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Bazarbachi AH, Labopin M, Raiola AM, Blaise D, Arcese W, Santarone S, Koc Y, Bramanti S, Kulagin A, Kwon M, Sica S, Sanz J, Brissot E, Nagler A, Ciceri F, Mohty M. Posttransplant cyclophosphamide versus anti-thymocyte globulin versus combination for graft-versus-host disease prevention in haploidentical transplantation for adult acute myeloid leukemia: A report from the European Society for Blood and Marrow Transplantation Acute Leukemia Working Party. Cancer 2024. [PMID: 38758817 DOI: 10.1002/cncr.35365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The optimal choice for graft-versus-host disease (GVHD) prophylaxis in haploidentical stem cell transplantation (haplo-SCT) remains debatable. Posttransplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG) are two common strategies, but little is known about their combination. METHODS Using the European Society for Blood and Marrow Transplantation (EBMT) registry, the authors identified 3649 adult patients with acute myeloid leukemia (AML) who underwent haplo-SCT in complete remission between 2007 and 2021 at 260 EBMT-participating centers who received either PTCy (n = 2999), ATG (n = 358), or combination prophylaxis (n = 292). Cord blood transplants, combined bone marrow and peripheral grafts, and transplants with ex vivo graft manipulation were excluded. Median follow-up was 31.8 months. RESULTS On multivariate analysis, adjusting for patient age and performance status, disease status at transplant, cytogenetic risk, conditioning intensity, stem cell source, female-to-male graft, and donor and patient CMV status, we present the following. Compared to PTCy, ATG had a higher risk of nonrelapse mortality (hazard ratio [HR], 1.6; p = .003), worse leukemia-free survival (HR, 1.4; p = .002), overall survival (HR, 1.49; p = .0009), and GVHD-free and relapse-free survival (HR, 1.29; p = .012). The combination of PTCy and ATG, however, led to significantly reduced rates of grade 2-4 (HR, 0.51; p = .0003) and grade 3-4 (HR, 0.5; p = .018) acute GVHD and did not affect any transplant outcomes compared to PTCy without ATG. CONCLUSION The authors conclude that ATG alone is a less effective prophylaxis strategy compared to PTCy, however, the combination of PTCy and ATG is superior to either monotherapy. They propose that this combination could be considered a potential new standard of care for GVHD prophylaxis in haplo-SCT for AML.
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Affiliation(s)
- Abdul-Hamid Bazarbachi
- EBMT Paris study office/CEREST-TC, Paris, France
- Department of Hematology, Saint Antoine Hospital, Paris, France
- INSERM UMR 938, Sorbonne University, Paris, France
- Division of Hematology/Oncology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Myriam Labopin
- EBMT Paris study office/CEREST-TC, Paris, France
- Department of Hematology, Saint Antoine Hospital, Paris, France
- INSERM UMR 938, Sorbonne University, Paris, France
| | - Anna Maria Raiola
- Hematology and Cellular Therapy Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Didier Blaise
- Transplantation and Cellular Immunotherapy Program, Department of Hematology, Institut Paoli Calmettes, MSC Lab, Aix Marseille University, Marseille, France
| | - William Arcese
- Stem Cell Transplant Unit, "Tor Vergata" University of Rome, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Stella Santarone
- Dipartimento Oncologico Ematologico, Terapia Intensiva Ematologica, Ospedale Civile, Pescara, Italy
| | - Yener Koc
- Bone Marrow Transplant Unit, Medicana International Hospital Istanbul, Istanbul, Turkey
| | - Stefania Bramanti
- Transplantation Unit Department of Oncology and Haematology, Istituto Clinico Humanitas, Milano, Italy
| | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Mi Kwon
- Sección de Trasplante de Medula Osea, Hospital Gregorio Marañón, Madrid, Spain
| | - Simona Sica
- Universita Cattolica S. Cuore, Istituto di Ematologia, Rome, Italy
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Eolia Brissot
- EBMT Paris study office/CEREST-TC, Paris, France
- Department of Hematology, Saint Antoine Hospital, Paris, France
- INSERM UMR 938, Sorbonne University, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fabio Ciceri
- IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
| | - Mohamad Mohty
- EBMT Paris study office/CEREST-TC, Paris, France
- Department of Hematology, Saint Antoine Hospital, Paris, France
- INSERM UMR 938, Sorbonne University, Paris, France
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2
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Penack O, Abouqateb M, Peczynski C, Boreland W, Kröger N, Stelljes M, Gedde-Dahl T, Blau IW, Schroeder T, Salmenniemi U, Kulagin A, Peffault de Latour R, Mielke S, Zeiser R, Moiseev I, Schoemans H, Koenecke C, Peric Z. ATG or post-transplant cyclophosphamide to prevent GVHD in matched unrelated stem cell transplantation? Leukemia 2024; 38:1156-1163. [PMID: 38538862 DOI: 10.1038/s41375-024-02225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 05/08/2024]
Abstract
There is a high risk of GVHD and non-relapse mortality (NRM) after allogeneic stem cell transplantations (alloSCT) from unrelated donors. Prophylaxis with rabbit anti-thymocyte globulin (rATG) is standard in Europe but post-transplantation Cyclophosphamide (PTCy) is an emerging alternative. We analyzed outcomes of rATG (n = 7725) vs. PTCy (n = 1039) prophylaxis in adult patients with hematologic malignancies undergoing peripheral blood alloSCT from 10/10 antigen-matched unrelated donors (MUD) between January 2018 and June 2021 in the EBMT database. The provided P-values and hazard ratios (HR) are derived from multivariate analysis. Two years after alloSCT, NRM in the PTCy group was 12.1% vs. 16.4% in the rATG group; p = 0.016; HR 0.72. Relapse was less frequent after PTCy vs. rATG (22.8% vs. 26.6%; p = 0.046; HR 0.87). Overall survival after PTCy was higher (73.1% vs. 65.9%; p = 0.001, HR 0.82). Progression free survival was better after PTCy vs. rATG (64.9% vs. 57.2%; p < 0.001, HR 0.83). The incidence of chronic GVHD was lower after PTCy (28.4% vs. rATG 31.4%; p = 0.012; HR 0.77), whereas the incidence and severity of acute GVHD were not significantly different. GVHD-free relapse-free survival was significantly higher in the PTCy arm compared to the rATG arm (2 y incidence: 51% vs. 45%; HR: 0.86 [95% CI 0.75-0.99], p = 0.035). In the absence of evidence from randomized controlled trials, our findings support a preference for the use of PTCy in adult recipients of peripheral blood alloSCTs from MUD.
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Affiliation(s)
- Olaf Penack
- Medical Clinic, Department for Haematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany.
- EBMT Transplant Complications Working Party, Paris, France.
| | - Mouad Abouqateb
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital; INSERM UMR-S 938, Sorbonne University, Paris, France
| | - Christophe Peczynski
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital; INSERM UMR-S 938, Sorbonne University, Paris, France
| | - William Boreland
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital; INSERM UMR-S 938, Sorbonne University, Paris, France
| | | | | | | | - Igor Wolfgang Blau
- Medical Clinic, Department for Haematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St Petersburg, Russia
| | | | | | - Robert Zeiser
- Department of Medicine I, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Ivan Moiseev
- RM Gorbacheva Research Institute, Pavlov University, St Petersburg, Russia
| | - Hélène Schoemans
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, University Hospitals Leuven and Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
| | - Christian Koenecke
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Zinaida Peric
- EBMT Transplant Complications Working Party, Paris, France
- Department of Haematology, University Hospital Centre Rijeka, Rijeka, Croatia
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3
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Badolato R, Alsina L, Azar A, Bertrand Y, Bolyard AA, Dale DC, Deyà-Martinez À, Dickerson KE, Ezra N, Hasle H, Kang HJ, Kiani-Alikhan S, Kuijpers TW, Kulagin A, Langguth D, Levin C, Neth O, Olbrich P, Peake J, Rodina Y, Rutten CE, Shcherbina A, Tarrant TK, Vossen MG, Wysocki CA, Belschner A, Bridger GJ, Chen K, Dubuc S, Hu Y, Jiang H, Li S, MacLeod R, Stewart M, Taveras AG, Yan T, Donadieu J. Phase 3 randomized trial of mavorixafor, CXCR4 antagonist, in WHIM syndrome. Blood 2024:blood.2023022658. [PMID: 38643510 DOI: 10.1182/blood.2023022658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024] Open
Abstract
We investigated efficacy and safety of mavorixafor, an oral CXCR4 antagonist for participants with Warts, Hypogammaglobulinemia, Infections, and Myelokathexis (WHIM) syndrome, a rare immunodeficiency caused by CXCR4 gain-of-function variants. This randomized (1:1), double-blind, placebo-controlled, phase 3 trial enrolled participants aged ≥12 years with WHIM syndrome and absolute neutrophil count (ANC) ≤400/μL. Participants received once-daily mavorixafor or placebo for 52 weeks. Primary endpoint was time (hours) above ANC threshold ≥500/μL (TATANC; over 24 hours). Secondary endpoints included TAT absolute lymphocyte count ≥1000/μL (TATALC; defined similar to TATANC); absolute changes in white blood cell (WBC), ANC, and ALC from baseline; annualized infection rate; infection duration and total infection score (combined infection number/severity). In 31 participants (mavorixafor, n=14; placebo, n=17), mavorixafor least squares (LS) mean TATANC was 15.0 hours, placebo 2.8 hours (P<0.001). Mavorixafor LS mean TATALC was 15.8 hours, placebo 4.6 hours (P<0.001). Higher absolute WBC, ANC, and ALC levels were seen with mavorixafor than placebo at each timepoint assessed. Annualized infection rates were 60% lower with mavorixafor versus placebo (LS mean 1.7 versus 4.2; nominal P=0.007) and total infection scores were 40% lower (7.4 [95% CI, 1.6-13.2] versus 12.3 [95% CI, 7.2-17.3]). Treatment with mavorixafor reduced infection frequency, severity, duration, and antibiotic use. No discontinuations occurred due to treatment-emergent adverse events (TEAEs); no related serious TEAEs were observed. Overall, mavorixafor-treated participants showed significant increases in LS mean TATANC and TATALC, reduced infection frequency, severity/duration. Mavorixafor was well tolerated in participants with WHIM syndrome. Trial was registered at ClinicalTrials.gov NCT03995108.
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Affiliation(s)
| | | | - Antoine Azar
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology, LYON, France
| | | | - David C Dale
- University of Washington School of Medicine, Seattle, Washington, United States
| | | | | | - Navid Ezra
- California Dermatology Institute, Thousand Oaks, California, United States
| | | | - Hyoung Jin Kang
- Seoul National University College of Medicine, Seoul, Korea, Republic of
| | | | | | | | - Daman Langguth
- Sullivan Nicolaides Pathology Auchenflower, Wesley Medical Center, Queensland, Australia
| | | | - Olaf Neth
- Ped Infectious Diseases and Immunodeficiency, Sevilla, Spain
| | | | - Jane Peake
- Queensland Children's Hospital, Queensland, Australia
| | - Yulia Rodina
- Dmitry Rogachev National Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | | | - Anna Shcherbina
- Dmitry Rogachev National Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Teresa K Tarrant
- Division of Rheumatology and Immunology, Department of Medicine,, Durham, North Carolina, United States
| | | | | | | | - Gary J Bridger
- X4 Pharmaceuticals, Inc., Boston, Massachusetts, United States
| | - Kelly Chen
- X4 Pharmaceuticals, Inc., Boston, Massachusetts, United States
| | - Susan Dubuc
- X4 Pharmaceuticals, Inc., Boston, Massachusetts, United States
| | - Yanping Hu
- X4 Pharmaceuticals, Inc., Boston, Massachusetts, United States
| | - Honghua Jiang
- X4 Pharmaceuticals, Inc., Boston, Massachusetts, United States
| | - Sunny Li
- X4 Pharmaceuticals, Inc., Boston, Massachusetts, United States
| | - Rick MacLeod
- X4 Pharmaceuticals, Inc., Boston, Massachusetts, United States
| | - Murray Stewart
- X4 Pharmaceuticals, Inc., Boston, Massachusetts, United States
| | | | - Tina Yan
- X4 Pharmaceuticals, Inc., Boston, Massachusetts, United States
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4
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Montoro J, Eikema DJ, Tuffnell J, Potter V, Kałwak K, Halkes CJJ, Kulagin A, Collin M, Wynn RF, Robinson S, Nicholson E, Sengeloev H, Halahleh K, Skorobogatova E, Sanz J, Passweg JR, Mielke S, Ryhänen SJ, Carpenter B, Gedde-Dahl T, Tholouli E, Fanin R, Lewalle P, Kulasekararaj AG, Risitano AM, Peffault de Latour R. Alternative donor transplantation for severe aplastic anemia: a comparative study of the SAAWP EBMT. Blood 2024:blood.2024024173. [PMID: 38643511 DOI: 10.1182/blood.2024024173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024] Open
Abstract
Selecting the most suitable alternative donor becomes challenging in severe aplastic anemia (SAA) when a matched sibling donor (MSD) is unavailable. We compared outcomes in SAA patients undergoing SCT from matched unrelated donors (MUD, n=1106), mismatched unrelated donors (MMUD, n=340), and haploidentical donors (Haplo, n=206) registered in the EBMT database (2012-2021). For Haplo-SCT, only those receiving post-transplant cyclophosphamide (PT-Cy) for graft-versus-host disease (GVHD) prophylaxis were included. Median age was 20 years, and the median time from diagnosis to transplantation 8.7 months. Compared to MUD, MMUD (HR, 2.93; 95% CI, 1.52-5.6) and Haplo (HR, 5.15; 95% CI, 2.5-10.58) showed significantly higher risks of primary graft failure. MUD had lower rates of acute GVHD compared to MMUD and Haplo, grade II-IV (13%, 22%, and 19%, respectively, p<0.001) and III-IV (5%, 9%, and 7%, respectively, p=0.028). The 3-year non-relapse mortality was 14% for MUD, 19% for MMUD, and 27% for Haplo (p<0.001), while overall survival (OS) and GVHD and relapse-free survival (GRFS) were 81% and 73% for MUD, 74% and 65% for MMUD, and 63% and 54% for Haplo, respectively (p<0.001). In addition to donor type, multivariable analysis identified other factors like patient age, performance status, and interval between diagnosis and transplant associated with GRFS. For SAA patients lacking an MSD, our findings support MUD transplantation as the preferable alternative donor. However, selecting between a MMUD or Haplo donor remains uncertain and requires further exploration.
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Affiliation(s)
- Juan Montoro
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | | | | | | | - Matthew Collin
- Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Robert F Wynn
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Emma Nicholson
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Jaime Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Stephan Mielke
- Karolinska Institute & University Hospital, Stockholm, Sweden
| | - Samppa Johannes Ryhänen
- University of Helsinki and Helsinki University Hospital, ChildrenÂ's Hospital, and Pediatric Research Center, Helsinki, Finland
| | | | | | | | | | - Philippe Lewalle
- institut jules Bordet uUiversite Libre de Bruxelles, Brussels, Belgium
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5
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Nagler A, Labopin M, Swoboda R, Schroeder T, Hamladji RM, Griskevicius L, Salmenniemi U, Rambaldi A, Mielke S, Kulagin A, Passweg J, Luft T, Gedde-Dahl T, Forcade E, Helbig G, Stelljes M, Castilla-Llorente C, Spyridonidis A, Brissot E, Ciceri F, Mohty M. Post-transplant cyclophosphamide, calcineurin inhibitor, and mycophenolate mofetil compared to anti-thymocyte globulin, calcineurin inhibitor, and methotrexate combinations as graft-versus-host disease prophylaxis post allogeneic stem cell transplantation from sibling and unrelated donors in patients with acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2024:10.1038/s41409-024-02284-5. [PMID: 38615143 DOI: 10.1038/s41409-024-02284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
Post-transplant cyclophosphamide plus calcineurin inhibitor (CNI)(tacrolimus or cyclosporine A) plus mycophenolate mofetil (PTCy/TAC or CSA/MMF) and anti-thymocyte globulin plus CNI (tacrolimus or cyclosporine A) plus methotrexate (ATG/TAC or CSA/MTX) are common graft-versus-host disease (GVHD) prophylaxis regimens. We compared the two regimens in patients with acute myeloid leukemia (AML) undergoing allogeneic transplantation from matched siblings or unrelated donors. 402 received PTCy/TAC or CSA/MMF and 5648 received ATG/TAC or CSA/MTX. Patients in the PTCy-based group were younger (48.7 vs. 51.5 years, p = 0.024) and there was a higher frequency of patient cytomegalovirus seropositivity and female donor to male patient combination in this group (77.8% vs. 71.8%, p = 0.009 and 18.4% vs. 14.4%, p = 0.029, respectively). More patients in the PTCy-based group received reduced-intensity conditioning (51.5% vs. 41%, p < 0.0001). No differences were observed in the incidence of acute GVHD grade II-IV and III-IV (21.2% vs. 20.4%, p = 0.92 and 8.1% vs. 6%, p = 0.1) or 2-year total and extensive chronic GVHD (33.7% vs. 30%, p = 0.09 and 10.7% vs. 11.2%, p = 0.81) between the groups. In the multivariate analysis, all transplant outcomes did not differ between the groups. PTCy/CNI/MMF and ATG/CNI/MTX are alternative regimens for GVHD prophylaxis in AML patients.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office; Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, Sorbonne University; INSERM UMR 938, Paris, France
| | - Ryszard Swoboda
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | | | | | | | | | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and Azienda Socio-Sanitaria Territoriale, Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, Petersburg, Russia
| | | | - Thomas Luft
- University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | - Alexandros Spyridonidis
- Department of Internal Medicine, Bone Marrow Transplantation Unit, University Hospital of Patras, Patras, Greece
| | - Eolia Brissot
- Department of Haematology, Saint Antoine Hospital, Sorbonne University; INSERM UMR 938, Paris, France
| | - Fabio Ciceri
- Department of Haematology and BMT, IRCCS Osspedale San Raffaele; Vita-Salute San Raffaele University, Milano, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office; Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, Sorbonne University; INSERM UMR 938, Paris, France
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6
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Schetelig J, Baldauf H, Heidenreich F, Hoogenboom JD, Spellman SR, Kulagin A, Schroeder T, Sengeloev H, Dreger P, Forcade E, Vydra J, Wagner-Drouet EM, Choi G, Paneesha S, Miranda NAA, Tanase A, de Wreede LC, Lange V, Schmidt AH, Sauter J, Fein JA, Bolon YT, He M, Marsh SGE, Gadalla SM, Paczesny S, Ruggeri A, Chabannon C, Fleischhauer K. Donor KIR genotype based outcome prediction after allogeneic stem cell transplantation: no land in sight. Front Immunol 2024; 15:1350470. [PMID: 38629074 PMCID: PMC11019434 DOI: 10.3389/fimmu.2024.1350470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/04/2024] [Indexed: 04/19/2024] Open
Abstract
Optimizing natural killer (NK) cell alloreactivity could further improve outcome after allogeneic hematopoietic cell transplantation (alloHCT). The donor's Killer-cell Immunoglobulin-like Receptor (KIR) genotype may provide important information in this regard. In the past decade, different models have been proposed aiming at maximizing NK cell activation by activating KIR-ligand interactions or minimizing inhibitory KIR-ligand interactions. Alternative classifications intended predicting outcome after alloHCT by donor KIR-haplotypes. In the present study, we aimed at validating proposed models and exploring more classification approaches. To this end, we analyzed samples stored at the Collaborative Biobank from HLA-compatible unrelated stem cell donors who had donated for patients with acute myeloid leukemia (AML) or myelodysplastic neoplasm (MDS) and whose outcome data had been reported to EBMT or CIBMTR. The donor KIR genotype was determined by high resolution amplicon-based next generation sequencing. We analyzed data from 5,017 transplants. The median patient age at alloHCT was 56 years. Patients were transplanted for AML between 2013 and 2018. Donor-recipient pairs were matched for HLA-A, -B, -C, -DRB1, and -DQB1 (79%) or had single HLA mismatches. Myeloablative conditioning was given to 56% of patients. Fifty-two percent of patients received anti-thymocyte-globulin-based graft-versus-host disease prophylaxis, 32% calcineurin-inhibitor-based prophylaxis, and 7% post-transplant cyclophosphamide-based prophylaxis. We tested several previously reported classifications in multivariable regression analyses but could not confirm outcome associations. Exploratory analyses in 1,939 patients (39%) who were transplanted from donors with homozygous centromeric (cen) or telomeric (tel) A or B motifs, showed that the donor cen B/B-tel A/A diplotype was associated with a trend to better event-free survival (HR 0.84, p=.08) and reduced risk of non-relapse mortality (NRM) (HR 0.65, p=.01). When we further dissected the contribution of B subtypes, we found that only the cen B01/B01-telA/A diplotype was associated with a reduced risk of relapse (HR 0.40, p=.04) while all subtype combinations contributed to a reduced risk of NRM. This exploratory finding has to be validated in an independent data set. In summary, the existing body of evidence is not (yet) consistent enough to recommend use of donor KIR genotype information for donor selection in routine clinical practice.
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Affiliation(s)
- Johannes Schetelig
- Department of Internal Medicine I, University Hospital TU Dresden, Dresden, Germany
- Clinical Trials Unit, DKMS Group, Dresden, Germany
| | | | - Falk Heidenreich
- Department of Internal Medicine I, University Hospital TU Dresden, Dresden, Germany
- Clinical Trials Unit, DKMS Group, Dresden, Germany
| | | | - Stephen R. Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program (NMDP), Minneapolis, MN, United States
| | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Thomas Schroeder
- Klinik für Hämatologie und Stammzelltransplantation, Universitätsklinikum Essen, Essen, Germany
| | - Henrik Sengeloev
- Bone Marrow Transplant Unit, Department of Hematology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Edouard Forcade
- Service Hématologie clinique de Thérapie cellulaire, Centre Hospitalier Universitaire Bordeaux, Université de Bordeaus, Bordeaux, France
| | - Jan Vydra
- Transplant Unit and Intensive Care Unit, Institute of Hematology and Bood Transfusion, Prague, Czechia
| | - Eva Maria Wagner-Drouet
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz, Mainz, Germany
| | - Goda Choi
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Shankara Paneesha
- Department of Haematology & Stem Cell Transplantation, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Nuno A. A. Miranda
- Department of Hematology, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | | | | | - Joshua A. Fein
- Department of Hematology & Medical Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States
| | - Yung-Tsi Bolon
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program (NMDP), Minneapolis, MN, United States
| | - Meilun He
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program (NMDP), Minneapolis, MN, United States
| | - Steven G. E. Marsh
- Anthony Nolan Research Institute, Royal Free Hospital, London & Cancer Institute, University College London, London, United Kingdom
| | - Shahinaz M. Gadalla
- National Cancer Institute, Division of Cancer Epidemiology & Genetics, Bethesda, MD, United States
| | - Sophie Paczesny
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
| | | | - Christian Chabannon
- Institut Paoli-Calmettes, Centre de Lutte Contre le Cancer, Marseille, France
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7
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Sanz J, Labopin M, Choi G, Kulagin A, Peccatori J, Vydra J, Remenyi PP, Versluis J, Rovira M, Blaise D, Labussiere-Wallet H, Montoro J, Sica S, Meijer E, Itälä-Remes M, Schaap N, Bulabois CE, Piemontese S, Mohty M, Ciceri F. Younger unrelated donors may be preferable over HLA match in the PTCy era: A study from the ALWP of the EBMT. Blood 2024:blood.2023023697. [PMID: 38657278 DOI: 10.1182/blood.2023023697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 04/26/2024] Open
Abstract
There is a paucity of information on how to select the most appropriate unrelated donor (UD) in hematopoietic stem cell transplant (HSCT) using post-transplant cyclophosphamide (PTCy). We retrospectively analyzed the characteristics of 10/10 matched unrelated donors (MUD) and 9/10 mismatched unrelated donors (MMUD) that may affect transplant outcomes in patients with acute myeloid leukemia (AML) in first or second complete remission (CR1 or CR2). The primary endpoint was leukemia-free survival (LFS). Overall, 1011 patients were included with a median age of 54 years (range, 18-77). Donors had a median age of 29 years (range, 18-64); 304 (30%) were females of which 150 (15% of whole group) were donors to male recipients, and 621 (61%) were MUDs; 522 (52%) had negative cytomegalovirus (CMV-neg) serostatus of which 189 (19%) were used for CMV-neg recipients. Donor age older than 30 years had a negative impact on relapse (HR 1.38; 95% CI 1.06-1.8), LFS (HR 1.4; 95% CI 1.12-1.74), overall survival (HR 1.45; 95% CI 1.14-1.85) and GVHD-free, relapse-free survival (HR 1.29; 95% CI 1.07-1.56). Additionally, CMV-neg donor for CMV-neg recipient was associated with improved LFS (HR 0.74; 95% CI 0.55-0.99). The use of MMUD and female donors for male recipients did not significantly impact any transplant outcomes. For patients undergoing HSCT from an UD with PTCy for AML, donor age < 30 years significantly improves survival. In this context, donor age might be prioritized over HLA match considerations. In addition, CMV neg donors are preferable for CMV neg recipients. However, further research is needed to validate and refine these recommendations.
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Affiliation(s)
- Jaime Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Goda Choi
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | | | - Montserrat Rovira
- Hospital Clinic Barcelona, Institute of Hematology & Oncology, Barcelona, Spain
| | - Didier Blaise
- Programme de Transplantation &Therapie Cellulaire, France
| | - Helene Labussiere-Wallet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, PIERRE BENITE Cedex, France
| | - Juan Montoro
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Ellen Meijer
- Amsterdam UMC, location VU medical center, Amsterdam, Netherlands
| | | | - Nicolaas Schaap
- Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
| | | | | | - Mohamad Mohty
- Hôpital Saint-Antoine, INSERM UMRs 938, and Université Sorbonne, Paris, France
| | - Fabio Ciceri
- San Raffaele Scientific Institute, Milano, Italy
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8
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Mussetti A, Rius-Sansalvador B, Moreno V, Peczynski C, Polge E, Galimard JE, Kröger N, Blaise D, Peffault de Latour R, Kulagin A, Mousavi A, Stelljes M, Hamladji RM, Middeke JM, Salmenniemi U, Sengeloev H, Forcade E, Platzbecker U, Reményi P, Angelucci E, Chevallier P, Yakoub-Agha I, Craddock C, Ciceri F, Schroeder T, Aljurf M, Ch K, Moiseev I, Penack O, Schoemans H, Mohty M, Glass B, Sureda A, Basak G, Peric Z. Artificial intelligence methods to estimate overall mortality and non-relapse mortality following allogeneic HCT in the modern era: an EBMT-TCWP study. Bone Marrow Transplant 2024; 59:232-238. [PMID: 38007531 DOI: 10.1038/s41409-023-02147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/04/2023] [Accepted: 11/03/2023] [Indexed: 11/27/2023]
Abstract
Allogeneic haematopoietic cell transplantation (alloHCT) has curative potential counterbalanced by its toxicity. Prognostic scores fail to include current era patients and alternative donors. We examined adult patients from the EBMT registry who underwent alloHCT between 2010 and 2019 for oncohaematological disease. Our primary objective was to develop a new prognostic score for overall mortality (OM), with a secondary objective of predicting non-relapse mortality (NRM) using the OM score. AI techniques were employed. The model for OM was trained, optimized, and validated using 70%, 15%, and 15% of the data set, respectively. The top models, "gradient boosting" for OM (AUC = 0.64) and "elasticnet" for NRM (AUC = 0.62), were selected. The analysis included 33,927 patients. In the final prognostic model, patients with the lowest score had a 2-year OM and NRM of 18 and 13%, respectively, while those with the highest score had a 2-year OM and NRM of 82 and 93%, respectively. The results were consistent in the subset of the haploidentical cohort (n = 4386). Our score effectively stratifies the risk of OM and NRM in the current era but do not significantly improve mortality prediction. Future prognostic scores can benefit from identifying biological or dynamic markers post alloHCT.
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Affiliation(s)
- A Mussetti
- Department of Haematology, Institut Català d'Oncologia - Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain.
| | - B Rius-Sansalvador
- Biomarkers and Susceptibility Unit (UBS), Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology (ICO), L'Hospitalet del Llobregat, Barcelona, Spain
- ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - V Moreno
- Biomarkers and Susceptibility Unit (UBS), Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology (ICO), L'Hospitalet del Llobregat, Barcelona, Spain
- ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Peczynski
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM Unité Mixte de Recherche (UMR)-S 938, Sorbonne University, Paris, France
| | - E Polge
- EBMT Global Committee (Shanghai and Paris Offices) and Acute Leukaemia Working Party, Hospital Saint-Antoine APHP and Sorbonne University, Paris, France
| | | | - N Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - R Peffault de Latour
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Université Paris Diderot, Institut Universitaire d'Hématologie, Sorbonne Paris Cité, Paris, France
| | - A Kulagin
- Raisa Memorial (RM) Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - A Mousavi
- Shariati Hospital, Haematology-Oncology and BMT Research, Tehran, Islamic Republic of Iran
| | - M Stelljes
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - R M Hamladji
- Centre Pierre et Marie Curie, Service Hématologie Greffe de Moëlle, Alger, Algeria
| | - J M Middeke
- Med. Klinik I, University Hospital, TU Dresden, Germany
| | - U Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - H Sengeloev
- Bone Marrow Transplant Unit Copenhagen, Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - E Forcade
- CHU Bordeaux, Service d'hématologie Clinique et Thérapie Cellulaire, 33000, Pessac, France
| | | | - P Reményi
- Department of Haematology and Stem Cell Transplant, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - E Angelucci
- Haematology and Cellular Therapy Unit. IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - I Yakoub-Agha
- CHU de Lille LIRIC, INSERM U995, Université de Lille, Lille, France
| | - C Craddock
- Department of Haematology, University Hospital Birmingham NHS Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK
| | - F Ciceri
- Haematology & Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - T Schroeder
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - M Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - I Moiseev
- R.M.Gorbacheva Memorial Institute of Oncology, Haematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - O Penack
- Department of Haematology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - H Schoemans
- Department of Haematology, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
| | - M Mohty
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - B Glass
- Klinik für Hämatologie und Stammzelltransplantation, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - A Sureda
- Department of Haematology, Institut Català d'Oncologia - Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | - G Basak
- Department of Haematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Z Peric
- School of medicine, University of Zagreb and University Hospital Centre Zagreb, Zagreb, Croatia
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9
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Griffin M, Eikema DJ, Verheggen I, Kulagin A, Tjon JML, Fattizzo B, Ingram W, Zaidi U, Desnica L, Giammarco S, Drozd-Sokolowska J, Xicoy B, Patriarca A, Loschi M, Szmigielska-Kaplon A, Beier F, Cignetti A, Drexler B, Gavriilaki E, Lanza F, Orvain C, Risitano AM, De la Camara R, De Latour RP. SARS-CoV-2 vaccination in 361 non-transplanted patients with aplastic anemia and/or paroxysmal nocturnal hemoglobinuria. Haematologica 2024; 109:283-286. [PMID: 37584297 PMCID: PMC10772488 DOI: 10.3324/haematol.2023.283863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
| | | | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian Federation
| | | | - Bruno Fattizzo
- SC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | | | - Uzma Zaidi
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi
| | | | - Sabrina Giammarco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | | | - Blanca Xicoy
- Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol; Josep Carreras Leukemia Research Institute, Barcelona
| | - Andrea Patriarca
- Azienda Ospedaliero-Universitaria Maggiore della Carità and translational medicine department University of Eastern Piedmont, Novara
| | | | | | - Fabian Beier
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University, Aachen
| | | | | | | | - Francesco Lanza
- Metropolitan Transplant Network, Hospital Santa Maria delle Croci, Ravenna, Italy 21: Centre Hospitalier Universitaire d'Angers, Angers
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10
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Nagler A, Labopin M, Blaise D, Raiola AM, Corral LL, Bramanti S, Sica S, Kwon M, Koc Y, Pavlu J, Kulagin A, Busca A, Rodríguez AB, Reményi P, Schmid C, Brissot E, Sanz J, Bazarbachi A, Giebel S, Ciceri F, Mohty M. Correction: Non-T-depleted haploidentical transplantation with post-transplant cyclophosphamide in patients with secondary versus de novo AML in first complete remission: a study from the ALWP/EBMT. J Hematol Oncol 2023; 16:106. [PMID: 37775766 PMCID: PMC10543832 DOI: 10.1186/s13045-023-01501-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Stefania Bramanti
- Transplantation Unit Department of Oncology and Haematology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mi Kwon
- Hematology Hospital GU Gregorio Marañon, Instituto de Investigacion Sanitaria Gregorio Marañon, Medicina UCM, Madrid, Spain
| | - Yener Koc
- Bone Marrow Transplant Unit, Medicana International Hospital Istanbul, Istanbuls, Turkey
| | - Jiri Pavlu
- Department of Haematology, Hammersmith Hospital, Imperial College, London, UK
| | - Alexander Kulagin
- Raisa Gorbacheva Memorial, Research Institute for Paediatric Oncology, Hematology, and Transplantation, First State Pavlov Medical University of St. Petersburg, St. Petersburg, Russia
| | - Alessandro Busca
- SSD Trapianto di Cellule Staminali, AOU Citta' Della Salute e della Scienza, Turin, Italy
| | | | - Péter Reményi
- Department Hematology and Stem Cell Transplant, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Christoph Schmid
- Department of Hematology and Oncology, Augsburg University Hospital, Augsburg, Germany
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Sorbonne University, and INSERM UMRs 938, Paris, France
| | - Jaime Sanz
- Hematology Department, Hospital Universitari Politècnic La Fe, Valencia, Spain
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Fabio Ciceri
- Ospedale San Raffaele, Haematology and BMT, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
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11
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Devillier R, Eikema DJ, Dufour C, Aljurf M, Wu D, Maschan A, Kulagin A, Halkes CJM, Collin M, Snowden J, Renard C, Ganser A, Sykora KW, Gibson BE, Maertens J, Itäla-Remes M, Corti P, Cornelissen J, Bornhäuser M, Araujo MC, Ozdogu H, Risitano A, Socie G, De Latour RP. Graft- versus-host disease and relapse/rejection-free survival after allogeneic transplantation for idiopathic severe aplastic anemia: a comprehensive analysis from the SAAWP of the EBMT. Haematologica 2023; 108:2305-2315. [PMID: 36951165 PMCID: PMC10483355 DOI: 10.3324/haematol.2022.281876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/15/2023] [Indexed: 03/24/2023] Open
Abstract
Survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT) for severe idiopathic aplastic anemia (SAA) has improved in recent years, approaching 75% at 5 years. However, an SAA-adapted composite endpoint, graft-versus-host disease (GvHD) and relapse/rejection-free survival (GRFS), may more accurately assess patient outcomes beyond survival. We analyzed GRFS to identify risk factors and specific causes of GRFS failure. Our retrospective analysis from the Severe Aplastic Anemia Working Party of the European Society for Blood and Marrow Transplantation included 479 patients with idiopathic SAA who underwent allo-HSCT in two conventional situations: i) upfront allo-HSCT from a matched related donor (MRD) (upfront cohort), and ii) allo-HSCT for relapsed or refractory SAA (rel/ref cohort). Relevant events for GRFS calculation included graft failure, grade 3-4 acute GvHD, extensive chronic GvHD, and death. In the upfront cohort (n=209), 5-year GRFS was 77%. Late allo-HSCT (i.e., >6 months after SAA diagnosis) was the main poor prognostic factor, specifically increasing the risk of death as the cause of GRFS failure (hazard ratio [HR]=4.08; 95% confidence interval [CI]: 1.41-11.83; P=0.010). In the rel/ref cohort (n=270), 5-year GRFS was 61%. Age was the main factor significantly increasing the risk of death (HR=1.04; 95% CI: 1.02-1.06; P<0.001), acute GvHD (HR=1.03; 95% CI: 1.00-1.07; P=0.041), and chronic GvHD (HR=1.04; 95% CI: 1.01-1.08; P=0.032) as the cause of GRFS failure. GRFS after upfront MRD allo-HSCT was very good, notably with early allo-HSCT, confirming that younger patients with an MRD should be transplanted immediately. GRFS was worse in cases of salvage allo-HSCT, most notably in older patients, questioning the utility of allo-HSCT earlier in the disease course.
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Affiliation(s)
| | | | - Carlo Dufour
- IRCCS Gaslini Children's Research Hospital, Genova
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh
| | - Depei Wu
- First Affiliated Hospital of Soochow University, Suzhou
| | - Alexei Maschan
- Federal Research Center for Pediatric Hematology, Moscow
| | | | | | | | - John Snowden
- Sheffield Teaching Hospitals, NHS Trust, Sheffield
| | - Cécile Renard
- Institut d`Hematologie et d'Oncologie Pediatrique, Lyon
| | - Arnold Ganser
- Hannover Medical School, Hematology Department, Hemostasis, Oncology and Stem Cell Transplantation, Hannover
| | - Karl-Walter Sykora
- Hannover Medical School, Hematology Department, Hemostasis, Oncology and Stem Cell Transplantation, Hannover
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12
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Nagler A, Labopin M, Swoboda R, Kulagin A, Velardi A, Sanz J, Labussière-Wallet H, Potter V, Kuball J, Sica S, Parovichnikova E, Bethge W, Maillard N, Platzbecker U, Stölzel F, Ciceri F, Mohty M. Long-term outcome of second allogeneic hematopoietic stem cell transplantation (HSCT2) for primary graft failure in patients with acute leukemia in remission: A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2023; 58:1008-1016. [PMID: 37253804 DOI: 10.1038/s41409-023-02012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
Second transplantation (HSCT2) is a potential treatment for primary graft failure (pGF). We assessed the outcome of HSCT2, performed between 2000 and 2021, for pGF in 243 patients with acute leukemia. Median age was 44.8 years. Conditioning at first HSCT (HSCT1) was myeloablative (MAC) in 58.4%. Median time from HSCT1 to HSCT2 was 48 days. Donors for HSCT2 were the same as for HSCT1 in 49%. Engraftment post HSCT2 was achieved by 73.7% of patients. The incidence of acute (a) graft versus host disease (GVHD) grades II-IV and III-IV was 23.2 and 8.1%. 5-year total and extensive chronic (c) GVHD was 22.3 and 10.1%. 5-year nonrelapse mortality (NRM), relapse incidence (RI), leukemia-free survival (LFS), overall survival (OS) and GVHD free, relapse-free survival (GRFS) was 51.6, 18.8, 29.6, 30.7 and 22.4%, respectively. Infections were the main cause of death. In multivariable analysis, being transplanted at second vs. first remission, lower Karnofsky performance status (KPS; <90) and receiving MAC at HSCT1 were adverse prognostic factors for NRM, LFS, OS, and GRFS, as was increased age for NRM, LFS, OS. We conclude that HSCT2 can rescue about a third of the patients who experienced pGF, but NRM is as high as 50%.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris study office; Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
| | - Ryszard Swoboda
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Alexander Kulagin
- First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St Petersburg, Russia
| | - Andrea Velardi
- Sezione di Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Ospedale Santa Maria della, Perugia, Italy
| | - Jaime Sanz
- Hematology Department, University Hospital La Fe, Valencia, Spain
| | | | - Victoria Potter
- Dept. of Haematological Medicine, Kings College Hospital, London, United Kingdom
| | - Jürgen Kuball
- University Medical Centre Dept. of Haematology, Utrecht, The Netherlands
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elena Parovichnikova
- National Research Center for Hematology, Bone Marrow Transplantation, Moscow, Russia
| | - Wolfgang Bethge
- Universitaet Tuebingen, Medizinische Klinik, Tuebingen, Germany
| | - Natacha Maillard
- Hopital La Miletrie Bone Marrow TransplantUnit, Clinical Hematology, Poitiers, France
| | - Uwe Platzbecker
- Medical Clinic and Policinic 1, Hematology and Cellular Therapy, University hospital Leipzig, Leipzig, Germany
| | - Friedrich Stölzel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
- Department of Medicine II, Division for Stem Cell Transplantation and Cellular Immunotherapy, University Hospital Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l. Haematology and BMT, Milano, Italy
| | - Mohamad Mohty
- EBMT Paris study office; Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Hospital Saint Antoine, EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France
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13
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Bodó I, Amine I, Boban A, Bumbea H, Kulagin A, Lukina E, Piekarska A, Zupan IP, Sokol J, Windyga J, Cermak J. Complement Inhibition in Paroxysmal Nocturnal Hemoglobinuria (PNH): A Systematic Review and Expert Opinion from Central Europe on Special Patient Populations. Adv Ther 2023; 40:2752-2772. [PMID: 37072660 PMCID: PMC10112829 DOI: 10.1007/s12325-023-02510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/28/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Hemolysis in paroxysmal nocturnal hemoglobinuria (PNH) is complement-mediated due to the lack of complement inhibitors in the hemopoietic cell membranes, making complement inhibition the best approach to manage PNH. Three complement inhibitors are approved by the European Medicines Agency as targeted therapy for PNH: eculizumab and ravulizumab, two humanized monoclonal antibodies targeting the same complement 5 (C5) epitope, approved in 2007 and 2019, respectively, and the more recently approved cyclic peptide, the complement 3 (C3) inhibitor pegcetacoplan. Although national and international PNH treatment guidelines exist, they do not take into consideration the latest clinical trial evidence. Given the lack of evidence-based data for some clinical situations encountered in real life, we identified specific populations of patients who may benefit from switching to proximal C3 from terminal C5 inhibition. METHODS The expert recommendations presented here were created using a Delphi-like process by a group of expert PNH specialists across Central Europe. Based on an initial advisory board meeting discussion, recommendations were prepared and reviewed as part of a Delphi survey to test agreement. RESULTS Using a systematic approach, literature databases were searched for relevant studies, and 50 articles were reviewed by the experts and included as supporting evidence. CONCLUSION Implementation of these recommendations uniformly across healthcare institutions will promote the best use of complement inhibition in managing PNH, and has the potential to positively impact patient outcomes in Central Europe and worldwide.
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Affiliation(s)
- Imre Bodó
- Department of Internal Medicine and Hematology, Semmelweis University, 46 Szentkirályi u., Budapest, 1088, Hungary.
| | - Ismail Amine
- Department of Hematology, Tokuda Hospital Sofia, Sofia, Bulgaria
| | - Ana Boban
- Division of Haematology, Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Horia Bumbea
- Bone Marrow Transplant Unit, Department of Hematology, Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Elena Lukina
- Department of Orphan Diseases, National Research Medical Center for Hematology, Moscow, Russia
| | - Agnieszka Piekarska
- Department of Hematology and Transplantology Medical, University of Gdansk, Gdansk, Poland
| | - Irena Preloznik Zupan
- Department of Hematology, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Juraj Sokol
- Department of Hematology and Transfusion Medicine, Jessenius Medical Faculty in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Jerzy Windyga
- Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Jaroslav Cermak
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
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14
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Nagler A, Labopin M, Blaise D, Raiola AM, Corral LL, Bramanti S, Sica S, Kwon M, Koc Y, Pavlu J, Kulagin A, Busca A, Rodríguez AB, Reményi P, Schmid C, Brissot E, Sanz J, Bazarbachi A, Giebel S, Ciceri F, Mohty M. Non-T-depleted haploidentical transplantation with post-transplant cyclophosphamide in patients with secondary versus de novo AML in first complete remission: a study from the ALWP/EBMT. J Hematol Oncol 2023; 16:58. [PMID: 37248463 PMCID: PMC10226209 DOI: 10.1186/s13045-023-01450-4] [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: 01/09/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
We compared outcomes of adult patients with secondary acute myeloid leukemia (sAML) versus de novo AML after non-T-depleted haploidentical stem cell transplant (HaploSCT) with post-transplant cyclophosphamide (PTCy). Seventeen hundred and eleven AML patients (sAML-231, de novo-1480) in first complete remission transplanted from 2010 to 2021, were included. Patients with de novo AML were younger, median age 55.8 versus 60.8 years, p < 0.0001, had better transplantation comorbidity index (HCT-CI) ≥ 3 21.3% versus 40.8%, p < 0.0001 and Karnofsky performance status (KPS) with KPS ≥ 90 in 78% versus 68.5%, respectively, p = 0.002. The two patient groups did not differ with respect to gender, cytomegalovirus serostatus, and cell source. Median time from diagnosis to HaploSCT was 5.2 versus 4.9 months, respectively, p = 0.005. Fewer sAML patients received myeloablative conditioning 35.1% versus 50.1%, p < 0.0001. Two hundred and eleven sAML and 410 de novo AML patients were included in the matched-pair analysis matching two de novo AML with each sAML. No significant difference was observed in any transplantation outcome parameter between the sAML versus de novo AML groups. Two-year non-relapse mortality and relapse incidence did not differ with HaploSCT for de novo versus sAML; 21.4% versus 21%, hazard ratio (HR) = 0.98, p = 0.9 and 23.4% versus 20.6%, HR = 0.92, p = 0.67, respectively. Two-year leukemia-free survival, overall survival, and graft-versus-host disease (GVHD)-free, relapse-free survival were also not different between the de novo AML and sAML groups 55.2% versus 58.4%, HR = 0.95, p = 0.67; 61.4% versus 66.4%, HR = 0.91, p = 0.51 and 46.3% versus 48.2%, HR = 0.92, p = 0.48, respectively. Similarly, the incidence of engraftment as well as acute and chronic GVHD was similar between the 2 cohorts. In conclusion, HaploSCT with PTCy may be able to overcome the bad prognosis of sAML as results are not significantly different to those of HaploSCT in de novo AML.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Stefania Bramanti
- Transplantation Unit Department of Oncology and Haematology, Istituto Clinico Humanitas, Milan, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mi Kwon
- Hematology Hospital GU Gregorio Marañon, Instituto de Investigacion Sanitaria Gregorio Marañon, Medicina UCM, Madrid, Spain
| | - Yener Koc
- Bone Marrow Transplant Unit, Medicana International Hospital Istanbul, Istanbuls, Turkey
| | - Jiri Pavlu
- Department of Haematology, Hammersmith Hospital, Imperial College, London, UK
| | - Alexander Kulagin
- Raisa Gorbacheva Memorial, Research Institute for Paediatric Oncology, Hematology, and Transplantation, First State Pavlov Medical University of St. Petersburg, St. Petersburg, Russia
| | - Alessandro Busca
- SSD Trapianto di Cellule Staminali, AOU Citta' Della Salute e della Scienza, Turin, Italy
| | | | - Péter Reményi
- Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Department Hematology and Stem Cell Transplant, Budapest, Hungary
| | - Christoph Schmid
- Department of Hematology and Oncology, Augsburg University Hospital, Augsburg, Germany
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Sorbonne University, and INSERM UMRs 938, Paris, France
| | - Jaime Sanz
- Hematology Department, Hospital Universitari Politècnic La Fe, Valencia, Spain
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Fabio Ciceri
- Ospedale San Raffaele, Haematology and BMT, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
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15
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Santoro N, Mooyaart JE, Devillier R, Koc Y, Vydra J, Castagna L, Gülbas Z, Martin JD, Araujo MC, Kulagin A, Arat M, Arroyo CH, Martelli MP, Di Ianni M, Hoogenboom JD, de Wreede LC, Ruggeri A, Chabannon C. Correction: Donor lymphocyte infusions after haploidentical stem cell transplantation with PTCY: A study on behalf of the EBMT cellular therapy & immunobiology working party. Bone Marrow Transplant 2023; 58:119-120. [PMID: 36517566 DOI: 10.1038/s41409-022-01855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nicole Santoro
- Department of Hematology and Oncology, Ospedale Civile "Santo Spirito", Pescara, Italy.
| | | | - Raynier Devillier
- Institut Paoli-Calmettes, Centre de Lutte Contre le Cancer, & Centre de Recherches en Cancérologie de Marseille (CRCM), Inserm UMR 1068, Université d'Aix-Marseille, Marseille, France
| | - Yener Koc
- Medicana International Hospital Istanbul, Istanbul, Turkey
| | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Zafer Gülbas
- Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - José Diez Martin
- Servicio de Hematología Hospital G. Universitario Gregorio Marañon, Instituto de Investigación sanitaria Gregorio Marañon, Department of Medicine Universidad Complutense, Madrid, Spain
| | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St, Petersburg, Russia
| | - Mutlu Arat
- Demiroglu Bilim University Istanbul Florence Nightingale Hospital Istanbul, Istanbul, Turkey
| | | | - Maria Paola Martelli
- Institute of Hematology, Centro Ricerche Emato-Oncologiche, Ospedale S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Mauro Di Ianni
- Department of Hematology and Oncology, Ospedale Civile "Santo Spirito", Pescara, Italy
| | | | | | - Annalisa Ruggeri
- San Raffaele Scientific Institute, Hematology and Bone marrow Transplantation unit, Milan, Italy
| | - Christian Chabannon
- Institut Paoli-Calmettes, Centre de Lutte Contre le Cancer & Centre d'Investigations Cliniques en Biothérapie, Université d'Aix-Marseille, Inserm CBT, 1409, Marseille, France
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16
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Ljungman P, Tridello G, Piñana JL, Ciceri F, Sengeloev H, Kulagin A, Mielke S, Yegin ZA, Collin M, Einardottir S, Lepretre SD, Maertens J, Campos A, Metafuni E, Pichler H, Folber F, Solano C, Nicholson E, Yüksel MK, Carlson K, Aguado B, Besley C, Byrne J, Heras I, Dignan F, Kröger N, Robin C, Khan A, Lenhoff S, Grassi A, Dobsinska V, Miranda N, Jimenez MJ, Yonal-Hindilerden I, Wilson K, Averbuch D, Cesaro S, Xhaard A, Knelange N, Styczynski J, Mikulska M, de la Camara R. Improved outcomes over time and higher mortality in CMV seropositive allogeneic stem cell transplantation patients with COVID-19; An infectious disease working party study from the European Society for Blood and Marrow Transplantation registry. Front Immunol 2023; 14:1125824. [PMID: 36960069 PMCID: PMC10028143 DOI: 10.3389/fimmu.2023.1125824] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 12/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. Methods This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic. Results The median age was 50.3 years (min - max; 1.0 - 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min - max; 0.0 - 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 - 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p<.0001), worse performance status (p<.0001), contracting COVID-19 within the first 30 days (p<.0001) or 30 - 100 days after HCT (p=.003), ongoing immunosuppression (p=.004), pre-existing lung disease (p=.003), and recipient CMV seropositivity (p=.004) had negative impact on overall survival while patients contracting COVID-19 in 2020 (p<.0001) or 2021 (p=.027) had worse overall survival than patients with COVID-19 diagnosed in 2022. Discussion Although the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death.
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Affiliation(s)
- Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Per Ljungman,
| | - Gloria Tridello
- European Society for Blood and Marrow Transplantation (EBMT) Data Office, Department of Medical Statistics & Bioinformatics, Leiden, Netherlands
| | - Jose Luis Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Fabio Ciceri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Henrik Sengeloev
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexander Kulagin
- Raisa Memorial (RM) Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Zeynep Arzu Yegin
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Matthew Collin
- Translational and Clinical Research Institute and The National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre, Newcastle, United Kingdom
| | - Sigrun Einardottir
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Johan Maertens
- Department of Hematology University Hospital Gasthuisberg, Leuven, Belgium
| | - Antonio Campos
- Marrow Transplant Department Inst. Português de Oncologia do Porto, Porto, Portugal
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Herbert Pichler
- St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Frantisek Folber
- Department of Internal Medicine, Hematology and Oncology University Hospital Brno, Brno, Czechia
- Department of Internal Medicine, Hematology and Oncology Masaryk University, Brno, Czechia
| | - Carlos Solano
- European Society for Blood and Marrow Transplantation (EBMT) Data Office, Department of Medical Statistics & Bioinformatics, Leiden, Netherlands
| | - Emma Nicholson
- Haematology-oncology Unit Royal Marsden Hospital, London, United Kingdom
| | - Meltem Kurt Yüksel
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Kristina Carlson
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Beatriz Aguado
- Department of Hematology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Caroline Besley
- University Hospitals Bristol and Weston National Health Service (NHS) Foundation Trust, Bristol, United Kingdom
| | - Jenny Byrne
- Department of Haematology Nottingham University Hospital, Nottingham, United Kingdom
| | - Immaculada Heras
- Department of Hematology, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Fiona Dignan
- Clinical Haematology Department Manchester Royal Infirmary, Manchester, United Kingdom
| | - Nicolaus Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Christine Robin
- Assistance Publique-Hôpitaux de Paris (APHP), Henri Mondor Hospital, Department of Hematology, Créteil, France
| | - Anjum Khan
- Department of Haematology Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Stig Lenhoff
- Department of Hematology Skåne’s University Hospital, Lund, Sweden
| | - Anna Grassi
- Bone Marrow Transplantation Unit, Azienda Sociosanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Veronika Dobsinska
- Department of Pediatric Hematology and Oncology, National Institute of Children’s Diseases, Comenius University, Bratislava, Slovakia
| | - Nuno Miranda
- Department of Haematology Inst. Portugues Oncologia, Lisbon, Portugal
| | - Maria-Jose Jimenez
- Department of Clinical Haematology Institut Catala d'Oncologia (ICO)-Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ipek Yonal-Hindilerden
- Istanbul Medical Faculty, Adult Hematopoietic Stem Cell Transplant Center, Istanbul University, Istanbul, Türkiye
| | - Keith Wilson
- Blood and Bone Marrow Transplantation Department University of Cardiff, Cardiff, United Kingdom
| | - Dina Averbuch
- Pediatric Infectious Diseases Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alienor Xhaard
- Hematology-Transplantation Unit, Department of Hematology: Hôpital St. Louis, Paris, France
| | - Nina Knelange
- European Society for Blood and Marrow Transplantation (EBMT) Leiden Study Unit, European Society for Blood and Marrow Transplantation (EBMT) Data Office, Leiden, Netherlands
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa and Ospedale Policlinico San Martino, Genova, Italy
| | - Rafael de la Camara
- Department of Hematology, Hospital Universitario de la Princesa, Madrid, Spain
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17
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Kulasekararaj A, Brodsky R, Kulagin A, Jang JH. Biosimilars in rare diseases - a focus on paroxysmal nocturnal hemoglobinuria. Haematologica 2022; 108:1232-1243. [PMID: 36519328 PMCID: PMC10153517 DOI: 10.3324/haematol.2022.281562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Indexed: 12/23/2022] Open
Abstract
Biologics, a class of medicines grown in and purified from genetically engineered cell cultures, have transformed the management of many cancers and rare diseases, such as paroxysmal nocturnal hemoglobinuria. As prescription drug spending has increased and exclusivity periods have expired, manufacturers have developed biosimilars—biologics that may be more affordable and highly similar to a licensed biological therapeutic, with no clinically meaningful differences in safety or efficacy. With biosimilars gaining regulatory approval around the globe and broadening patient access to biologics, this review aims to help rare disease healthcare providers familiarize themselves with biosimilars, understand their development and regulatory approval process, and address practical considerations that may facilitate their use.
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Affiliation(s)
- Austin Kulasekararaj
- Department of Haematological Medicine, King's College London School of Medicine, London, United Kingdom. ORCID 0000-0003-3180-3570
| | - Robert Brodsky
- Division of Hematology, Johns Hopkins Medicine, Baltimore, MD.
| | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia. ORCID 0000-0002-9589-4136.
| | - Jun Ho Jang
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine.
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18
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Baron F, Labopin M, Tischer J, Ciceri F, Raiola AM, Blaise D, Sica S, Vydra J, Fanin R, Diez-Martin JL, Bulabois CE, Stölzel F, Busca A, Jindra P, Koc Y, Chevallier P, Forcade E, Rösler W, Passweg J, Kulagin A, Carella AM, Simand C, Bazarbachi A, Pioltelli P, Nagler A, Mohty M. Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia. Bone Marrow Transplant 2022; 57:1657-1663. [PMID: 35978005 DOI: 10.1038/s41409-022-01781-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/09/2022]
Abstract
HLA-haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) is frequently used as treatment for patients with active acute myeloid leukemia (AML). Here, we investigated whether 9/10 HLA-mismatched unrelated donor transplantation (MMUD-HCT) with post-transplant cyclophosphamide (PTCy) is an adequate alternative. Inclusion criteria in this retrospective registry study consisted of adult patients, first HCT with a Haplo donor or MMUD between 2010 and 2020 using PTCy as graft-versus-host disease (GVHD) prophylaxis, and primary refractory or relapsed disease. MMUD patients were pair-matched 1 to 2 with Haplo-recipients. A total of 73 MMUD patients met the inclusion criteria. Their data were compared to those of 146 Haplo patients in a matched-pair analysis. Median follow-up was 27 months in MMUD patients and 36 months in Haplo recipients. Two-year incidences of relapse and non-relapse mortality (NRM) were 40% and 18% in MMUD patients, respectively, versus 50% (P = 0.23) and 24% (P = 0.18) in Haplo recipients. Two-year leukemia-free survival (LFS) and overall survival (OS) was 42% and 46% in MMUD recipients, respectively, versus 26% (P = 0.1) and 28% (P = 0.061) in Haplo-patients. In conclusions, in AML patients with active disease at transplantation, MMUD-HCT results in at least comparable outcomes to Haplo-HCT when PTCy is applied.
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Affiliation(s)
- Frédéric Baron
- Laboratory of Hematology, GIGA-I3, University of Liege and CHU of Liège, Liege, Belgium.
| | - Myriam Labopin
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Service d'Hématologie Clinique, Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs 938, Paris, France.,Sorbonne University, Paris, France
| | - Johanna Tischer
- University Hospital of Munich - Campus Grosshadern, LMU, Department of Internal Medicine III, München, Germany
| | - Fabio Ciceri
- IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Didier Blaise
- Programme de Transplantation &Therapie Cellulaire, Département d'hématologie Centre de Recherche en Cancérologie de Marseille, Aix-Marseille University, Institut Paoli Calmettes, Marseille, France
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Renato Fanin
- Division of Hematology, University Hospital and DAME, Udine, Italy
| | - Jose Luis Diez-Martin
- Head of Hematology Department, Hospital G U Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañon, Medicine Dpt. UCM, Madrid, Spain
| | - Claude Eric Bulabois
- CHU Grenoble Alpes - Université Grenoble Alpes, Service d'Hématologie, CS, 10217, Grenoble, France
| | - Friedrich Stölzel
- Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, TU Dresden, Dresden, Germany
| | - Alessandro Busca
- S.S.C.V.D Trapianto di Cellule Staminali A.O.U Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Pavel Jindra
- Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | - Yener Koc
- Medicana International Hospital Istanbul, Bone Marrow Transplant Unit, Istanbul, Turkey
| | | | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | - Wolf Rösler
- Department of Internal Medicine 5, University Hospital Erlangen, Erlangen, Germany
| | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Angelo Michele Carella
- Ematologia e Centro Trapianti CSE Dipartimento di Scienze Mediche Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pietro Pioltelli
- Ospedale San Gerardo, Clinica Ematologica dell'Universita Milano-Biocca, Monza, Italy
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mohamad Mohty
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Service d'Hématologie Clinique, Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs 938, Paris, France.,Sorbonne University, Paris, France
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Dale DC, Alsina L, Azar A, Badolato R, Bertrand Y, Deya A, Dickerson KE, Ezra N, Hasle H, Kang HJ, Kiani-Alikhan S, Kuijpers T, Kulagin A, Langguth D, Levin C, Neth O, Peake J, Rutten CE, Shcherbina A, Tarrant TK, Vossen MG, Wysocki CA, Belschner A, Cadavid D, Hu Y, Jiang H, MacLeod R, Tang W, Tillinger M, Donadieu J. PB1938: 4WHIM: EVALUATING MAVORIXAFOR, AN ORAL CXCR4 ANTAGONIST, IN PATIENTS WITH WHIM SYNDROME VIA A GLOBAL PHASE 3, RANDOMIZED, PLACEBO-CONTROLLED TRIAL WITH OPEN-LABEL EXTENSION. Hemasphere 2022. [PMCID: PMC9431515 DOI: 10.1097/01.hs9.0000850592.82147.9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Beynarovich A, Lepik K, Mikhailova N, Borzenkova E, Volkov N, Moiseev I, Zalyalov Y, Kondakova E, Kozlov A, Stelmakh L, Pirogova O, Zubarovskaya L, Kulagin A, Afanasyev B. Favorable outcomes of allogeneic hematopoietic stem cell transplantation with fludarabine-bendamustine conditioning and posttransplantation cyclophosphamide in classical Hodgkin lymphoma. Int J Hematol 2022; 116:401-410. [PMID: 35511399 DOI: 10.1007/s12185-022-03355-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for patients with relapsed and refractory classic Hodgkin lymphoma (rrHL). However, the optimal conditioning regimen and GVHD prophylaxis for rrHL remain undetermined. The aim of this study was to investigate outcomes of allo-HSCT with a fludarabine plus bendamustine (FluBe) conditioning regimen and GVHD prophylaxis with posttransplantation cyclophosphamide (PTCY) in patients with rrHL. METHODS Allo-HSCT results in 58 adult patients with rrHL were analyzed retrospectively. RESULTS Three-year overall survival and event-free survival were 81% (95% CI 65-91) and 55% (95% CI 38-72), respectively. The cumulative incidence of relapse (CIR) at 3 years was 33% (95% CI 13-51). The cumulative incidence of aGVHD grade II-IV and severe aGVHD grade III-IV was 36% (95% CI 22-48) and 22% (95% CI 9-33), respectively. The cumulative incidence of cGVHD was 32% (95% CI 17-45), including moderate or severe cGVHD in 17% (95% CI 4-28). Patients who developed aGVHD after allo-HSCT had significantly lower CIR (24% vs 49%, p = 0.004). The use of PBSC as a graft source also significantly reduced CIR (4% vs 61%, p = 0.002). CONCLUSIONS FluBe-PTCY allo-HSCT facilitates favorable outcomes, low toxicity, and mortality in rrHL.
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Affiliation(s)
- Anastasia Beynarovich
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia.
| | - Kirill Lepik
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Natalia Mikhailova
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Evgenia Borzenkova
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Nikita Volkov
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Ivan Moiseev
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Yuri Zalyalov
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Elena Kondakova
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Andrey Kozlov
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Lilia Stelmakh
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Olga Pirogova
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Lyudmila Zubarovskaya
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Alexander Kulagin
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
| | - Boris Afanasyev
- Department of Bone Marrow Transplantation, Raisa Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, Roentgena str. 12, 197022, Saint Petersburg, Russia
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21
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Kulasekararaj AG, Griffin M, Langemeijer S, Usuki K, Kulagin A, Ogawa M, Yu J, Mujeebuddin A, Nishimura JI, Lee JW, Peffault de Latour R. Long-term safety and efficacy of ravulizumab in patients with paroxysmal nocturnal hemoglobinuria: 2-year results from two pivotal phase 3 studies. Eur J Haematol 2022; 109:205-214. [PMID: 35502600 PMCID: PMC9546219 DOI: 10.1111/ejh.13783] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The complement component 5 (C5) inhibitor ravulizumab demonstrated non-inferiority to eculizumab following 26 weeks of treatment in complement inhibitor-naïve and complement inhibitor-experienced patients with paroxysmal nocturnal hemoglobinuria (PNH; studies 301 and 302, respectively). This study aims to describe the results of both studies from 27 weeks to 2 years. METHODS Patients (N = 441) continued to receive ravulizumab throughout the extension period. Efficacy endpoints included lactate dehydrogenase (LDH) normalization, transfusion avoidance and fatigue score (FACIT-F). Safety analyses were also performed. RESULTS From 27 weeks to 2 years, improvements in LDH levels were maintained in both study populations. Transfusion avoidance was maintained in 81.9% (study 301) and 85.6% (study 302) of patients, and FACIT-F scores remained stable. Ravulizumab was well tolerated, and the incidence of adverse events (AEs) were similar between patients of both studies. Incidence of serious AEs deemed related to ravulizumab treatment was low (<3%). CONCLUSIONS This study reports, to date, the longest period of follow-up in over 400 patients with PNH treated with ravulizumab (662 patient-years). Long-term, ravulizumab demonstrated durable efficacy and was well tolerated, highlighting the importance of C5 inhibitors as the mainstay of PNH treatment.
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Affiliation(s)
- Austin G Kulasekararaj
- Department of Haematological Medicine, King's College Hospital, National Institute for Health Research and Wellcome King's Clinical Research Facility and King's College London, London, UK
| | | | | | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St Petersburg, Russia
| | - Masayo Ogawa
- Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
| | - Ji Yu
- Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
| | | | | | - Jong Wook Lee
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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22
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Petit AF, Kulasekararaj AG, Eikema D, Maschan A, Adjaoud D, Kulagin A, Grassi A, Fagioli F, Griskevicius L, Snowden JA, Johansson JJ, Dalle J, Byrne J, Risitano AM, Peffault de Latour R, Dufour C. Upfront unrelated donor hematopoietic stem cell transplantation in patients with idiopathic aplastic anemia: A retrospective study of the Severe Aplastic Anemia Working Party of European Bone Marrow Transplantation. Am J Hematol 2022; 97:E1-E3. [PMID: 34553406 DOI: 10.1002/ajh.26354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Alexey Maschan
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology Moscow Russian Federation
| | - Dalila Adjaoud
- CHU de la Timone, Hématologie Pédiatrique 264 rue Saint Pierre Marseille France
| | - Alexander Kulagin
- RM Gorbacheva Research Institute Pavlov University St Petersburg Russian Federation
| | | | - Franca Fagioli
- Regina Margherita, Children Hospital University of Turin Turin Italy
| | - Laimonas Griskevicius
- Vilnius University Hospital, Santaros Klinikos, Vilnius Lithuania and Vilnius University Vilnius
| | - John A. Snowden
- Sheffield Teaching Hospital NHS Foundation Trust Sheffield UK
| | | | | | | | - Antonio M. Risitano
- AORN San Giuseppe Moscati Avellino Italy
- Federico II, University of Naples Naples Italy
| | - Régis Peffault de Latour
- French reference Center for Aplastic Anemia and PNH, BMT unit, Saint‐Louis Hospital Paris France
| | - Carlo Dufour
- Hematology Unit, IRCCS, Gaslini Institute Genova Italy
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23
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Gusak A, Fedorova L, Lepik K, Volkov N, Popova M, Moiseev I, Mikhailova N, Baykov V, Kulagin A. Immunosuppressive Microenvironment and Efficacy of PD-1 Inhibitors in Relapsed/Refractory Classic Hodgkin Lymphoma: Checkpoint Molecules Landscape and Macrophage Populations. Cancers (Basel) 2021; 13:cancers13225676. [PMID: 34830831 PMCID: PMC8616219 DOI: 10.3390/cancers13225676] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Classic Hodgkin lymphoma contains rare malignant Hodgkin/Reed–Sternberg cells and abundant reactive populations in the tumor microenvironment. Many aspects of the interaction between tumor cells and immune cells remain unclear. Nevertheless, the microenvironment is believed to play a crucial role in tumor resistance and progression. Current knowledge about the role and dynamics of the tumor microenvironment in Hodgkin lymphoma during anti-PD-1 treatment is limited. The aim of this study was to identify possible predictive and prognostic morphological markers in the treatment of patients with relapsed or refractory classic Hodgkin lymphoma treated with nivolumab and to assess the variability of reactive cell populations after nivolumab therapy. The study was aimed to optimize therapeutic strategy in patients with relapsed or refractory classic Hodgkin lymphoma. Abstract To date, the impact of the tumor microenvironment on the prognosis of patients with classic Hodgkin lymphoma (cHL) during anti-PD-1 therapy has been studied insufficiently. This retrospective study included 61 primary samples of lymph nodes from patients who had relapsed/refractory (r/r) cHL and were treated with nivolumab. Repeated samples were obtained in 15 patients at relapse or disease progression after immunotherapy. Median follow-up was 55 (13–63) months. The best overall response rate and progression-free survival (PFS) were analyzed depending on the expression of CD68, CD163, PD-1, LAG-3, TIM-3, CTLA-4, TIGIT, CD163/c-maf in the tumor microenvironment in primary and sequential biopsies. The combination of CD163/c-maf antibodies was used for the identification of M2 macrophages (M2). A low number of macrophages in primary samples was associated with inferior PFS during nivolumab treatment (for CD163-positive cells p = 0.0086; for CD68-positive cells p = 0.037), while a low number of M2 with higher PFS (p = 0.014). Complete response was associated with a lower level of M2 (p = 0.011). In sequential samples (before and after nivolumab therapy) an increase in PD-1 (p = 0.011) and LAG-3 (p = 0.0045) and a depletion of CD68 (p = 0.057) and CD163 (p = 0.0049)-positive cells were observed. The study expands understanding of the cHL microenvironment structure and dynamics during nivolumab therapy in patients with r/r cHL.
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24
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Fedorova L, Gusak A, Lepik K, Volkov N, Popova M, Moiseev I, Mikhailova N, Baykov V, Kulagin A. 832MO Immune microenvironment in classical Hodgkin lymphoma: Composition and dynamics in patients with relapsed/refractory disease. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Kozlov A, Estrina M, Paina O, Bykova T, Osipova A, Kozhokar P, Rakhmanova Z, Solodova I, Morozova E, Alyansky A, Kulagina I, Gevorgian A, Dotsenko A, Moiseev I, Chukhlovin A, Kulagin A, Bondarenko S, Semenova E, Zubarovskaya L. Extracorporeal Photopheresis in Children with Chronic Graft-Versus-Host Disease. Pharmaceuticals (Basel) 2021; 14:808. [PMID: 34451905 PMCID: PMC8398239 DOI: 10.3390/ph14080808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
Chronic graft versus host disease (cGVHD) remains a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). It significantly decreases survival and quality of life. The present study demonstrates retrospective data on extracorporeal photopheresis (ECP) in children with cGVHD. A total of 42 children with steroid-refractory cGVHD were enrolled in the study. The majority of patients had acute leukemia (n = 32, 76%). All patients received ECP as second (n = 18, 43%) or third (n = 24, 57%) line of therapy. Initial ECP schedule consisted of bimonthly regimen for two consecutive days with possibility of further tapering according to response. Any concurrent treatment administered before ECP could be continued if considered necessary. Complete response to ECP was registered in seven (17%) patients and partial response in 24 (57%). Overall response according to organ involvement was as follows: skin (n = 24, 75%), mucous membranes (n = 16, 73%), liver (n = 8, 80%), gut (n = 4, 80%), lungs (n = 2, 22%) and joints (n = 2, 67%). Five-year overall, progression-free and failure-free survival was 57%, 56% and 30%, respectively. Non-relapse mortality at 5 years was 14%. We didn't observe any clinically significant complications in children that could be attributed to the procedure. ECP remains important and safe treatment option in children with cGVHD.
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Affiliation(s)
- Andrey Kozlov
- RM Gorbacheva Research Institute, Pavlov University, 197022 St. Petersburg, Russia; (M.E.); (O.P.); (T.B.); (A.O.); (P.K.); (Z.R.); (I.S.); (E.M.); (A.A.); (I.K.); (A.G.); (A.D.); (I.M.); (A.C.); (A.K.); (S.B.); (E.S.); (L.Z.)
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26
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Fedorova L, Lepik K, Mikhailova N, Kondakova E, Kotselyabina P, Shmidt D, Kozlov A, Zalyalov Y, Borzenkova E, Baykov V, Moiseev I, Kulagin A. 903P Combination of nivolumab with brentuximab vedotin in therapy of relapsed and refractory Hodgkin lymphoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Halkes C, de Wreede LC, Knol C, Simand C, Aljurf M, Tbakhi A, Vazquez L, Bloor A, Wagner-Drouet E, Vural F, Bodova I, Isaksson C, Diaz MÁ, Gruhn B, Snowden J, Arat M, Bazarbachi A, Spilleboudt C, Kulagin A, Marsh JC, Passweg J, Risitano AM, Peffault de Latour R, Dufour C. Allogeneic stem cell transplantation for acquired pure red cell aplasia. Am J Hematol 2019; 94:E294-E296. [PMID: 31396977 DOI: 10.1002/ajh.25609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Constantijn Halkes
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Cora Knol
- European Society for Blood and Marrow Transplantation (EBMT), Data Office Leiden, Leiden, The Netherlands
| | - Célestine Simand
- Département d'Oncologie et d'Hématologie, Hôpital de Hautepierre, Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mahmoud Aljurf
- Hematology and HSCT Program, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdelghani Tbakhi
- Department of Cell Therapy & Applied Genomics, King Hussein Cancer Center, Amman, Jordan
| | - Lourdes Vazquez
- Department Hematology, Hospital Clínico Universitario, Salamanca, Spain
| | - Adrian Bloor
- Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Eva Wagner-Drouet
- Hematology, Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Filiz Vural
- Ege University Medical Faculty Adult Hematology and StemCell Transplantation Unit, Ege University Medical School, Izmir, Turkey
| | - Ivana Bodova
- Bone Marrow Transplantation Unit, Department of Pediatric Hematology and Oncology, National Institute of Children's Diseases, Bratislava, Slovakia
| | - Cecilia Isaksson
- Department of Haematology, Cancer Centre, Umea University Hospital, Umea, Sweden
| | - Miguel Ángel Diaz
- Deparment of Pediatrics, Division of Pediatric Hematology/Oncology; Hematopoietic Stem Cell Transplantation and Cellular Therapy Unit, Nino Jesus Children's Hospital, Madrid, Spain
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - John Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mutlu Arat
- Hematology and HSCT Unit, Sisli Florence Nightingale Hospital, Istanbul, Turkey
| | - Ali Bazarbachi
- Department of internal medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Chloé Spilleboudt
- Department of Hematology, Institut Jules Bordet (ULB) Brussels, Bruxelles, Belgium
| | - Alexander Kulagin
- Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Judith Cw Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, London, UK
| | - Jakob Passweg
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Antonio M Risitano
- BMT Program, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Regis Peffault de Latour
- Saint-Louis Hospital, French Reference Center for Aplastic Anemia and PNH, Paris Diderot University, Paris, France
| | - Carlo Dufour
- Haematology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Kulagin A, Lisukov I, Ivanova M, Golubovskaya I, Kruchkova I, Bondarenko S, Vavilov V, Stancheva N, Babenko E, Sipol A, Pronkina N, Kozlov V, Afanasyev B. Prognostic value of paroxysmal nocturnal haemoglobinuria clone presence in aplastic anaemia patients treated with combined immunosuppression: results of two-centre prospective study. Br J Haematol 2013; 164:546-54. [DOI: 10.1111/bjh.12661] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 10/09/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Alexander Kulagin
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
| | - Igor Lisukov
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
| | - Maria Ivanova
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
| | - Irina Golubovskaya
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
| | | | - Sergey Bondarenko
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
| | - Vladimir Vavilov
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
| | - Natalia Stancheva
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
| | - Elena Babenko
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
| | - Alexandra Sipol
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
| | | | | | - Boris Afanasyev
- First Pavlov State Medical University of St. Petersburg; St. Petersburg Novosibirsk Russia
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Risitano AM, Selleri C, Serio B, Torelli GF, Kulagin A, Maury S, Halter J, Gupta V, Bacigalupo A, Sociè G, Tichelli A, Schrezenmeier H, Marsh J, Passweg J, Rotoli B. Alemtuzumab is safe and effective as immunosuppressive treatment for aplastic anaemia and single-lineage marrow failure: a pilot study and a survey from the EBMT WPSAA. Br J Haematol 2010; 148:791-6. [DOI: 10.1111/j.1365-2141.2009.08027.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Kulagin A, Lisukov I, Denisova V, Kruchkova I, Sizikova S, Gilevich A, Pronkina N, Kozhevnikov V, Kozlov V. Severe pancytopenia associated with a minor paroxysmal nocturnal haemoglobinuria clone and response to ciclosporin A in a heavily pretreated multiple myeloma patient. Br J Haematol 2008; 141:122-3. [DOI: 10.1111/j.1365-2141.2008.07003.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Lisukov I, Sizikova S, Kulagin A, Kruchkova I, Gilevich A, Klimova I, Kozlov V. Successful autologous stem cell transplantation in Ph-positive ALL patient with refractory invasive pulmonary aspergillosis. Bone Marrow Transplant 2004; 34:559-60. [PMID: 15286688 DOI: 10.1038/sj.bmt.1704639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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