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Watanabe M, Kanda J, Fukuda T, Uchida N, Ikegame K, Kataoka K, Kobayashi H, Ara T, Ishikawa J, Matsuoka KI, Sugio Y, Nakazawa H, Ikeda T, Atsuta Y, Kondo E, Suzuki R. Impact of GVHD on lymphoma progression: Nationwide study from Japanese Society for Transplantation and Cellular Therapy. Br J Haematol 2023; 203:446-459. [PMID: 37614023 DOI: 10.1111/bjh.19041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
The graft-versus-lymphoma (GVL) effect and its association with acute and chronic GVHD (aGVHD, cGVHD) has not been comprehensively elucidated. We retrospectively analysed 2204 Japanese patients with non-Hodgkin lymphomas (NHLs; indolent B-NHLs, n = 689; aggressive B-NHLs, n = 720; mature T/NK-NHLs, n = 795) receiving a first allo-HSCT in 2003-2017. Pre-transplant lymphoma control showed complete response (CR) in 759 and non-CR in 1445. We assessed the impact of aGVHD/cGVHD on lymphoma progression and other outcomes. Although aGVHD/cGVHD showed no statistical impact on lymphoma progression in the overall cohort, their impact was clear in certain groups: Grade I-II aGVHD in CR patients (HR, 0.63; 95% CI, 0.43-0.91), especially in mature T/NK-NHL (HR, 0.46; 95% CI, 0.26-0.83) and extensive cGVHD in patients with mature aggressive B-NHLs (HR, 0.55; 95% CI, 0.31-0.97). In total, limited cGVHD was associated with superior survivals (progression-free survival: HR, 0.71; 95% CI, 0.56-0.90), whereas severe GVHDs showed negative impacts on them. Our results support the presence of GVL effects differentially associated with GVHD in different lymphoma subtypes/controls. Meanwhile, it was also suggested that we should manage GVHDs within a limited activity, considering the negative impact of severe GVHDs. As pre-transplant lymphoma control remains a strong factor influencing transplant outcomes, improving its management is an important issue to be addressed.
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Affiliation(s)
- Mizuki Watanabe
- Department of Hematology, Kyoto University Hospital, Kyoto, Japan
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Junya Kanda
- Department of Hematology, Kyoto University Hospital, Kyoto, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Kazuhiro Ikegame
- Department of Hematology, Hyogo College of Medicine Hospital, Tokyo, Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Takahide Ara
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Yasuhiro Sugio
- Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Hideyuki Nakazawa
- Department of Hematology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Ikeda
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Eisei Kondo
- Department of Hematology, Kawasaki Medical School, Izumo, Japan
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
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Ali T, Behfar M, Mohseni R, Salajegheh P, Kheder M, Abou-Fakher F, Nikfetrat Z, Jafari F, Naji P, Hamidieh AA. Escalated Dose Donor Lymphocyte Infusion Treatment in Patients with Primary Immune Deficiencies After HSCT with Reduced-Intensity Conditioning Regimen. Hematol Oncol Stem Cell Ther 2022; 15:272-278. [PMID: 34242597 DOI: 10.1016/j.hemonc.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/06/2021] [Accepted: 06/13/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE/BACKGROUND Mixed chimerism is a major concern after allogenic hematopoietic stem cell transplantation (HSCT) using a reduced-intensity conditioning (RIC) regimen in primary immunodeficiencies (PIDs). A donor lymphocyte infusion (DLI) escalating dose regimen has been developed with the aim of reducing toxicity while preserving efficacy. However, the graft-versus-host disease (GvHD) development remains the most common and adverse effect of DLI and continues to be a limiting factor in its application, especially nonmalignant diseases such as PIDs. We prospectively evaluated PID patients after HSCT using RIC in Childrens Medical Center, who were candidates for an escalating dose of DLI for MC from 2016 to 2018. METHODS With the median follow-up of 16.4 months, 12 patients (nine males and three females) with a median age of 3.72 years received DLI. The median number of DLI was 3.2 (range, 1-5), the maximum and total dose of DLIs administered per patient were 3.6 × 107 (range, 1-5) cells/kg CD3+ and 9.3 × 107 (range, 1-15) cells/kg CD3+ cells, respectively. RESULTS Median donor chimerism at baseline before the DLIs was 41% (range, 11-73%), patients received DLIs at a median of 105 (range, 37-230) days and 52 (range, 3-168) days after the HSCT and onset of the MC, respectively. At the final assessment, six (54.5%) patients improved after DLIs at a median of 47.3 days. CONCLUSION PID patients may benefit from DLI with an escalating dose regimen, but the GvHD development remains a concern during the DLI, and the optimum dose and frequency must be standardized.
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Affiliation(s)
- Tahani Ali
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Hematopoietic Stem Cell Transplant Center, Children's Hospital, Damascus University, Damascus, Syria
| | - Maryam Behfar
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Hematopoietic Stem Cell Transplant Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rashin Mohseni
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pourya Salajegheh
- Department of Pediatric, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maged Kheder
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Hematopoietic Stem Cell Transplant Center, Children's Hospital, Damascus University, Damascus, Syria
| | - Faihaa Abou-Fakher
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Hematopoietic Stem Cell Transplant Center, Children's Hospital, Damascus University, Damascus, Syria
| | - Zeynab Nikfetrat
- Pediatric Hematopoietic Stem Cell Transplant Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Jafari
- Pediatric Hematopoietic Stem Cell Transplant Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Naji
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Qualls D, Kumar A, Epstein-Peterson Z. Targeting the immune microenvironment in mantle cell lymphoma: implications for current and emerging therapies. Leuk Lymphoma 2022; 63:2515-2527. [PMID: 35704674 PMCID: PMC9741766 DOI: 10.1080/10428194.2022.2086244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
Mantle cell lymphoma (MCL) is a morphologically and phenotypically heterogeneous subtype of non-Hodgkin lymphoma, and has historically been associated with poor outcomes. However, recent advances in our understanding of this disease have yielded new targeted and immune-based therapies with promising activity. Immune-based therapies such as monoclonal antibodies, immunomodulators, and CAR T cells have significantly improved outcomes and are now standard of care in MCL. In this review, we describe our current understanding of the immune microenvironment of MCL, discuss current immunotherapeutic approaches, and highlight promising novel immune-based therapies and combination therapies that may further improve outcomes for patients with MCL.
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Affiliation(s)
- David Qualls
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center. New York, NY, USA
| | - Anita Kumar
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center. New York, NY, USA
| | - Zachary Epstein-Peterson
- Lymphoma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center. New York, NY, USA
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Moldovianu AM, Crisan AM, Varady Z, Coriu D. The Difficult-to-Treat del 17 p Patient—A Case Report in Chronic Lymphocytic Leukemia. Medicina (B Aires) 2021; 58:medicina58010033. [PMID: 35056341 PMCID: PMC8778873 DOI: 10.3390/medicina58010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/01/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) treatment strategies have evolved to include mechanism-driven drugs but now raise new questions regarding their optimum timing and sequencing. In high-risk patients, switching from pathway inhibitors to allogeneic stem cell transplantation (allo-HCT) is still a matter of intense debate. We report the case of a CLL patient with 17 p deletion treated with ibrutinib as a bridge to allo-HCT. Early relapse after allo-HCT urged the initiation of salvage therapy, including donor lymphocytes infusions, ibrutinib, and venetoclax. We aim to outline and discuss the potential benefits of novel therapies, the current role of allo-HCT in CLL, drug timing and sequencing, and the unmet need to improve the long-term outcome of high-risk CLL patients.
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Affiliation(s)
- Ana-Maria Moldovianu
- Department of Hematology and Bone Marrow Transplant, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania; (A.-M.M.); (Z.V.); (D.C.)
- Department of Hematology, University of Medicine and Pharmacy “Carol Davila”, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
| | - Ana Manuela Crisan
- Department of Hematology and Bone Marrow Transplant, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania; (A.-M.M.); (Z.V.); (D.C.)
- Department of Hematology, University of Medicine and Pharmacy “Carol Davila”, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
- Correspondence:
| | - Zsofia Varady
- Department of Hematology and Bone Marrow Transplant, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania; (A.-M.M.); (Z.V.); (D.C.)
| | - Daniel Coriu
- Department of Hematology and Bone Marrow Transplant, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania; (A.-M.M.); (Z.V.); (D.C.)
- Department of Hematology, University of Medicine and Pharmacy “Carol Davila”, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
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5
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Eldershaw SA, Pearce H, Inman CF, Piper KP, Abbotts B, Stephens C, Nicol S, Croft W, Powell R, Begum J, Taylor G, Nunnick J, Walsh D, Sirovica M, Saddique S, Nagra S, Ferguson P, Moss P, Malladi R. DNA and modified vaccinia Ankara prime-boost vaccination generates strong CD8 + T cell responses against minor histocompatibility antigen HA-1. Br J Haematol 2021; 195:433-446. [PMID: 34046897 DOI: 10.1111/bjh.17495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
Allogeneic immune responses underlie the graft-versus-leukaemia effect of stem cell transplantation, but disease relapse occurs in many patients. Minor histocompatibility antigen (mHAg) peptides mediate alloreactive T cell responses and induce graft-versus-leukaemia responses when expressed on patient haematopoietic tissue. We vaccinated nine HA-1-negative donors against HA-1 with a 'prime-boost' protocol of either two or three DNA 'priming' vaccinations prior to 'boost' with modified vaccinia Ankara (MVA). HA-1-specific CD8+ T cell responses were observed in seven donors with magnitude up to 1·5% of total CD8+ T cell repertoire. HA-1-specific responses peaked two weeks post-MVA challenge and were measurable in most donors after 12 months. HA-1-specific T cells demonstrated strong cytotoxic activity and lysed target cells with endogenous HA-1 protein expression. The pattern of T cell receptor (TCR) usage by HA-1-specific T cells revealed strong conservation of T cell receptor beta variable 7-9 (TRBV7-9) usage between donors. These findings describe one of the strongest primary peptide-specific CD8+ T cell responses yet recorded to a DNA-MVA prime-boost regimen and this may reflect the strong immunogenicity of mHAg peptides. Prime-boost vaccination in donors or patients may prove of substantial benefit in boosting graft-versus-leukaemia responses.
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MESH Headings
- Adult
- Aged
- Allografts
- Antigens, Neoplasm/immunology
- Cytotoxicity, Immunologic
- Epitopes/immunology
- Gene Rearrangement, beta-Chain T-Cell Antigen Receptor
- Graft vs Leukemia Effect/immunology
- HLA-A2 Antigen/immunology
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunogenicity, Vaccine
- Immunologic Memory
- Male
- Middle Aged
- Minor Histocompatibility Antigens/immunology
- Oligopeptides/immunology
- Peptides/immunology
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- T-Lymphocytes, Cytotoxic/immunology
- Vaccination
- Vaccines, Attenuated
- Vaccines, DNA/immunology
- Vaccines, DNA/therapeutic use
- Vaccinia virus/immunology
- Viral Vaccines/immunology
- Viral Vaccines/therapeutic use
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Affiliation(s)
- Suzy A Eldershaw
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Hayden Pearce
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Charlotte F Inman
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Karen P Piper
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Ben Abbotts
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Christine Stephens
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Samantha Nicol
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Wayne Croft
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Richard Powell
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Jusnara Begum
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Graham Taylor
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
| | - Jane Nunnick
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Donna Walsh
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Mirjana Sirovica
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Shamyla Saddique
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Sandeep Nagra
- Department of Haematology, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, UK
| | - Paul Ferguson
- Department of Haematology, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
- Department of Haematology, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, UK
| | - Ram Malladi
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, Birmingham, UK
- Department of Haematology, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, UK
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6
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Cieri N, Maurer K, Wu CJ. 60 Years Young: The Evolving Role of Allogeneic Hematopoietic Stem Cell Transplantation in Cancer Immunotherapy. Cancer Res 2021; 81:4373-4384. [PMID: 34108142 PMCID: PMC8416782 DOI: 10.1158/0008-5472.can-21-0301] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/27/2021] [Accepted: 06/07/2021] [Indexed: 12/30/2022]
Abstract
The year 2020 marked the 30th anniversary of the Nobel Prize in Medicine awarded to E. Donnall Thomas for the development of allogeneic hematopoietic stem cell transplantation (allo-HSCT) to treat hematologic malignancies and other blood disorders. Dr. Thomas, "father of bone marrow transplantation," first developed and reported this technique in 1957, and in the ensuing decades, this seminal study has impacted fundamental work in hematology and cancer research, including advances in hematopoiesis, stem cell biology, tumor immunology, and T-cell biology. As the first example of cancer immunotherapy, understanding the mechanisms of antitumor biology associated with allo-HSCT has given rise to many of the principles used today in the development and implementation of novel transformative immunotherapies. Here we review the historical basis underpinning the development of allo-HSCT as well as advances in knowledge obtained by defining mechanisms of allo-HSCT activity. We review how these principles have been translated to novel immunotherapies currently utilized in clinical practice and describe potential future applications for allo-HSCT in cancer research and development of novel therapeutic strategies.
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Affiliation(s)
- Nicoletta Cieri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts
| | - Katie Maurer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts
| | - Catherine J Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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7
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Schmid C, Kuball J, Bug G. Defining the Role of Donor Lymphocyte Infusion in High-Risk Hematologic Malignancies. J Clin Oncol 2021; 39:397-418. [PMID: 33434060 DOI: 10.1200/jco.20.01719] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Christoph Schmid
- Department of Hematology and Oncology, Augsburg University Hospital, Augsburg, Germany
| | - Jürgen Kuball
- Department of Hematology and Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gesine Bug
- Department of Medicine 2, Goethe University, Frankfurt am Main, Germany
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8
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Haploidentical Stem Cell Transplantation in Lymphomas-Expectations and Pitfalls. J Clin Med 2020; 9:jcm9113589. [PMID: 33171719 PMCID: PMC7695017 DOI: 10.3390/jcm9113589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023] Open
Abstract
T-cell replete Haploidentical stem cell transplantation (Haplo-SCT) with Post-transplant cyclophosphamide (PT-Cy) is an emerging therapeutic option for patients with advanced relapsed or refractory lymphoma. The feasibility of this platform is supported by several retrospective studies showing a toxicity profile that is improved relative to umbilical cord blood and mismatched unrelated donor (UD) transplant and comparable to matched unrelated donor transplant. In particular, cumulative incidence of chronic graft-versus-host disease (GVHD) is reduced after Haplo-SCT relative to UD and matched related donor (MRD) transplant thanks to PT-Cy employed as GVHD prophylaxis. This achievement, together with a similar incidence of acute GVHD and disease relapse, results in a promising advantage of Haplo-SCT in terms of relapse-free/GVHD free survival. Unmet needs of the Haplo-SCT platform are represented by the persistence of a not negligible rate of non-relapse mortality, especially due to infections and disease relapse. Future efforts are warranted in order to reduce life-threatening infections and to employ Halo-SCT with PT-Cy as a platform to build new immunotherapeutic strategies.
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9
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Lamure S, Paul F, Gagez AL, Delage J, Vincent L, Fegueux N, Sirvent A, Gehlkopf E, Veyrune JL, Yang LZ, Kanouni T, Cacheux V, Moreaux J, Bonafoux B, Cartron G, De Vos J, Ceballos P. A Retrospective Comparison of DLI and gDLI for Post-Transplant Treatment. J Clin Med 2020; 9:jcm9072204. [PMID: 32664688 PMCID: PMC7408819 DOI: 10.3390/jcm9072204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
Donor lymphocyte infusion (DLI) is used to prevent or treat haematological malignancies relapse after allogeneic stem cell transplantation (allo-SCT). Recombinant human granulocyte colony-stimulated factor primed DLI (gDLI) is derived from frozen aliquots of the peripheral blood stem cell collection. We compared the efficacy and safety of gDLI and classical DLI after allo-SCT. We excluded haploidentical allo-SCT. Initial diseases were acute myeloblastic leukaemia (n = 45), myeloma (n = 38), acute lymphoblastic leukaemia (n = 20), non-Hodgkin lymphoma (n = 10), myelodysplasia (n = 8), Hodgkin lymphoma (n = 8), chronic lymphocytic leukaemia (n = 7), chronic myeloid leukaemia (n = 2) and osteomyelofibrosis (n = 1). Indications for DLI were relapse (n = 96) or pre-emptive treatment (n = 43). Sixty-eight patients had classical DLI and 71 had gDLI. The response rate was 38.2%, the 5-year progression-free survival (PFS) rate was 38% (29–48) and the 5-year overall survival (OS) rate was 37% (29–47). Graft versus host disease rate was 46.7% and 10.1% of patients died from toxicity. There were no differences between classical DLI and gDLI in terms of response (p = 0.28), 5-year PFS (p = 0.90), 5-year OS (p. 0.50), GvHD (p = 0.86), treated GvHD (p = 0.81) and cause of mortality (p. 0.14). In conclusion, this study points out no major effectiveness or toxicity of gDLI compared to classical DLI.
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Affiliation(s)
- Sylvain Lamure
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
- UMR-CNRS 5535, Institut de Génétique Moléculaire de Montpellier, 34090 Montpellier, France
| | - Franciane Paul
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
| | - Anne-Laure Gagez
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Direction de la Stratégie, des Affaires Médicales et de l’Innovation, Santélys Association, 59120 Loos, France
| | - Jérémy Delage
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Clinique du Parc, 34170 Castelnau le Lez, France
| | - Laure Vincent
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
| | - Nathalie Fegueux
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
| | - Anne Sirvent
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
| | - Eve Gehlkopf
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
| | - Jean Luc Veyrune
- Department of Cell and Tissue Engineering, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (J.L.V.); (L.Z.Y.)
| | - Lu Zhao Yang
- Department of Cell and Tissue Engineering, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (J.L.V.); (L.Z.Y.)
| | - Tarik Kanouni
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
| | - Valère Cacheux
- Department of Biological Haematology, CHU Montpellier, 34295 Montpellier, France; (V.C.); (J.M.)
| | - Jérôme Moreaux
- Department of Biological Haematology, CHU Montpellier, 34295 Montpellier, France; (V.C.); (J.M.)
- IGH, CNRS, University of Montpellier, 34094 Montpellier, France
- Institut Universitaire de France, 75005 Paris, France
| | - Beatrice Bonafoux
- Department of Immunology, CHU Montpellier, 34295 Montpellier, France;
| | - Guillaume Cartron
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
- UMR-CNRS 5535, Institut de Génétique Moléculaire de Montpellier, 34090 Montpellier, France
| | - John De Vos
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
- Department of Cell and Tissue Engineering, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (J.L.V.); (L.Z.Y.)
- Correspondence: (J.D.V.); (P.C.)
| | - Patrice Ceballos
- Department of Clinical Haematology, CHU Montpellier, 34295 Montpellier, France; (S.L.); (F.P.); (A.-L.G.); (J.D.); (L.V.); (N.F.); (A.S.); (E.G.); (T.K.); (G.C.)
- Federation of Haematology, University of Montpellier, 34295 Montpellier, France
- Correspondence: (J.D.V.); (P.C.)
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10
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Abstract
OPINION STATEMENT Cellular immunotherapy has been rapidly evolving and increasingly utilized in the management of relapsed and refractory lymphoma. CD19-specific chimeric antigen receptor T cells (CARTs) have achieved impressive results in pivotal clinical trials. Although CART development continues, these products have fundamental limitations that may make them less desirable in particular settings. For example, CARTs can only target cell surface antigens and thus are incapable of targeting intracellular tumor-associated proteins. In contrast to CARTs, conventional T cell receptors (TCR) allow T cells to target any cellular antigen, including intracellular proteins, since they interact with peptides presented by MHC I and II molecules. T cells recognizing EBV antigens through native TCRs have been successfully employed for treatment and prophylaxis of EBV-associated lymphomas, including post-transplant lymphoproliferative disorder. Currently, transgenic TCR-transduced T cells targeting nonviral tumor antigens remain experimental but, if successful, could become an invaluable cellular therapy option. Because the manufacturing process of autologous T cell products, including CARTs and other tumor-specific T cells, takes several weeks, patients often need bridging therapy to maintain disease control, which may be challenging. Novel cellular platforms, such as genetically modified NK and NKT cells, may be amenable to allogeneic use and thus may allow production as a readily available, "off-the-shelf" product. As cellular therapies beyond CART continue to grow, available therapeutic options for relapsed and refractory lymphoma patients are expected to expand further.
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Affiliation(s)
- Mahmoud R Gaballa
- Hematology-Oncology Section, Department of Medicine, Baylor College of Medicine, 6565 Fannin A6-080, Houston, TX, 77019, USA
| | - Carlos A Ramos
- Hematology-Oncology Section, Department of Medicine, Baylor College of Medicine, 6565 Fannin A6-080, Houston, TX, 77019, USA.
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11
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Bair SM, Porter DL. Accelerating chimeric antigen receptor therapy in chronic lymphocytic leukemia: The development and challenges of chimeric antigen receptor T-cell therapy for chronic lymphocytic leukemia. Am J Hematol 2019; 94:S10-S17. [PMID: 30861173 DOI: 10.1002/ajh.25457] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/27/2022]
Abstract
Studies of chimeric antigen receptor (CAR) T-cell therapy in chronic lymphocytic leukemia (CLL) have demonstrated the potential to produce deep remissions-and possibly cures-in some patients with heavily pretreated, high-risk, relapsed, and refractory disease. Unfortunately, most clinical trials of CAR T cells in CLL report complete responses only in the minority of patients, although recent studies have begun to elucidate the factors most predictive of response. These studies have suggested strategies for optimizing CAR T-cell fitness as well as the pre-existing host immune response, approaches that will likely lead to improvements in the efficacy of CAR T cells in CLL. Treating patients earlier in the course of their disease or using combination therapies with CAR T cells may further enhance efficacy. In this review, we summarize the existing literature on CAR T cell therapy in CLL, discuss mechanisms of response and resistance, and describe challenges facing the field.
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Affiliation(s)
- Steven M. Bair
- Cell Therapy and Transplant Program, Division of Hematology‐Oncology, Perelman School of Medicine and Abramson Cancer CenterUniversity of Pennsylvania Philadelphia Pennsylvania
| | - David L. Porter
- Cell Therapy and Transplant Program, Division of Hematology‐Oncology, Perelman School of Medicine and Abramson Cancer CenterUniversity of Pennsylvania Philadelphia Pennsylvania
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12
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Yafour N, Couturier MA, Azarnoush S, Girault S, Hermet E, Masouridi Levrat S, Schmidt A, Michallet M, Etancelin P, Guillaume T, Malard F, Sirvent A, Yakoub-Agha I, Poiré X. [Second allogeneic hematopoietic stem cell transplant: Guidelines from the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC)]. Bull Cancer 2018; 106:S40-S51. [PMID: 30409466 DOI: 10.1016/j.bulcan.2018.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/31/2018] [Indexed: 01/10/2023]
Abstract
Disease recurrence and graft dysfunction after allogeneic hematopoietic stem cell transplantation (allo-HSCT) currently remain among the major causes of treatment failure in malignant and non-malignant hematological diseases. A second allo-HSCT is a valuable therapeutic option to salvage those situations. During the 8th annual harmonization workshops of the french Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines on feasibility, indications, donor choice and conditioning in the case of a second allo-HSCT. In case of relapse, a second allo-HSCT with reduced intensity or non-myeloablative conditioning is a reasonable option, particularly in patients with a good performance status (Karnofsky/Lansky>80%), low co-morbidity score (EBMT score≤3), a longer remission duration after the first allo-HSCT (>6 months), and who present low disease burden at the time of second allo-HSCT. Matched related donors tend to be associated with better outcomes. In the presence of graft dysfunction (primary and secondary graft rejection), an immunoablative conditioning regimen is recommended. A donor change remains a valid option, especially in the absence of graft-versus-host disease after the first allo-HSCT.
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Affiliation(s)
- Nabil Yafour
- Établissement Hospitalier et Universitaire 1er-Novembre 1954, service d'hématologie et de thérapie cellulaire, BP 4166, 31000 Ibn Rochd, Oran, Algérie; Université d'Oran 1, Ahmed Ben Bella, faculté de médecine, Oran, Algérie.
| | - Marie Anne Couturier
- Hôpital Morvan, institut cancérologie-hématologie, CHRU Brest, 2, avenue Foch, 29200 Brest, France
| | - Saba Azarnoush
- Université Paris Diderot, hôpital Robert-Debré, service d'immuno-hématologie pédiatrique, 48, boulevard Sérurier, 75019 Paris, France
| | - Stéphane Girault
- CHU Limoges, hématologie clinique et thérapie cellulaire, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Eric Hermet
- Université d'Auvergne EA3846, CIC-501, CHU Estaing, service de thérapie cellulaire et d'hématologie clinique adulte, Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Stavroula Masouridi Levrat
- Geneva university hospitals, division of hematology, department of medical specialties, rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Suisse
| | - Aline Schmidt
- CHU d'Angers, maladies du sang, 4, rue Larrey, 49100 Angers, France; Université d'Angers, Inserm U892/CNRS 6299, 49035 Angers, France
| | - Mauricette Michallet
- Centre hospitalier Lyon Sud, hématologie clinique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex Lyon, France
| | - Pascaline Etancelin
- Centre Henri-Becquerel, laboratoire de génétique oncologique, rue d'Amiens, 76000 Rouen, France
| | - Thierry Guillaume
- CHU de Nantes, Hôtel-Dieu, service d'hématologie, 1, place Ricordeau, 44000 Nantes, France
| | - Florent Malard
- AP-HP, hôpital Saint-Antoine, service d'hématologie et de thérapie cellulaire, 75012 Paris, France
| | - Anne Sirvent
- CHU Montpellier, hôpital Arnaud-de-Villeneuve, service de l'onco-hématologie pédiatrique, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, maladies du sang, unité d'Allogreffe de CSH, 59000 Lille, France; Université de Lille 2, LIRIC, Inserm U995, 59000 Lille, France
| | - Xavier Poiré
- Cliniques universitaires Saint-Luc, service d'hématologie, 10, avenue Hippocrate, 1200 Bruxelles, Belgique
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13
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Epperla N, Hamadani M, Ahn KW, He F, Kodali D, Kleman A, Hari PN, Pasquini M, Fenske TS, Craig MD, Kanate AS, Bachanova V. Survival of Lymphoma Patients Experiencing Relapse or Progression after an Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:983-988. [DOI: 10.1016/j.bbmt.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 01/13/2018] [Indexed: 01/23/2023]
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14
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Grant M, Bollard CM. Developing T-cell therapies for lymphoma without receptor engineering. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:622-631. [PMID: 29222313 PMCID: PMC6142576 DOI: 10.1182/asheducation-2017.1.622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
T-cell therapy has emerged from the bench for the treatment of patients with lymphoma. Responses to T-cell therapeutics are regulated by multiple factors, including the patient's immune system status and disease stage. Outside of engineering of chimeric antigen receptors and artificial T-cell receptors, T-cell therapy can be mediated by ex vivo expansion of antigen-specific T cells targeting viral and/or nonviral tumor-associated antigens. These approaches are contributing to enhanced clinical responses and overall survival. In this review, we summarize the available T-cell therapeutics beyond receptor engineering for the treatment of patients with lymphoma.
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Affiliation(s)
- Melanie Grant
- Center for Cancer and Immunology Research, Children’s National Health System, Washington, DC; and
| | - Catherine M. Bollard
- Center for Cancer and Immunology Research, Children’s National Health System, Washington, DC; and
- Departments of Pediatrics and Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC
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15
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Developing T-cell therapies for lymphoma without receptor engineering. Blood Adv 2017; 1:2579-2590. [PMID: 29296911 DOI: 10.1182/bloodadvances.2017009886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022] Open
Abstract
T-cell therapy has emerged from the bench for the treatment of patients with lymphoma. Responses to T-cell therapeutics are regulated by multiple factors, including the patient's immune system status and disease stage. Outside of engineering of chimeric antigen receptors and artificial T-cell receptors, T-cell therapy can be mediated by ex vivo expansion of antigen-specific T cells targeting viral and/or nonviral tumor-associated antigens. These approaches are contributing to enhanced clinical responses and overall survival. In this review, we summarize the available T-cell therapeutics beyond receptor engineering for the treatment of patients with lymphoma.
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16
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Mohammadi S, Norooznezhad AH, Mohammadi AM, Nasiri H, Nikbakht M, Saki N, Vaezi M, Alimoghaddam K, Ghavamzadeh A. Optimizing peripheral blood stem cells transplantation outcome through amend relapse and graft failure: a review of current literature. Exp Hematol Oncol 2017; 6:24. [PMID: 28808609 PMCID: PMC5550945 DOI: 10.1186/s40164-017-0082-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/24/2017] [Indexed: 11/17/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been considered as a valuable approach in treatment of numerous malignant and none malignant hematologic disorders. However, relapse and poor graft function (PGF) after allo-SCT remain to be controversial issues which may affect the transplantation outcome. Relevant articles were searched in MEDLINE database (2000–2016) using keywords and phrases: donor lymphocyte infusions, allogeneic stem cells transplantation, relapsed hematologic malignancies, booster schedules, cell dose, laboratory monitoring protocols and technical aspects of apheresis. Relapse of disease and PGF could be reduced via noting some main points such as choosing the suitable time and patient for donor lymphocyte infusion (DLI) and also determination of patients who ought to candidate for second allogeneic HSCT or for the use of stem cell boost. DLI and stem cell booster are promising treatment strategies noted in this review. Finally, this paper discusses indications and technical aspects of DLI and stem cell booster in hematological malignancies and emphasizes their therapeutic or pre-emptive potentials.
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Affiliation(s)
- Saeed Mohammadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | | | - Ashraf Malek Mohammadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Hajar Nasiri
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Mohsen Nikbakht
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Najmaldin Saki
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Vaezi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Kamran Alimoghaddam
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
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17
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Kharfan-Dabaja MA, El-Jurdi N, Ayala E, Kanate AS, Savani BN, Hamadani M. Is myeloablative dose intensity necessary in allogeneic hematopoietic cell transplantation for lymphomas? Bone Marrow Transplant 2017; 52:1487-1494. [PMID: 28368373 DOI: 10.1038/bmt.2017.55] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/21/2016] [Accepted: 01/08/2017] [Indexed: 12/25/2022]
Abstract
The advent of novel immunotherapy and tyrosine kinase inhibitors has ushered a new era in the treatment of Hodgkin and non-Hodgkin lymphomas. Allogeneic hematopoietic cell transplantation remains, however, a vital component in the management and potential cure of lymphomas, especially in the relapsed setting. Considering the biological and clinical heterogeneity of various subtypes of lymphomas, the optimal intensity of conditioning regimens remains controversial. Reduced intensity conditioning regimens have broadened applicability of the procedure to older and frail patients. Observational studies suggest that although reduced intensity allografting is associated with higher risk of relapse, overall survival is comparable and in some cases even better, than observed with myeloablative regimens. Here, we review the available published data pertaining to allogeneic hematopoietic cell transplantation using reduced intensity or myeloablative conditioning for various lymphoma histologies. Owing to the lack of randomized prospective trials, recommendations are mainly based on registry and single-institution studies. Special emphasis must be given to implementing strategies to prevent relapse when using reduced intensity regimens. Identifying particular patients who may benefit from myeloablative regimens in lymphomas remains to be better defined.
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Affiliation(s)
- M A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - N El-Jurdi
- Division of Hematology-Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - E Ayala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - A S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA
| | - B N Savani
- Division of Hematology and Oncology and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Hamadani
- Division of Hematology-Oncology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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18
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Li Pira G, Di Cecca S, Biagini S, Girolami E, Cicchetti E, Bertaina V, Quintarelli C, Caruana I, Lucarelli B, Merli P, Pagliara D, Brescia LP, Bertaina A, Montanari M, Locatelli F. Preservation of Antigen-Specific Functions of αβ T Cells and B Cells Removed from Hematopoietic Stem Cell Transplants Suggests Their Use As an Alternative Cell Source for Advanced Manipulation and Adoptive Immunotherapy. Front Immunol 2017; 8:332. [PMID: 28386262 PMCID: PMC5362590 DOI: 10.3389/fimmu.2017.00332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/08/2017] [Indexed: 12/20/2022] Open
Abstract
Hematopoietic stem cell transplantation is standard therapy for numerous hematological diseases. The use of haploidentical donors, sharing half of the HLA alleles with the recipient, has facilitated the use of this procedure as patients can rely on availability of a haploidentical donor within their family. Since HLA disparity increases the risk of graft-versus-host disease, T-cell depletion has been used to remove alloreactive lymphocytes from the graft. Selective removal of αβ T cells, which encompass the alloreactive repertoire, combined with removal of B cells to prevent EBV-related lymphoproliferative disease, proved safe and effective in clinical studies. Depleted αβ T cells and B cells are generally discarded as by-products. Considering the possible use of donor T cells for donor lymphocyte infusions or for generation of pathogen-specific T cells as mediators of graft-versus-infection effect, we tested whether cells in the discarded fractions were functionally intact. Response to alloantigens and to viral antigens comparable to that of unmanipulated cells indicated a functional integrity of αβ T cells, in spite of the manipulation used for their depletion. Furthermore, B cells proved to be efficient antigen-presenting cells, indicating that antigen uptake, processing, and presentation were fully preserved. Therefore, we propose that separated αβ T lymphocytes could be employed for obtaining pathogen-specific T cells, applying available methods for positive selection, which eventually leads to indirect allodepletion. In addition, these functional T cells could undergo additional manipulation, such as direct allodepletion or genetic modification.
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Affiliation(s)
- Giuseppina Li Pira
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Stefano Di Cecca
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Simone Biagini
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Elia Girolami
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Elisabetta Cicchetti
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Valentina Bertaina
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Concetta Quintarelli
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy; Department of "Medicina Clinica e Chirurgia", University of Naples Federico II, Naples, Italy
| | - Ignazio Caruana
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Barbarella Lucarelli
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Pietro Merli
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Daria Pagliara
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Letizia Pomponia Brescia
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Alice Bertaina
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Mauro Montanari
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital , Rome , Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy; Department of Pediatrics, University of Pavia, Pavia, Italy
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19
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Green K, Pearce K, Sellar RS, Jardine L, Nicolson PLR, Nagra S, Bigley V, Jackson G, Dickinson AM, Thomson K, Mackinnon S, Craddock C, Peggs KS, Collin M. Impact of Alemtuzumab Scheduling on Graft-versus-Host Disease after Unrelated Donor Fludarabine and Melphalan Allografts. Biol Blood Marrow Transplant 2017; 23:805-812. [PMID: 28212937 PMCID: PMC6588535 DOI: 10.1016/j.bbmt.2017.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/08/2017] [Indexed: 12/11/2022]
Abstract
Alemtuzumab conditioning is highly effective at reducing the incidence of acute and chronic graft versus host disease (GVHD) in reduced intensity fludarabine and melphalan transplantation with ciclosporin monotherapy. Less frequent and lower dose scheduling may be used with sibling donors but an optimal regimen for matched unrelated donors has not been defined. In this retrospective observational study of 313 patients, the incidence and severity of GVHD was compared in patients receiving the standard 100mg regimen (20mg on day -7 to -3), 60mg (30mg day -4 and -2) or 50mg (10mg on day -7 to -3). Patients treated with 100mg, 60mg or 50mg developed acute GVHD grade I-IV with an incidence of 74%, 65% and 64%, respectively, while 36%, 32% and 41% developed chronic GHVD. An excess of severe acute grade III/IV GVHD was observed in the 50mg cohort (15% vs. 2-6%; p = 0.016). The relative risk of severe acute grade GVHD remained more than three-fold higher in the 50mg cohort, compared with 100mg, after adjustment for differences in age, gender mismatch, CMV risk and diagnosis (p = 0.030). The findings indicate that 60mg doses of alemtuzumab is comparable to 100mg but lower dosing may increase the risk of severe grade GVHD.
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Affiliation(s)
- Kile Green
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kim Pearce
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rob S Sellar
- Cancer Institute, University College London, London, United Kingdom; Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Laura Jardine
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Northern Centre for Bone Marrow Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Sandeep Nagra
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Venetia Bigley
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Northern Centre for Bone Marrow Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Graham Jackson
- Northern Centre for Bone Marrow Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Anne M Dickinson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kirsty Thomson
- Cancer Institute, University College London, London, United Kingdom; Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stephen Mackinnon
- Cancer Institute, University College London, London, United Kingdom; Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Charles Craddock
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Karl S Peggs
- Cancer Institute, University College London, London, United Kingdom; Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Matthew Collin
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Northern Centre for Bone Marrow Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
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20
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Picleanu AM, Novelli S, Monter A, Garcia-Cadenas I, Caballero AC, Martino R, Esquirol A, Briones J, Sierra J. Allogeneic hematopoietic stem cell transplantation for non-Hodgkin's lymphomas: a retrospective analysis of 77 cases. Ann Hematol 2017; 96:787-796. [PMID: 28168350 DOI: 10.1007/s00277-017-2934-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a therapeutic option for relapsed, advanced, and otherwise incurable non-Hodgkin's lymphomas (NHL) suggested by the existence of a graft-versus-lymphoma effect. The main complications are graft-versus-host disease and infections. We performed a retrospective analysis of patients with NHL, who received an allo-SCT between January 1995 and December 2014. The parameters that had an impact on overall survival were age ≤60 years old, chemosensitive disease pre-allo-SCT, and indolent NHL histology. The parameters that had an impact on progression-free survival were age ≤60 years old and chemosensitive disease pre-allo-SCT. Only aggressive NHL histology and refractory disease pre-allo-SCT showed an increased risk of death in the multivariate model. The use of allo-SCT for young patients with multiple relapsed chemosensitive indolent NHL is a suitable option. Despite poor prognosis, young aggressive NHL patients can be considered for allo-SCT provided they have chemosensitive disease.
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Affiliation(s)
- Ana M Picleanu
- Hematology Department, Hospital Filantropia, Craiova, Romania
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Anna Monter
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Garcia-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana C Caballero
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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21
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van Bergen CAM, van Luxemburg-Heijs SAP, de Wreede LC, Eefting M, von dem Borne PA, van Balen P, Heemskerk MHM, Mulder A, Claas FHJ, Navarrete MA, Honders WM, Rutten CE, Veelken H, Jedema I, Halkes CJM, Griffioen M, Falkenburg JHF. Selective graft-versus-leukemia depends on magnitude and diversity of the alloreactive T cell response. J Clin Invest 2017; 127:517-529. [PMID: 28067665 DOI: 10.1172/jci86175] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 11/17/2016] [Indexed: 01/10/2023] Open
Abstract
Patients with leukemia who receive a T cell-depleted allogeneic stem cell graft followed by postponed donor lymphocyte infusion (DLI) can experience graft-versus-leukemia (GVL) reactivity, with a lower risk of graft-versus-host disease (GVHD). Here, we have investigated the magnitude, diversity, and specificity of alloreactive CD8 T cells in patients who developed GVL reactivity after DLI in the absence or presence of GVHD. We observed a lower magnitude and diversity of CD8 T cells for minor histocompatibility antigens (MiHAs) in patients with selective GVL reactivity without GVHD. Furthermore, we demonstrated that MiHA-specific T cell clones from patients with selective GVL reactivity showed lower reactivity against nonhematopoietic cells, even when pretreated with inflammatory cytokines. Expression analysis of MiHA-encoding genes showed that similar types of antigens were recognized in both patient groups, but in patients who developed GVHD, T cell reactivity was skewed to target broadly expressed MiHAs. As an inflammatory environment can render nonhematopoietic cells susceptible to T cell recognition, prevention of such circumstances favors induction of selective GVL reactivity without development of GVHD.
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22
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Yun S, Vincelette ND, Abraham I, Puvvada S, Anwer F. Outcome Comparison of Allogeneic versus Autologous Stem Cell Transplantation in Transformed Low-Grade Lymphoid Malignancies: A Systematic Review and Pooled Analysis of Comparative Studies. Acta Haematol 2016; 136:244-255. [PMID: 27802434 DOI: 10.1159/000449031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/09/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Some patients with low-grade lymphoid malignancies develop transformed disease, requiring stem cell transplantation (SCT). SCT outcomes in transformed low-grade lymphoid malignancies may differ from those of nontransformed disease or other aggressive non-Hodgkin lymphomas. We conducted a pooled analysis of the clinical outcomes of allogeneic versus high-dose therapy (HDT) with autologous SCT in adult patients with transformed low-grade lymphoid malignancies. METHODS A PubMed, EMBASE, and Cochrane search yielded 4 comparative studies reporting allogeneic versus HDT with autologous SCT outcomes in adults (age ≥18) with transformed low-grade lymphoid malignancies, including follicular, chronic/small lymphocytic, and marginal zone lymphoma. Risk ratio (RR) and 95% CI were calculated using random-effects models. RESULTS Rates for overall survival (OS) were 51.0 versus 69.5% (RR = 1.55, 95% CI 1.19-2.02, p = 0.001), rates of relapse were 37.3 versus 35.3% (RR = 1.04, 95% CI 0.70-1.55, p = 0.84), and rates of transplant-related mortality (TRM) were 33.3 versus 7.2% (RR = 4.52, 95% CI 2.75-7.43, p < 0.00001) for allogeneic versus autologous SCT. Previous rituximab treatment, reduced intensity conditioning regimen prior to SCT, or original pathology had no prognostic impact. CONCLUSION HDT followed by autologous SCT was associated with lower TRM and a better OS, but there was no difference in relapse versus allogeneic SCT. Autologous SCT may be the better therapeutic option, considering the second chance of allogeneic SCT in the case of relapse.
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Affiliation(s)
- Seongseok Yun
- Department of Hematology and Oncology, H. Lee Moffitt Cancer Center, Tampa, Fla., USA
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23
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Peled JU, Jenq RR. Not just leukemia: CMV may protect against lymphoma recurrence after allogeneic transplant. Leuk Lymphoma 2016; 58:759-761. [PMID: 27733072 DOI: 10.1080/10428194.2016.1239265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan U Peled
- a Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Robert R Jenq
- a Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
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24
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Capria S, Barberi W, Perrone S, Ferretti A, Salaroli A, Annechini G, D'Elia GM, Foà R, Pulsoni A. Reappraising the timing of transplant for indolent non-Hodgkin lymphomas. Expert Rev Hematol 2016; 9:951-64. [PMID: 27539362 DOI: 10.1080/17474086.2016.1226128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Indolent non-Hodgkin lymphomas (iNHL) remain incurable with standard approaches. The timing of autologous stem cell transplant (ASCT) is changing following the introduction of new drugs that can potentially defer the transplant, improved reduced intensity conditioning (RIC) and haploidentical allogeneic SCT (allo-SCT). AREAS COVERED The most relevant aspects concerning the role of hematopoietic stem cell transplantation in the management of iNHL are discussed. Literature search methodology included examination of PubMed index and meeting presentations. Expert commentary: ASCT is not currently employed as consolidation in first-line, being reserved to patients with refractory/relapsed disease. The curative potential of graft-versus-lymphoma (GVL) after RIC allo-SCT could be particularly beneficial in patients with iNHL relapsing after ASCT. This scenario could be modified in the near future by better definition of high-risk patients at diagnosis, by the improvement of minimal residual disease (MRD) evaluation and by the introduction of new drugs in the therapeutic algorithm.
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Affiliation(s)
- Saveria Capria
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Walter Barberi
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Salvatore Perrone
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Antonietta Ferretti
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Adriano Salaroli
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Giorgia Annechini
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Gianna Maria D'Elia
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Robin Foà
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
| | - Alessandro Pulsoni
- a Hematology, Department of Cellular Biotechnologies and Hematology , Sapienza University , Rome , Italy
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25
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Castagna L, Sarina B, Bramanti S, Perseghin P, Mariotti J, Morabito L. Donor lymphocyte infusion after allogeneic stem cell transplantation. Transfus Apher Sci 2016; 54:345-55. [PMID: 27216544 DOI: 10.1016/j.transci.2016.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Allogeneic stem cell transplantation (allo-SCT) is considered the cornerstone in the treatment of several malignant and not malignant hematological diseases. However, relapse of hematological disease after allo-SCT is considered the most challenging point in the field. The risk can be reduced through optimal patients, donor and disease selection before allo-SCT, but harnessing donor immune system is an appealing way to treat or avoid disease relapse. Donor lymphocyte infusion (DLI) is a simple and effective therapy after allo-SCT. In this paper, the efficacy of DLI will be analyzed in different hematological diseases, focusing also on their therapeutic or pre-emptive use.
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Affiliation(s)
- Luca Castagna
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
| | - Barbara Sarina
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Stefania Bramanti
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | | | - Jacopo Mariotti
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Lucio Morabito
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
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26
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Li Pira G, Di Cecca S, Montanari M, Moretta L, Manca F. Specific removal of alloreactive T-cells to prevent GvHD in hemopoietic stem cell transplantation: rationale, strategies and perspectives. Blood Rev 2016; 30:297-307. [PMID: 27066851 DOI: 10.1016/j.blre.2016.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/06/2016] [Accepted: 03/08/2016] [Indexed: 01/05/2023]
Abstract
Hemopoietic stem cell transplantation (HSCT) is a standard procedure for treatment of malignant and non-malignant hematological diseases. HSCT donors include HLA-identical siblings, matched or mismatched unrelated donors and haploidentical related donors. Graft-versus-host disease (GvHD), mediated by donor alloreactive T-cells in the graft, can be triggered by minor histocompatibility antigens in HLA-identical pairs, by alleles at loci not considered for MUD-matching or by the mismatched haplotype in haplo-HSCT. Therefore, removal of donor T-cells, that contain the alloreactive precursors, is required, but T-cell depletion associates with opportunistic infections and with reduced graft-versus-leukemia effect. Selective T-cell depletion strategies have been introduced, like removal of αβ T-lymphocytes and of naive T-cells, two subsets including the alloreactive precursors, but the ultimate goal is specific removal of alloreactive T-cells. Here we review the different approaches to deplete alloreactive T-cells only and discuss pros and cons, specificity, efficiency and efficacy. Combinations of different methods and innovative approaches are also proposed for depleting specific alloreactive T-cells with high efficiency.
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Affiliation(s)
- Giuseppina Li Pira
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy; Unit of Immuno-hematology and Transfusion Medicine, IRCCS Bambino Gesù Children's Hospital, Piazza S. Onoforio 4, 00165 Rome, Italy.
| | - Stefano Di Cecca
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy.
| | - Mauro Montanari
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy; Unit of Immuno-hematology and Transfusion Medicine, IRCCS Bambino Gesù Children's Hospital, Piazza S. Onoforio 4, 00165 Rome, Italy.
| | - Lorenzo Moretta
- Immunology Area, IRCCS Bambino Gesù Children's Hospital, Piazza S. Onoforio 4, 00165 Rome, Italy.
| | - Fabrizio Manca
- Immunology Area, IRCCS Bambino Gesù Children's Hospital, Piazza S. Onoforio 4, 00165 Rome, Italy.
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27
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Lucarelli B, Merli P, Bertaina V, Locatelli F. Strategies to accelerate immune recovery after allogeneic hematopoietic stem cell transplantation. Expert Rev Clin Immunol 2015; 12:343-58. [PMID: 26588325 DOI: 10.1586/1744666x.2016.1123091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The interplay existing between immune reconstitution and patient outcome has been extensively demonstrated in allogeneic hematopoietic stem cell transplantation. One of the leading causes of infection-related mortality is the slow recovery of T-cell immunity due to the conditioning regimen and/or age-related thymus damage, poor naïve T-cell output, and restricted T-cell receptor (TCR) repertoires. With the aim of improving posttransplantation immune reconstitution, several immunotherapy approaches have been explored. Donor leukocyte infusions are widely used to accelerate immune recovery, but they carry the risk of provoking graft-versus-host disease. This review will focus on sophisticated strategies of thymus function-recovery, adoptive infusion of donor-derived, allodepleted T cells, T-cell lines/clones specific for life-threatening pathogens, regulatory T cells, and of T cells transduced with suicide genes.
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Affiliation(s)
- Barbarella Lucarelli
- a Department of Pediatric Hematology-Oncology , IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Pietro Merli
- a Department of Pediatric Hematology-Oncology , IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Valentina Bertaina
- a Department of Pediatric Hematology-Oncology , IRCCS, Bambino Gesù Children's Hospital , Rome , Italy
| | - Franco Locatelli
- a Department of Pediatric Hematology-Oncology , IRCCS, Bambino Gesù Children's Hospital , Rome , Italy.,b Department of Pediatrics , University of Pavia , Pavia , Italy
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28
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Pereira TDM, Danby R, Rocha V. Donor lymphocyte infusion after allogeneic hematopoietic stem cell transplantation. Int J Hematol Oncol 2015. [DOI: 10.2217/ijh.15.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Donor lymphocyte infusion, a rescue therapy after hematopoietic stem cell transplantation, has been increasingly adopted, as modalities of stem cell transplantation have widened. First described as donor lymphocyte transfusion or cell therapy, it consists of infusion of donor lymphocytes, collected in steady state or after growth factor enhancement. As in literature the most used name is donor lymphocyte infusion, we'll adopt it here. Its most striking efficacy is observed in patients with chronic myelogenous leukemia, who relapsed after allogeneic stem cells transplantation. However, graft-versus-host disease, its main complication, may still hamper its feasibility.
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Affiliation(s)
- Thales Dalessandro Meneguin Pereira
- Oxford University Hospitals NHS Trust, Department of Clinical Haematology, Level 2, Cancer & Haematology Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK
| | - Robert Danby
- Oxford University Hospitals NHS Trust, Department of Clinical Haematology, Level 2, Cancer & Haematology Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK
| | - Vanderson Rocha
- Oxford University Hospitals NHS Trust, Department of Clinical Haematology, Level 2, Cancer & Haematology Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK
- BRC Blood Theme, NIHR Oxford Biomedical Centre, Oxford University Hospital, Oxford, OX3 9DS, UK
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29
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Lucarelli B, Merli P, Strocchio L, Cefalo MG, Brescia LP, Locatelli F. T Cell Immunotherapy for Immune Reconstitution and GVHD Prevention After Allogeneic Hematopoietic Stem Cell Transplantation. CURRENT STEM CELL REPORTS 2015. [DOI: 10.1007/s40778-015-0027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Wang JS, Wang Z, Wang YN, Wu L, Fu L, Wei N. Allogeneic Hematopoietic Stem Cell Transplantation: A Salvage Treatment for Relapsed or Refractory Lymphoma. Indian J Hematol Blood Transfus 2015; 31:426-33. [PMID: 26306066 DOI: 10.1007/s12288-014-0497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/30/2014] [Indexed: 11/24/2022] Open
Abstract
To analyze the efficacy and safety of allogeneic hematopoietic stem cell transplantation (Allo-HSCT) in patients with relapsed or refractory lymphoma, the therapeutic efficacy, safety, and survival of 23 patients were evaluated. There were 18 (78.3 %) patients with relapsed lymphoma and 5 (21.7 %) patients with refractory lymphoma. Patients were grafted from human leukocyte antigen (HLA)-matched (10) or mismatched (7) related donors, or matched unrelated donors (6). The responses after Allo-HSCT included 13 (56.5 %) cases of complete remission, 5 (21.7 %) cases of partial remission, and 5 (21.7 %) cases of progressive disease. Overall, 16 of 23 patients were alive at a median follow up of 1,035 days (range 60-2,613), five patients died because of non-relapsed mortality, and two patients died of progressive disease. Progression-free survival rates were 64.6 and 48.4 % at 12 and 24 months, respectively, and overall survival rates were 68.6 and 59.5 % at 12 and 24 months, respectively. Allo-HSCT may be a salvage treatment for relapsed or refractory lymphoma. Myeloablative conditioning regimens may be effective and safe.
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Affiliation(s)
- Jing-Shi Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050 People's Republic of China
| | - Zhao Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050 People's Republic of China
| | - Yi-Ni Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050 People's Republic of China
| | - Lin Wu
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050 People's Republic of China
| | - Li Fu
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050 People's Republic of China
| | - Na Wei
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, 100050 People's Republic of China
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31
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The Impact of Graft-versus-Host Disease on the Relapse Rate in Patients with Lymphoma Depends on the Histological Subtype and the Intensity of the Conditioning Regimen. Biol Blood Marrow Transplant 2015; 21:1746-53. [PMID: 25981509 DOI: 10.1016/j.bbmt.2015.05.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/11/2015] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to analyze the impact of graft-versus-host disease (GVHD) on the relapse rate of different lymphoma subtypes after allogeneic hematopoietic cell transplantation (allo-HCT). Adult patients with a diagnosis of Hodgkin lymphoma, diffuse large B cell lymphoma, follicular lymphoma (FL), peripheral T cell lymphoma, or mantle cell lymphoma (MCL) undergoing HLA-identical sibling or unrelated donor hematopoietic cell transplantation between 1997 and 2009 were included. Two thousand six hundred eleven cases were included. A reduced-intensity conditioning (RIC) regimen was used in 62.8% of the transplantations. In a multivariate analysis of myeloablative cases (n = 970), neither acute (aGVHD) nor chronic GVHD (cGVHD) were significantly associated with a lower incidence of relapse/progression in any lymphoma subtype. In contrast, the analysis of RIC cases (n = 1641) showed that cGVHD was associated with a lower incidence of relapse/progression in FL (risk ratio [RR], .51; P = .049) and in MCL (RR, .41; P = .019). Patients with FL or MCL developing both aGVHD and cGVHD had the lowest risk of relapse (RR, .14; P = .007; and RR, .15; P = .0019, respectively). Of interest, the effect of GVHD on decreasing relapse was similar in patients with sensitive disease and chemoresistant disease. Unfortunately, both aGVHD and cGVHD had a deleterious effect on treatment-related mortality and overall survival (OS) in FL cases but did not affect treatment-related mortality, OS or PFS in MCL. This study reinforces the use of RIC allo-HCT as a platform for immunotherapy in FL and MCL patients.
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32
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Jardine L, Publicover A, Bigley V, Hale G, Pearce K, Dickinson A, Jackson G, Collin M. A comparative study of reduced dose alemtuzumab in matched unrelated donor and related donor reduced intensity transplants. Br J Haematol 2015; 168:874-81. [PMID: 25640315 PMCID: PMC4737113 DOI: 10.1111/bjh.13239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
Abstract
In vivo T cell depletion with 100 mg alemtuzumab prevents graft-versus-host disease (GVHD) in reduced intensity conditioned transplants but is associated with delayed immune reconstitution, a higher risk of infection and relapse. De-escalation studies have shown that a reduced dose of 30 mg is as effective as 100 mg in preventing GVHD in matched related donor (MRD) transplants. Dose reduction in matched unrelated donor (MUD) transplants is feasible but the comparative efficacy of alemtuzumab in this setting is not known and opinions vary widely concerning the optimal level of GVHD prophylaxis that should be achieved. Through retrospective analysis we made an objective comparison of MUD transplants receiving an empirically reduced dose of 60 mg, with MRD transplants receiving a 30 mg dose. We observed proportionate levels of alemtuzumab according to dose but an inverse relationship with body surface area particularly in MRD transplants. MUD transplants experienced more acute and chronic GVHD, higher T cell chimerism, more sustained use of ciclosporin and less need for donor lymphocyte infusion than MRD transplants. Thus, doubling the dose of alemtuzumab to 60 mg did not provide equivalent prevention of GVHD after MUD transplant although there was no difference in non-relapse mortality or survival compared with MRD transplants.
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Affiliation(s)
- Laura Jardine
- Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | - Venetia Bigley
- Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | - Kim Pearce
- Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - Anne Dickinson
- Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - Graham Jackson
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Matthew Collin
- Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
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33
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High-dose chemotherapy followed by autologous and allogeneic hematopoietic stem cell transplantation in patients with follicular non-Hodgkin’s lymphoma in the rituximab era. TUMORI JOURNAL 2015; 101:2-7. [PMID: 25702654 DOI: 10.5301/tj.5000203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 11/20/2022]
Abstract
High-dose chemotherapy in lymphomas, and mainly non-Hodgkin’s lymphomas, has been advancing since the 1970s. This therapeutic strategy is based on the supposed existence of a dose-response curve for cytotoxic agents. However, the available data are contradictory, so high-dose chemotherapy cannot be guaranteed as consolidation treatment for first-remission follicular lymphoma or diffuse large cell lymphoma. The objective of this paper is to review the current knowledge about high-dose chemotherapy followed by hematopoietic stem cell transplantation in follicular non-Hodgkin’s lymphoma. The published studies on follicular lymphoma after first remission, recurrent follicular lymphoma, and transformed follicular lymphoma were assessed together with the data available on diffuse large cell lymphoma. During analysis of the studies, difficulties were encountered in comparing studies due to the heterogeneous nature of the data. High-dose chemotherapy as consolidation treatment after first remission or in recurrent or refractory disease was also analyzed.
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34
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Chimerism analysis in peripheral blood using indel quantitative real-time PCR is a useful tool to predict post-transplant relapse in acute leukemia. Bone Marrow Transplant 2014; 50:259-65. [DOI: 10.1038/bmt.2014.254] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 01/11/2023]
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35
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Lifting the mantle: Unveiling new treatment approaches in relapsed or refractory mantle cell lymphoma. Blood Rev 2014; 29:143-52. [PMID: 25468719 DOI: 10.1016/j.blre.2014.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/06/2014] [Accepted: 10/10/2014] [Indexed: 11/20/2022]
Abstract
The management of relapsed/refractory mantle cell lymphoma (MCL) remains a clinical challenge. A standard second-line treatment for relapsed/refractory MCL does not exist. Management of relapsed/refractory MCL requires an individualized treatment approach, incorporating factors such as: functional status, prior treatments, response to prior therapies, and disease biology. Generally, there are two categories of salvage therapy; the first, non-cross-resistant cytotoxic chemotherapeutic agents and, the second, pathway-targeted agents. For transplant eligible patients, the optimal therapy usually consists of salvage, remission re-induction phase followed, whenever possible, by a consolidation phase. Bendamustine and/or high dose cytarabine plus rituximab based chemotherapy represent the most common salvage therapy with an overall response rate of 70-80%. Consolidation with a reduced intensity conditioning allogeneic stem cell transplantation represents the only potentially curative treatment. Overall survival ranges from 30% to 50% at 5 years with this approach. For transplant ineligible patients, ibrutinib is the most effective treatment with an overall response rate of almost 70% and median response duration of 17.5 months. Lacking an effective consolidation, this approach is not considered curative. In this review we characterize the main therapeutic approaches available in this setting and summarize our preferred clinical treatment approach.
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36
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Allogeneic hematopoietic cell transplantation for indolent non-Hodgkin lymphoma: indications and outcomes. Curr Opin Hematol 2014; 20:509-14. [PMID: 24104411 DOI: 10.1097/moh.0b013e328365a151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Allogeneic hematopoietic cell transplantation (HCT) can potentially cure indolent non-Hodgkin lymphoma (NHL). However, the optimal timing and indications remain unclear. Here, we review recent published reports on the subject and summarize our approach. RECENT FINDINGS Recent prospective clinical trials of allogeneic HCT in indolent NHL are marked by substantial variation in eligibility criteria, patient populations, and transplant approach. Nonetheless, several common themes are apparent. Indolent NHL is highly susceptible to immunologic graft-versus-lymphoma effects and relapse rates after allogeneic HCT are uniformly low. Allogeneic HCT early in the disease course produces the highest overall and progression-free survival, but also increases patient exposure to potential transplant-related complications such as chronic graft-versus-host disease. In contrast, allogeneic HCT can be reserved as a 'last resort' for patients who are refractory to conventional chemotherapy, delaying their exposure to graft-versus-host disease and other transplant-associated risks. No trials have directly addressed the optimal timing of allogeneic HCT in indolent NHL nor prospectively compared different transplant approaches. SUMMARY Excellent outcomes have been reported with allogeneic HCT for indolent NHL, both early and late in the disease course. The optimal timing of allogeneic HCT is unknown and depends heavily on patient preferences.
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Parmar S, Ritchie DS. Allogeneic transplantation as anticancer immunotherapy. Curr Opin Immunol 2014; 27:38-45. [PMID: 24534447 DOI: 10.1016/j.coi.2014.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/19/2014] [Accepted: 01/20/2014] [Indexed: 02/03/2023]
Abstract
Allogeneic stem cell transplantation (AlloSCT) utilizes HLA-matched donor bone marrow or peripheral blood stem cell grafts to reconstitute haematopoiesis and immunity in patients with bone marrow failure or hematological malignancies. It is now clear that much of the anti-cancer effect of AlloSCT is due to the ability of engrafting donor derived lymphocyte populations to eradicate residual malignant clones, through a phenomenon known as the graft-versus-tumor (GVT) effect. Recognition of the importance of GVT in the long-term control of cancer has allowed substantial reductions in the pre-transplant conditioning intensity, leading to the development of reduced-intensity or even non-myeloablative transplant regimens in some patient groups. These reduced intensity regimens still allow donor cell engraftment and GVT, whilst reducing the morbidity and mortality associated with traditional myeloablative conditioning. Through clinical observations and experimental models of AlloSCT substantial insights have been provided into the mechanisms of immunological control of malignancy even outside the setting of AlloSCT, providing an opportunity to duplicate these anti-cancer mechanisms via non-allogeneic immunotherapies.
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Allogeneic transplantation after reduced-intensity conditioning with fludarabine-CY for both indolent and aggressive lymphoid malignancies. Bone Marrow Transplant 2014; 49:513-8. [PMID: 24419517 DOI: 10.1038/bmt.2013.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 11/08/2022]
Abstract
We studied the outcome of allo-SCT after reduced-intensity conditioning in relapsed or refractory indolent and aggressive lymphoid malignancies. All 54 patients (diagnosis: B-CLL n=13, indolent lymphoma n=12, aggressive lymphoma n=13, transformed lymphoma n=16) received conditioning with fludarabine and CY between July 2001 and November 2010. They underwent allo-SCT because of relapse after auto-SCT or because no other therapy could lead to a meaningful remission. Patients received an unmanipulated peripheral blood stem-cell graft. Median follow-up was 67 months. Thirty-two patients had received rituximab. Immediately after transplantation, remission status had improved in 21 patients, all without DLI. During the follow-up six additional patients achieved CR without further therapy. Four-year OS (EFS) was 46% (46%) for B-CLL, 83% (75%) for indolent lymphoma, 69% (55%) for aggressive lymphoma and 74% (67%) for transformed lymphoma (P=0.28 (P=0.54)). Forty two percent developed acute GVHD, 68% chronic GVHD (16% limited, 52% extensive). Previous auto-SCT did not influence OS, while acute GVHD did. Two-year non-relapse mortality was 16%. In conclusion, reduced-intensity conditioning with fludarabine-CY is feasible and effective for both indolent and aggressive lymphoid malignancies, even after previous auto-SCT. Because of the excellent anti-B-cell/lymphoma activity fludarabine-CY decreases tumor load, gaining time for the development of a graft versus lymphoma effect.
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Linn YC. Adoptive immunotherapy with polyclonal T cells and natural killer cells for hematological malignancies: current status and future prospects. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.13.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
SUMMARY Adoptive cellular therapy with polyclonal T cells and natural killer cells are immunotherapeutic modalities being studied in solid tumors and hematological malignancies to treat disease and prevent relapse. These include unexpanded polyclonal T cells, short-term activation by cytokine into lymphokine-activated killer cells, longer term expansion by cytokine stimulation giving rise to cytokine-induced killer cells or expansion under costimulation with beads expressing anti-CD3 and anti-CD28. Similarly natural killer cells can be given with or without activation and expansion. Here we review the published work and clinical trials involving each cell type in the autologous, matched allogeneic, haploidentical and nontransplant settings, comparing and contrasting each cell type and discussing their potential applications.
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Affiliation(s)
- Yeh-Ching Linn
- Department of Hematology, Singapore General Hospital, Outram Road, Singapore 169608
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Berglund D, Karlsson M, Biglarnia AR, Lorant T, Tufveson G, Korsgren O, Carlsson B. Obtaining regulatory T cells from uraemic patients awaiting kidney transplantation for use in clinical trials. Clin Exp Immunol 2013; 173:310-22. [PMID: 23607776 PMCID: PMC3722931 DOI: 10.1111/cei.12112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2013] [Indexed: 02/06/2023] Open
Abstract
Adoptive transfer of regulatory T cells (T(regs)) has been proposed for use as a cellular therapy to induce transplantation tolerance. Preclinical data are encouraging, and clinical trials with T(reg) therapy are anticipated. In this study, we investigate different strategies for the isolation and expansion of CD4(+) CD25(high) CD127(low) T(regs) from uraemic patients. We use allogeneic dendritic cells (DCs) as feeder cells for the expansion and compare T(reg) preparations isolated by either fluorescence activated cell sorting (FACS) or magnetic activated cell sorting (MACS) that have been expanded subsequently with either mature or tolerogenic DCs. Expanded T(reg) preparations have been characterized by their purity, cytokine production and in-vitro suppressive ability. The results show that T(reg) preparations can be isolated from uraemic patients by both FACS and MACS. Also, the type of feeder cells used in the expansion affects both the purity and the functional properties of the T(reg) preparations. In particular, FACS-sorted T(reg) preparations expanded with mature DCs secrete more interleukin (IL)-10 and granzyme B than FACS-sorted T(reg) preparations expanded with tolerogenic DCs. This is a direct comparison between different isolation techniques and expansion protocols with T(regs) from uraemic patients that may guide future efforts to produce clinical-grade T(regs) for use in kidney transplantation.
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Affiliation(s)
- D Berglund
- Department of Surgical Sciences, Section of Transplantation Surgery, Uppsala University, Uppsala, Sweden.
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Buhmann R, Michael S, Juergen H, Horst L, Peschel C, Kolb HJ. Immunotherapy with FBTA05 (Bi20), a trifunctional bispecific anti-CD3 x anti-CD20 antibody and donor lymphocyte infusion (DLI) in relapsed or refractory B-cell lymphoma after allogeneic stem cell transplantation: study protocol of an investigator-driven, open-label, non-randomized, uncontrolled, dose-escalating Phase I/II-trial. J Transl Med 2013; 11:160. [PMID: 23815981 PMCID: PMC3702397 DOI: 10.1186/1479-5876-11-160] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/27/2013] [Indexed: 11/10/2022] Open
Abstract
Background Patients with B cell malignancies refractory to allogeneic stem cell transplantation (SCT) can be treated by subsequent immunotherapy with donor lymphocyte infusions (DLI). But unlike myeloid leukemia, B cell leukemia and lymphoma are less sensitive to allogeneic adoptive immunotherapy. Moreover, the beneficial graft-versus-lymphoma (GVL) effect may be associated with moderate to severe graft-versus-host disease (GVHD). Thus, novel therapeutic approaches augmenting the anti-tumor efficacy of DLI and dissociating the GVL effect from GVHD are needed. The anti-CD20 x anti-CD3 trifunctional bispecific antibody (trAb) FBTA05 may improve the targeting of tumor cells by redirecting immune allogeneic effector cells while reducing the risk of undesirable reactivity against normal host cells. Hence, FBTA05 may maximize GVL effects by simultaneously decreasing the incidence and severity of GVHD. Methods/Design Based on this underlying treatment concept and on promising data taken from preclinical results and a small pilot study, an open-label, non-randomized, uncontrolled, dose-escalating phase I/II-study is conducted to evaluate safety and preliminary efficacy of the investigational antibody FBTA05 in combination with DLI for patients suffering from rituximab- and/or alemtuzumab-refractory, CD20-positive low- or high-grade lymphoma after allogeneic SCT. During the first trial phase with emphasis on dose escalation a maximum of 24 patients distributed into 4 cohorts will be enrolled. For the evaluation of preliminary efficacy data a maximum of 12 patients (6 patients with low-grade lymphoma and/or Chronic Lymphocytic Leukemia (CLL) / 6 patients with high-grade or aggressive lymphoma) will attend the second phase of this clinical trial. Discussion Promising data (e.g. induction of cellular immunity; GVL predominance over GVHD; achievement of partial or complete responses; prolongation of time-to-progression) obtained from this phase I/II trial would represent the first milestone in the clinical evaluation of a novel immunotherapeutic concept for treatment-resistant low- and high-grade lymphoma and NHL patients in relapse. Trial registration NCT01138579
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Affiliation(s)
- Raymund Buhmann
- Department of Medicine III, Klinikum der Universitaet Muenchen, Grosshadern, Marchioninistrasse 15, Munich 81377, Germany.
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Robinson SP, Canals C, Luang JJ, Tilly H, Crawley C, Cahn JY, Pohlreich D, Le Gouill S, Gilleece M, Milpied N, Attal M, Biron P, Maury S, Rambaldi A, Maertens J, Capria S, Colombat P, Montoto S, Sureda A. The outcome of reduced intensity allogeneic stem cell transplantation and autologous stem cell transplantation when performed as a first transplant strategy in relapsed follicular lymphoma: an analysis from the Lymphoma Working Party of the EBMT. Bone Marrow Transplant 2013; 48:1409-14. [PMID: 23771004 DOI: 10.1038/bmt.2013.83] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/26/2013] [Accepted: 05/01/2013] [Indexed: 01/04/2023]
Abstract
Both auto-SCT and reduced intensity allo-SCT (RIST) are employed in the treatment of relapsed follicular lymphoma (FL). We have analysed the outcome of these two transplant procedures when used as a first transplant in this setting. We conducted a retrospective comparison of 726 patients who underwent an auto-SCT and 149 who underwent a RIST as a first transplant procedure for relapsed FL as reported to the Lymphoma Working Party of the European Bone Marrow Transplant. The non-relapse mortality (NRM) was significantly worse for patients undergoing a RIST (relative risk (RR) 4.0, P<0.001). The 1-year NRM was 15% for those undergoing a RIST compared with 3% for those undergoing an auto-SCT. Disease relapse or progression were significantly worse for those receiving an auto-SCT (RR 3.1, P<0.001). Patients undergoing a RIST had a 5-year relapse rate of 20% compared with 47% for those undergoing an auto-SCT. The PFS at 5 years was 57% for patients receiving a RIST compared with 48% for those receiving an auto-SCT. There was no significant difference in OS between the two groups. RIST is associated with a higher NRM and lower relapse rate in patients with relapsed FL.
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Affiliation(s)
- S P Robinson
- BMT Unit, Bristol Children's Hospital, Bristol, UK
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El-Jurdi N, Reljic T, Kumar A, Pidala J, Bazarbachi A, Djulbegovic B, Kharfan-Dabaja MA. Efficacy of adoptive immunotherapy with donor lymphocyte infusion in relapsed lymphoid malignancies. Immunotherapy 2013; 5:457-66. [DOI: 10.2217/imt.13.31] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: There is a perceived benefit associated with the administration of donor lymphocyte infusion (DLI) in patients with lymphoid malignancies relapsing after allogeneic hematopoietic cell transplantation. However, it is unclear if and how this benefit varies according to specific diseases. Because administration of DLI is not universally effective and could be associated with significant toxicities resulting in morbidity and mortality, it is imperative to identify cases where benefits outweigh harms of the procedure. Materials & methods: We conducted a systematic review of the published literature and extracted and pooled data independently for each disease cohort: acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), multiple myeloma (MM), non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). Results: In summary, 39 studies met inclusion criteria. The pooled proportion (95% CI) for complete response was 27% (16–40) in ALL, 55% (15–92) in CLL, 26% (19–33) in MM, 52% (33–71) in NHL and 37% (20–56) in HL. Conclusion: Complete response rates appear higher when DLI is used for relapsed CLL and lymphomas (NHL and HL), and less pronounced in ALL or MM. Absence of data pertaining to disease-specific prognostic determinants, such as adverse genetic or molecular abnormalities, or quantitative disease burden when applicable, limit our ability to identify cases in whom benefits from DLI outweigh risks associated with the procedure within a particular disease.
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Affiliation(s)
- Najla El-Jurdi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Tea Reljic
- Center for Evidence-Based Medicine, University of South Florida, College of Medicine, Tampa, FL, USA
| | - Ambuj Kumar
- Center for Evidence-Based Medicine, University of South Florida, College of Medicine, Tampa, FL, USA
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Joseph Pidala
- Department of Blood & Marrow Transplantation, Moffitt Cancer Center, 12902 Magnolia Drive, FOB-3, Tampa, FL 33612, USA
- Department of Oncologic Sciences, Moffitt Cancer Center/University of South Florida College of Medicine, Tampa, FL, USA
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Division of Hematology–Oncology & Bone Marrow Transplantation Program, American University of Beirut, Beirut, Lebanon
| | - Benjamin Djulbegovic
- Center for Evidence-Based Medicine, University of South Florida, College of Medicine, Tampa, FL, USA
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, Moffitt Cancer Center/University of South Florida College of Medicine, Tampa, FL, USA
| | - Mohamed A Kharfan-Dabaja
- Department of Oncologic Sciences, Moffitt Cancer Center/University of South Florida College of Medicine, Tampa, FL, USA
- Division of Hematology–Oncology & Bone Marrow Transplantation Program, American University of Beirut, Beirut, Lebanon
- Department of Blood & Marrow Transplantation, Moffitt Cancer Center, 12902 Magnolia Drive, FOB-3, Tampa, FL 33612, USA.
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Rager A, Porter DL. Cellular therapy following allogeneic stem-cell transplantation. Ther Adv Hematol 2013; 2:409-28. [PMID: 23556106 DOI: 10.1177/2040620711412416] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Allogeneic hematopoietic stem-cell transplantation (HSCT) is the most effective approach for many patients with hematologic malignancies. Unfortunately, relapse remains the most common cause of death after allogeneic HSCT, and the prognosis of relapsed disease is poor for most patients. Induction of a graft-versus-leukemia (GVL), or graft-versus-tumor, effect through the use of donor leukocyte infusion (DLI), or donor lymphocyte infusion, has been remarkably successful for relapsed chronic myelogenous leukemia. Unfortunately, response to DLI in other hematologic malignancies is much less common and depends on many factors including histology, pace and extent of relapse, and time from HSCT to relapse. Furthermore, graft-versus-host disease (GVHD) is common after DLI and often limits successful immunotherapy. Ultimately, manipulations to minimize GVHD while preserving or enhancing GVL are necessary to improve outcomes for relapse after allogeneic HSCT.
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Donor lymphocyte infusion for relapsed hematological malignancies after allogeneic hematopoietic cell transplantation: prognostic relevance of the initial CD3+ T cell dose. Biol Blood Marrow Transplant 2013; 19:949-57. [PMID: 23523892 DOI: 10.1016/j.bbmt.2013.03.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/06/2013] [Indexed: 11/20/2022]
Abstract
The impact of donor lymphocyte infusion (DLI) initial cell dose on its outcome is known in patients with chronic myeloid leukemia but limited in patients with other hematological malignancies. In this retrospective study, we evaluated the effect of initial DLI CD3(+) cell dose on graft-versus-host disease (GVHD) and overall survival after DLI given for relapse of any hematological malignancies after allogeneic hematopoietic cell transplantation (HCT) with high- or reduced-intensity conditioning. The cohort included 225 patients. Initial DLI CD3(+) cell dose per kilogram of recipient body weight was ≤ 1 × 10(7) (n = 84; group A), >1.0 to <10 × 10(7) (n = 58; group B), and ≥ 10 × 10(7) (n = 66; group C). The initial cell dose was unknown for the remaining 17 patients. Cumulative incidence rates of GVHD at 12 months after DLI were 21%, 45%, and 55% for groups A, B, and C, respectively. Multivariate analysis showed that initial DLI CD3(+) cell ≥ 10 × 10(7) dose per kilogram is associated with an increased risk of GVHD after DLI (P = .03). Moreover, an initial DLI CD3(+) cell dose of 10 × 10(7) or higher did not decrease the risk of relapse and did not improve overall survival. Thus, these results support the use of less than 10 × 10(7) CD3(+) cell per kilogram as the initial cell dose of DLI for treatment of persistent or recurrent hematological malignancy after HCT.
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The role of allogeneic haematopoietic progenitor cell transplantation in patients with diffuse large B-cell non-Hodgkin lymphomas (DLBCL). Bone Marrow Transplant 2013; 48:1271-8. [PMID: 23318539 DOI: 10.1038/bmt.2012.266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 11/04/2012] [Accepted: 11/13/2012] [Indexed: 11/08/2022]
Abstract
Despite the undoubted improvement in the prognosis of patients with diffuse large B-cell lymphomas (DLBCLs) with the addition of rituximab in the front-line treatment, a significant proportion of patients still relapse. Salvage immune-chemotherapy followed by high-dose therapy with autologous haematopoietic cell transplantation (auto-HCT) remains the treatment of choice for such patients, especially in those who demonstrate chemosensitive disease. In recent years, allogeneic haematopoietic cell transplantation (allo-HCT) has increasingly been used for patients who are resistant to salvage treatment or relapse after an auto-HCT. Strategies using reduced intensity conditioning regimens have allowed application of this approach to a broader range of patients. PFS is up to 55% with a risk of relapse up to 80% depending on different studies. In multivariate analysis, several factors have been associated with favourable outcome including chemosensitivity of the disease, younger age and Karnofsky performance status at the time of the transplant being the strongest ones. DLIs have shown to induce durable responses in relapsed or progressed disease; however, its role remains controversial as the results are inferior to the responses seen in other haematological malignancies. More recently, the addition of MoAbs in the non-myeloablative conditioning regimens has shown encouraging results. In conclusion, allo-HCT is a feasible option in selective patients with chemosensitive DBCL, as it reduces the risk of relapse; however, this is achieved at the cost of significant non-relapse mortality.
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Abstract
Abstract
Patients with advanced follicular lymphoma (FL) have numerous treatment options, including observation, radiotherapy, single-agent or combination chemotherapy, mAbs, and radioimmunoconjugates. These therapies can extend progression-free survival but none can provide a cure. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curable therapy for FL, with the field shifting more toward the use of reduced-intensity conditioning regimens because of the lower associated nonrelapse mortality compared with myeloablative regimens. However, GVHD and infection are still problematic in the allo-HSCT population. Autologous HSCT (auto-HSCT) confers high response rates and prolongs progression-free survival in relapsed patients who are chemosensitive, and an increasing amount of data suggest that auto-HSCT may be curative if offered to relapsed patients who are not heavily pretreated. Auto-HSCT has no role as consolidation therapy for patients in first remission based on the results from 3 large randomized trials. Novel conditioning regimens with radioimmunoconjugates have been used in both auto-HSCT and allo-HSCT regimens and results have shown efficacy even in chemorefractory patients. Therefore, with the exception of patients in first remission, the optimal timing for HSCT remains controversial. However, the outcomes seen after auto-HSCT and allo-HSCT continue to improve, and HSCT represents a treatment modality that should be considered in all FL patients, especially while their disease remains chemoresponsive.
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Li HW, Sachs J, Pichardo C, Bronson R, Zhao G, Sykes M. Nonalloreactive T cells prevent donor lymphocyte infusion-induced graft-versus-host disease by controlling microbial stimuli. THE JOURNAL OF IMMUNOLOGY 2012; 189:5572-81. [PMID: 23136200 DOI: 10.4049/jimmunol.1200045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In mice, graft-versus-host reactions, associated with powerful graft-versus-tumor effects, can be achieved without graft-versus-host disease (GVHD) by delayed administration of donor lymphocyte infusions (DLI) to established mixed chimeras. However, GVHD sometimes occurs after DLI in established mixed chimeric patients. In contrast to mice, in which T cell recovery from the thymus occurs prior to DLI administration, human T cell reconstitution following T cell-depleted hematopoietic cell transplantation is slow, resulting in lymphopenia at the time of DLI. We demonstrate in this study that T cell lymphopenia is an independent risk factor for GVHD following DLI in the absence of known inflammatory stimuli. DLI-induced GVHD was prevented in lymphopenic recipients by prior administration of a small number of nonalloreactive polyclonal T cells, insufficient to prevent lymphopenia-associated expansion of subsequently administered T cells, through a regulatory T cell-independent mechanism. GVHD was not inhibited by T cells with irrelevant specificity. Moreover, administration of antibiotics reduced the severity of GVHD in lymphopenic hosts. Accumulation of DLI-derived effector T cells and host hematopoietic cell elimination were markedly diminished by regulatory T cell-depleted, nonalloreactive T cells. Finally, thymectomized mixed chimeras showed increased GVHD following delayed DLI. Collectively, our data demonstrate that in the absence of known conditioning-induced inflammatory stimuli, T cell lymphopenia is a risk factor for GVHD in mixed chimeras receiving delayed DLI. Our data suggest that the predisposition to GVHD can at least in part be explained by the presence of occult inflammatory stimuli due to the absence of T cells to control microbial infections.
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Affiliation(s)
- Hao Wei Li
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02129, USA
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Challenges for the next decade: allogeneic stem cell transplantation in chronic lymphocytic leukemia. Leuk Suppl 2012; 1:S33-4. [PMID: 27175243 DOI: 10.1038/leusup.2012.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Although hematopoietic stem cell transplantation (allogeneic SCT (allo-SCT)) is the treatment of choice for many aggressive hematological malignancies, the role of allo-SCT in chronic lymphocytic leukemia (CLL) is still a matter of debate and can be considered one of the more important challenges for the next decade. In the era of novel drugs and humanized antibodies, the long-term outcome of patients has improved, and a critical reappraisal of autologous and allo-SCT in CLL treatment is warranted.
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50
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Yan CH, Liu DH, Xu LP, Liu KY, Zhao T, Wang Y, Chen H, Chen YH, Han W, Huang XJ. Modified donor lymphocyte infusion-associated acute graft-versus-host disease after haploidentical T-cell-replete hematopoietic stem cell transplantation: incidence and risk factors. Clin Transplant 2012; 26:868-76. [PMID: 22432715 DOI: 10.1111/j.1399-0012.2012.01618.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2012] [Indexed: 01/19/2023]
Affiliation(s)
- Chen-Hua Yan
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
| | - Dai-Hong Liu
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
| | - Lan-Ping Xu
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
| | - Kai-Yan Liu
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
| | - Ting Zhao
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
| | - Yu Wang
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
| | - Huan Chen
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
| | - Yu-Hong Chen
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
| | - Wei Han
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
| | - Xiao-Jun Huang
- Peking University People's Hospital; Peking University Institute of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation; Beijing; China
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