue.
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Howard CA, Fernandez-Vina MA, Appelbaum FR, Confer DL, Devine SM, Horowitz MM, Mendizabal A, Laport GG, Pasquini MC, Spellman SR. Recommendations for donor human leukocyte antigen assessment and matching for allogeneic stem cell transplantation: consensus opinion of the Blood and Marrow Transplant Clinical Trials Network (BMT CTN). Biol Blood Marrow Transplant 2015; 21:4-7. [PMID: 25278457 PMCID: PMC4272893 DOI: 10.1016/j.bbmt.2014.09.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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: 09/16/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) conducts large, multi-institutional clinical trials with the goal of improving the outcomes of hematopoietic cell transplantation (HCT) for patients with life-threatening disorders. Well-designed HCT trials benefit from standardized criteria for defining diagnoses, treatment plans, and graft source selection. In this perspective, we summarize evidence supporting criteria for the selection of related and unrelated adult volunteer progenitor cell donors or umbilical cord blood units. These standardized criteria for graft source selection have been adopted by the BMT CTN to enhance the interpretation of clinical findings within and among future clinical protocols.
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Affiliation(s)
- C Alan Howard
- Immunobiology Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - Frederick R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Dennis L Confer
- Immunobiology Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; National Marrow Donor Program, Minneapolis, Minnesota
| | - Steven M Devine
- Blood and Marrow Transplant Program, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Ginna G Laport
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephen R Spellman
- Immunobiology Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota.
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Kim H, Lee KH, Kim I, Sohn SK, Jung CW, Joo YD, Kim SH, Kim BS, Choi JH, Kwak JY, Kim MK, Bae SH, Shin HJ, Won JH, Lee WS, Oh S, Kim HJ, Park JH. Allogeneic hematopoietic cell transplantation without total body irradiation from unrelated donor in adult patients with idiopathic aplastic anemia: fludarabine versus cyclophosphamide-ATG. Leuk Res 2014; 38:730-6. [PMID: 24840870 DOI: 10.1016/j.leukres.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/12/2013] [Revised: 12/23/2013] [Accepted: 01/02/2014] [Indexed: 11/19/2022]
Abstract
Total body irradiation (TBI) has traditionally been used in the conditioning regimen for allogenetic hematopoietic stem cell transplantation (alloHCT) from an unrelated donor (u-HCT). However, patients are increasingly receiving a fludarabine-based conditioning regimen without TBI, as it seemed less toxic than TBI. We need to know the clinical results of non-TBI u-HCT treatments. We retrospectively investigated the clinical outcomes of allogenetic hematopoietic cell transplantation (alloHCT) from an unrelated donor without TBI (non-TBI u-HCT) and compared the clinical outcomes of fludarabine-based (FLU group) and cyclophosphamide-ATG (Cy-ATG group) conditioning regimens. Sixty-one patients received the non-TBI conditioning regimen for u-HCT (32 in the FLU group and 29 in the Cy-ATG group). The cumulative incidence of neutrophil engraftment at 30 days, platelet>20K/μL at 30 days, acute graft-versus host disease (aGvHD) at 100 days, and chronic GvHD (cGvHD) at 2 years were 87.01%, 65.57%, 35.20%, and 26.64%, respectively. However, transplantation outcomes and overall survival rates did not differ between the FLU and Cy-ATG groups. Only infused CD34+ cells >3×10(6)kg(-1) was identified as a favorable factor for survival in the multivariate analysis. In conclusion, non-TBI u-HCT was feasible and there was no difference between the FLU and Cy-ATG groups in terms of transplantation outcomes.
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Affiliation(s)
- Hawk Kim
- Ulsan University Hospital, 877 Baneojinsunwhan-doro, Ulsan, Republic of Korea.
| | - Kyoo-Hyung Lee
- Asan Medical Center, 86 Asanbyeongwon-gil, Seoul, Republic of Korea
| | - Inho Kim
- Seoul National University Hospital, 101 Daehang-ro, Seoul, Republic of Korea
| | - Sang Kyun Sohn
- Kyungpook National University Hospital, 135, Dongdeok-ro, Daegu, Republic of Korea
| | - Chul Won Jung
- Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul, Republic of Korea
| | - Young Don Joo
- Inje University Haeundae Paik Hospital, 875 Haeundae-ro, Busan, Republic of Korea
| | - Sung-Hyun Kim
- Dong-A University Medical Center, 26 Daesingongwon-ro, Busan, Republic of Korea
| | - Byung Soo Kim
- Korea University Hospital Seoul Hospital, 73 Inchon-ro, Seoul, Republic of Korea
| | - Jung Hye Choi
- Hanyang University Hospital, 222 Wangsimni-ro, Seoul, Republic of Korea
| | - Jae-Yong Kwak
- Chonbuk National University Hospital, 20 Geonji-ro, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Min Kyoung Kim
- Yeungnam University Medical Center, 170 Hyeonchung-ro, Daegu, Republic of Korea
| | - Sung Hwa Bae
- Daegu Catholic University Hospital, 33 Duryugongwon-ro 17-gil, Daegu, Republic of Korea
| | - Ho Jin Shin
- Pusan National University Hospital, 179 Gudeok-ro, Busan, Republic of Korea
| | - Jong-Ho Won
- Soonchunhyang University Seoul Hospital, 59 Dassagwan-ro, Seoul, Republic of Korea
| | - Won Sik Lee
- Inje University Busan Paik Hospital, 75 Bokji-ro, Busan, Republic of Korea
| | - Sukjoong Oh
- Kangbuk Samsung Hospital, 29 Saemunan-ro, Seoul, Republic of Korea
| | - Hyo Jung Kim
- Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea.
| | - Jae-Hoo Park
- Ulsan University Hospital, 877 Baneojinsunwhan-doro, Ulsan, Republic of Korea.
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Zhu X, Lai X, Luo Y, Shi J, Tan Y, Zheng W, He J, Xie W, Li L, Zhang J, Ye X, Lin M, Cai Z, Huang H. Combination of low-dose mycophenolate mofetil with cyclosporine and methotrexate as GVHD prophylaxis in unrelated donor allogeneic stem cell transplantation. Leuk Res 2013; 37:1046-51. [PMID: 23849987 DOI: 10.1016/j.leukres.2013.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
Abstract
We report the results of HLA-matched unrelated donor allogeneic stem cell transplantation with new GVHD prophylaxis regimen consisted of cyclosporine, methotrexate and low-dose mycophenolate mofetil in 139 patients with hematologic malignancies. The incidence of grades II-IV and III-IV acute GVHD were 43.0% and 17.3%, respectively. The incidence of chronic GVHD was 42.1%, with 16.5% extensive grade. The cumulative incidence of transplant-related mortality at 100 days and 3 years were 7.9% and 29.7%, respectively. Three-year overall survival, disease-free survival and relapse incidence were 58.7%, 55.3% and 19.6%, respectively. These results suggest the new regime may be effective for the prophylaxis of acute and chronic GVHD in unrelated donor transplantation.
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Affiliation(s)
- Xiaoli Zhu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
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Yao S, Hahn T, Zhang Y, Haven D, Senneka M, Dunford L, Parsons S, Confer D, McCarthy PL. Unrelated donor allogeneic hematopoietic cell transplantation is underused as a curative therapy in eligible patients from the United States. Biol Blood Marrow Transplant 2013; 19:1459-64. [PMID: 23811537 DOI: 10.1016/j.bbmt.2013.06.014] [Citation(s) in RCA: 22] [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: 10/27/2012] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) is a curative therapy for hematologic disorders including acute lymphoblastic and myeloid leukemia, chronic lymphocytic and myeloid leukemia, Hodgkin's and non-Hodgkin lymphoma, multiple myeloma, and myelodysplastic syndrome. To determine the utilization of alloHCT from unrelated donors (URDs) in the United States, we calculated the number of patients diagnosed with hematologic disorders age 20 to 74 years based on 2004 to 2008 Surveillance, Epidemiology and End Results and 2007 US Census data, estimated the percentage of patients who would be eligible for URD alloHCT after discounting the mortality rate during induction therapy and the rate of severe comorbidities, and compared these with the actual 2007 alloHCTs facilitated by the National Marrow Donor Program. We found that the number of URD alloHCT as a percentage of the estimated potential transplantations ranged from 11% for multiple myeloma to 54% for chronic myeloid leukemia, with an average percentage of 26% for all the disorders considered. In an analysis stratified by age groups (20 to 44, 45 to 64, and 65 to 74 years), the utilization of URD alloHCT was higher in younger patients than in older patients for all disorders. Of acute lymphoblastic and myeloid leukemia patients, approximately 66% underwent URD alloHCT later in the course of their disease (in second or greater complete remission). URD alloHCT is likely underused for potentially curable hematologic disorders, particularly in older patients. Understanding the reasons for low use of alloHCT may lead to strategies to expand the use of this curative therapy for more patients with hematologic disorders.
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Affiliation(s)
- Song Yao
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
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