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Luo C, Li X, Yan B, Qin D, Tian X, Wang P, Chen R, Zhang P, Gong Q, Peng X, Li X, Zeng D, Liu X, Wu T, Chen J, Wu X, Xu S. Quadruple stem cells transplantation of haploidentical bone marrow and PBSCs supporting by third-party umbilical cord blood and MSCs achieved excellent outcomes. Ann Hematol 2023; 102:3285-3287. [PMID: 37592091 DOI: 10.1007/s00277-023-05399-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Chengxin Luo
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Xiaohong Li
- Institute of Hematology, The Fifth Medical Center, General Hospital of PLA, Beijing, China
| | - Bei Yan
- Institute of Hematology, The Fifth Medical Center, General Hospital of PLA, Beijing, China
| | - Dabing Qin
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Xiaobo Tian
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Ping Wang
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Run Chen
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Pei Zhang
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Qiang Gong
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Xi Peng
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Xi Li
- Department of Hematology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Dongfeng Zeng
- Department of Hematology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xiaoliang Liu
- Department of Hematology, The First Hospital of Jilin University, Jilin, China
| | - Tao Wu
- Department of Hematology, The 940Th Hospital of Joint Logistics Support Force of PLA, Gansu, China
| | - Jieping Chen
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Xiaoxiong Wu
- Institute of Hematology, The Fifth Medical Center, General Hospital of PLA, Beijing, China.
| | - Shuangnian Xu
- Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China.
- Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China.
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Old age: the crown of life, our play's last act. Question and answers on older patients undergoing allogeneic hematopoietic cell transplantation. Curr Opin Hematol 2023; 30:14-21. [PMID: 36539361 DOI: 10.1097/moh.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Several studies showed that age alone should not be used as an arbitrary parameter to exclude patients from allogeneic hematopoietic cell transplantation (HCT). The accessibility to allogeneic HCT programs for older patients with hematological diseases is growing up constantly. The Center for International Blood and Marrow Transplant Research has recently shown that over 30% of allogeneic HCT recipients are at least 60 years old and that nearly 4% are aged 70 or more. Historically, the use of allogeneic HCT among elderly patients has been limited by age restrictions, reflecting physicians' concerns regarding prohibitive transplant-related mortality and HCT-associated morbidity. RECENT FINDINGS The introduction of reduced intensity/toxicity conditioning regimens has allowed transplant Centers to carry out allogeneic HCT on patients previously considered not ideal candidates. The integration of specific risk scores could lead to better capture mental and physical frailties of older patients. Older adults less frequently have available medically fit siblings, able to donate, so, unrelated donors, familial haploidentical donors or umbilical cord blood grafts could potentially abrogate such a difficulty, allowing the curative potential of allogeneic HCT. SUMMARY The appropriate assessing of allogeneic HCT feasibility for elderly patients should be the resonate application of different clinical and biological principles.
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Shi PA, Luchsinger LL, Greally JM, Delaney CS. Umbilical cord blood: an undervalued and underutilized resource in allogeneic hematopoietic stem cell transplant and novel cell therapy applications. Curr Opin Hematol 2022; 29:317-326. [PMID: 36066376 PMCID: PMC9547826 DOI: 10.1097/moh.0000000000000732] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to primarily discuss the unwarranted decline in the use of umbilical cord blood (UCB) as a source of donor hematopoietic stem cells (HSC) for hematopoietic cell transplantation (HCT) and the resulting important implications in addressing healthcare inequities, and secondly to highlight the incredible potential of UCB and related birthing tissues for the development of a broad range of therapies to treat human disease including but not limited to oncology, neurologic, cardiac, orthopedic and immunologic conditions. RECENT FINDINGS When current best practices are followed, unrelated donor umbilical cord blood transplant (CBT) can provide superior quality of life-related survival compared to other allogeneic HSC donor sources (sibling, matched or mismatched unrelated, and haploidentical) through decreased risks of relapse and chronic graft vs. host disease. Current best practices include improved UCB donor selection criteria with consideration of higher resolution human leukocyte antigen (HLA) typing and CD34+ cell dose, availability of newer myeloablative but reduced toxicity conditioning regimens, and rigorous supportive care in the early posttransplant period with monitoring for known complications, especially related to viral and other infections that may require intervention. Emerging best practice may include the use of ex vivo expanded single-unit CBT rather than double-unit CBT (dCBT) or 'haplo-cord' transplant, and the incorporation of posttransplant cyclophosphamide as with haploidentical transplant and/or incorporation of novel posttransplant therapies to reduce the risk of relapse, such as NK cell adoptive transfer. Novel, non-HCT uses of UCB and birthing tissue include the production of UCB-derived immune effector cell therapies such as unmodified NK cells, chimeric antigen receptor-natural killer cells and immune T-cell populations, the isolation of mesenchymal stem cells for immune modulatory treatments and derivation of induced pluripotent stem cells haplobanks for regenerative medicine development and population studies to facilitate exploration of drug development through functional genomics. SUMMARY The potential of allogeneic UCB for HCT and novel cell-based therapies is undervalued and underutilized. The inventory of high-quality UCB units available from public cord blood banks (CBB) should be expanding rather than contracting in order to address ongoing healthcare inequities and to maintain a valuable source of cellular starting material for cell and gene therapies and regenerative medicine approaches. The expertise in Good Manufacturing Practice-grade manufacturing provided by CBB should be supported to effectively partner with groups developing UCB for novel cell-based therapies.
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Affiliation(s)
- Patricia A. Shi
- Lindsley F. Kimball Research Institute, New York Blood Center, New York City, NY 10065
| | - Larry L. Luchsinger
- Lindsley F. Kimball Research Institute, New York Blood Center, New York City, NY 10065
| | - John M. Greally
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY 10461
| | - Colleen S. Delaney
- Division of Hematology-Oncology, Seattle Children’s Hospital, Seattle WA; and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195
- Deverra Therapeutics, Inc., Seattle, WA 98102
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Zhang D, Chen J. Efficacy of decitabine combined with allogeneic hematopoietic stem cell transplantation in the treatment of recurrent and refractory acute myeloid leukemia (AML): A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30644. [PMID: 36123842 PMCID: PMC9478241 DOI: 10.1097/md.0000000000030644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This analysis aimed to assess the effect of decitabine combined with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treating recurrent and refractory acute myeloid leukemia. METHOD The present analysis was carried out according to the principles of Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline statement. Web of Science, Embase, PubMed, The Cochrane Library, CNKI, VIP, and WanFang Data databases were searched for trials published from their corresponding inception to September 13, 2021. Retrospective research or published randomized controlled trials in Chinese or English were ruled out. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database scale. Mean differences with 95% confidence intervals were used to analyze continuous data. The I2 test was used to determine heterogeneity, and the meta-analysis was conducted using Revman 5.4. RESULTS Eight studies including 795 participants in total were identified. Decitabine and allo-HSCT showed significant reductions in recurrence after transplantation (odds ratio [OR] = 0.29, 95% confidence interval [CI] (0.17, 0.50), P < .00001), leukemia-free survival (OR = 2.17, 95% CI (1.47, 3.21), P < .0001), graft related death (OR = 0.50, 95% CI (0.25, 0.98), P = .04), and significant improvements in complete remission (OR = 0.39, 95% CI = 0.23-0.68, P = .0007) and partial remission (OR = 0.46, 95%CI = 0.27-0.78, P = .004). The median follow-up time, acute graft-versus-host disease, and no remission had no significant difference between treatment and control groups (the median follow-up time: OR = -1.76, 95% CI (-6.28, 2.76), P = .45; acute graft-versus-host disease: OR = 0.72, 95% CI (0.50, 1.03), P = .08; no remission: OR = 3.19, 95%CI = 2.06-4.94, P = .05). Overall, the magnitude of the effect was found to be in the small to moderate range. CONCLUSION Decitabine combined with allo-HSCT can obtain lower recurrence risk and longer disease-free survival time, and improve the prognosis of patients. The safety is relatively stable. Due to the varying quality level of the included studies, the validation of multiple high-quality studies still needs improvement.
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Affiliation(s)
- Donghui Zhang
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jiahui Chen
- Department of Clinical Skills Training Center, Clinical Academic Affairs Office, The First Hospital of Lanzhou University, Lanzhou, China
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5
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Failure to reach hematopoietic allogenic stem cell transplantation in patients with myelodysplastic syndromes planned for transplantation: a population-based study. Bone Marrow Transplant 2022; 57:598-606. [PMID: 35105966 PMCID: PMC8993688 DOI: 10.1038/s41409-022-01582-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/14/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
The only potential cure for patients with myelodysplastic syndrome (MDS) is allogeneic hematopoietic stem cell transplantation (HCT). However, a proportion of patients who are HCT candidates do not finally get transplanted. This population-based study aimed to characterize HCT candidates were attempting to reach HCT fail and to identify causes and risk factors for failure. Data were collected from (1) the national Swedish registry, enrolling 291 transplant candidates between 2009–2018, and (2) Karolinska University Hospital, enrolling 131 transplantation candidates between 2000 and 2018. Twenty-five % (nation-wide) and 22% (Karolinska) failed to reach HCT. Reasons for failure to reach HCT were progressive and refractory disease (47%), no donor identified (22%), identification of comorbidity (18%), and infectious complications (14%). Factors associated with failure to reach HCT were IPSS-R cytogenetic risk-group very poor, mixed MDS/MPN disease, low blast count (0–4.9%), and low hemoglobin levels (≤7.9 g/dL). Transplanted patients had a longer overall survival (OS) compared to patients who failed to reach transplantation (83 months versus 14 months; p < 0.001). The survival advantage was seen for the IPSS-R risk groups intermediate, high, and very high. This study demonstrated that a high proportion of HCT-candidates fail to reach HCT and underlines the difficulties associated with bridging MDS patients to HCT.
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Wang X, Zhang X, Yu U, Wang C, Yang C, Li Y, Li C, Wen F, Li C, Liu S. Co-Transplantation of Haploidentical Stem Cells and a Dose of Unrelated Cord Blood in Pediatric Patients with Thalassemia Major. Cell Transplant 2021; 30:963689721994808. [PMID: 33593080 PMCID: PMC7894585 DOI: 10.1177/0963689721994808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Allogeneic stem cell transplantation is a cure for patients suffering from thalassemia major (TM). Historically, patients were limited by the selection of donors, while the advancement of haploidentical stem cell transplantation (haplo-SCT) has greatly expanded the donor pool. However, the outcomes of haplo-SCT in TM recipients vary between different programs. In this study, we retrospectively studied 73 pediatric TM patients (median age, 7 years; range, 3 to 14 years) who underwent haplo-cord transplantation. Both the estimated overall survival and transfusion-free survival were 95.26% (CI 95.77% to 96.23%). Neither primary nor secondary graft failures were observed. The median follow-up period was 811 days (range, 370 to 1433 days). Median neutrophil and platelet engraftment times were 22 days (range, 8 to 48 days) and 20 days (range, 8 to 99 days), respectively. Acute graft-versus-host disease (aGVHD) was observed in 52% of patients and of these, 25% developed grade III to IV aGVHD. Cord blood engraftment was associated with delayed immune recovery and increased aGVHD severity. Viral DNAemia occurred in a relatively high proportion of patients but only 7% of patients developed CMV disease, while another 7% of patients had post-transplantation lymphoproliferative disorder. Long-term complication outcomes were good. Only one patient developed extensive chronic GVHD. No surviving patients were reliant on blood transfusion by the time this manuscript was submitted. This is one of the largest studies on the outcomes of pediatric TM patients who received stem cell transplantations from alternative donors. The haplo-cord program is safe and practical for TM patients that do not have matched donors.
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Affiliation(s)
- Xiaodong Wang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaoling Zhang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Uet Yu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Chunjing Wang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Chunlan Yang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yue Li
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Changgang Li
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Feiqiu Wen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Chunfu Li
- Nanfang-Chunfu Children's Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China.,Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sixi Liu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
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7
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Gao L, Zhang Y, Wang S, Kong P, Su Y, Hu J, Jiang M, Bai H, Lang T, Wang J, Liu L, Yang T, Huang X, Liu F, Lou S, Liu Y, Zhang C, Liu H, Gao L, Liu J, Zhu L, Wen Q, Chen T, Wang P, Rao J, Mao M, Wang C, Duan X, Luo L, Peng X, Cassady K, Zhong JF, Zhang X. Effect of rhG-CSF Combined With Decitabine Prophylaxis on Relapse of Patients With High-Risk MRD-Negative AML After HSCT: An Open-Label, Multicenter, Randomized Controlled Trial. J Clin Oncol 2020; 38:4249-4259. [PMID: 33108244 PMCID: PMC7768335 DOI: 10.1200/jco.19.03277] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Relapse is a major cause of treatment failure after allogeneic hematopoietic stem-cell transplantation (allo-HSCT) for high-risk acute myeloid leukemia (HR-AML). The aim of this study was to explore the effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) combined with minimal-dose decitabine (Dec) on the prevention of HR-AML relapse after allo-HSCT.
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Affiliation(s)
- Lei Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yanqi Zhang
- Department of Health Statistics, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Sanbin Wang
- Department of Hematology, General Hospital of Kunming Military Region of the People's Liberation Army (PLA), Kunming, China
| | - Peiyan Kong
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yi Su
- Department of Hematology, General Hospital of Chengdu Military Region of the PLA, Chengdu, China
| | - Jiong Hu
- Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Jiang
- Department of Hematology, the Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hai Bai
- Department of Hematology, General Hospital of Lanzhou Military Region of the PLA, Lanzhou, China
| | - Tao Lang
- Department of Hematology, Xinjiang Provincial People's Hospital, Urumqi, China
| | - Jishi Wang
- Department of Hematology, Affiliated Hospital of Guiyang Medical University, Guiyang, China
| | - Li Liu
- Department of Hematology, Tangdu Hospital, Forth Military Medical University (Air Force Medical University), Xi'an, China
| | - Tonghua Yang
- Department of Hematology, Yunnan Provincial People's Hospital, Kunming, China
| | - Xiaobing Huang
- Department of Hematology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Fang Liu
- Department of Hematology, General Hospital of Chengdu Military Region of the PLA, Chengdu, China
| | - Shifeng Lou
- Department of Hematology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Cheng Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hong Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jia Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lidan Zhu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Qin Wen
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ting Chen
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ping Wang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jun Rao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Min Mao
- Department of Hematology, Xinjiang Provincial People's Hospital, Urumqi, China
| | - Cunbang Wang
- Department of Hematology, General Hospital of Lanzhou Military Region of the PLA, Lanzhou, China
| | - Xianlin Duan
- Department of Hematology, the Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Le Luo
- Department of Hematology, General Hospital of Kunming Military Region of the People's Liberation Army (PLA), Kunming, China
| | - Xiangui Peng
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Kaniel Cassady
- Departments of Diabetes Immunology and Hematology/Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope, Duarte, CA
| | - Jiang F Zhong
- Department of Otolaryngology, Keck School of Medicine, University of Southern California, CA
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
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Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults. Blood Adv 2020; 3:3488-3498. [PMID: 31725894 DOI: 10.1182/bloodadvances.2019000790] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
Limitations found on geriatric assessment (GA) track with worse outcomes after hematopoietic cell transplantation (HCT). We report on a multidisciplinary team clinic (MDC), consisting of a cancer-specific GA and a multidisciplinary team of providers, to assess candidacy and create an individualized optimization plan for allogeneic HCT candidates aged ≥60 years and autologous HCT and adoptive T-cell therapy candidates aged ≥70 years. Among the 247 patients evaluated in the MDC, allogeneic HCT candidates comprised the majority (60%), followed by autologous HCT (37%) with occasional older cellular therapy candidates (3%). Almost all patients meeting program-required minimum ages for MDC optimization at our institution were assessed (98%). Relative to historical control subjects undergoing GA alone, allogeneic HCT patients aged ≥60 years who underwent MDC appraisal had similar frequencies of high-risk disease, reduced intensity regimens, and high comorbidity but fewer GA-graded functional impairments. The MDC cohort experienced fewer inpatient deaths, shorter length of stay, and fewer discharges to nursing facilities compared with control subjects. Improvements in early mortality were observed over time; 1-year overall survival improved from 43% in the pre-MDC era to 70% in the recent MDC era, and 1-year nonrelapse mortality decreased from 43% to 18%. The 31 autologous HCT recipients aged ≥70 years optimized by the MDC achieved 0% nonrelapse mortality and 97% overall survival at 1 year. A GA-guided MDC for older HCT candidates is feasible and seems to reduce transplant-associated morbidity and mortality. An MDC should encourage broader and safer utilization of transplantation in older patients.
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9
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Xu X, Yang J, Cai Y, Li S, Niu J, Zhou K, Jiang Y, Xu X, Shen C, Huang C, Qiu H, Wei D, Kang M, Tong Y, Wei Z, Liu P, Wan L, Song X. Low dose anti-thymocyte globulin with low dose posttransplant cyclophosphamide (low dose ATG/PTCy) can reduce the risk of graft-versus-host disease as compared with standard-dose anti-thymocyte globulin in haploidentical peripheral hematopoietic stem cell transplantation combined with unrelated cord blood. Bone Marrow Transplant 2020; 56:705-708. [PMID: 32873913 PMCID: PMC7943423 DOI: 10.1038/s41409-020-01047-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 08/07/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Xiaoqian Xu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Jun Yang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Yu Cai
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Su Li
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Jiahua Niu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Kun Zhou
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Ying Jiang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Xiaowei Xu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Chang Shen
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Chongmei Huang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Huiying Qiu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Daolin Wei
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Mei Kang
- Clinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yin Tong
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China
| | - Zheng Wei
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liping Wan
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China.
| | - Xianmin Song
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100 Haining Road, 200080, Shanghai, China.
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10
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Orfali N, van Besien K. Combining haplo-identical and cord blood stem cell grafts - might the whole be greater than the sum of its parts? Leuk Lymphoma 2020; 61:753-756. [PMID: 32048529 DOI: 10.1080/10428194.2020.1725509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nina Orfali
- Department of Bone Marrow Transplantation, Weill Cornell Medicine, New York, NY, USA
| | - Koen van Besien
- Department of Bone Marrow Transplantation, Weill Cornell Medicine, New York, NY, USA
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11
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Hsu J, Chen Z, Shore T, Gergis U, Mayer S, Phillips A, Guarner D, Hsu YM, Cushing MM, Van Besien K. Outcomes of Allogeneic Stem Cell Transplant for Elderly Patients with Hematologic Malignancies. Biol Blood Marrow Transplant 2019; 26:789-797. [PMID: 31891814 DOI: 10.1016/j.bbmt.2019.12.766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/03/2019] [Accepted: 12/26/2019] [Indexed: 12/23/2022]
Abstract
Reduced-intensity conditioning (RIC) regimens, improved HLA matching, and better supportive care allow allogeneic stem cell transplant (alloSCT) to be offered to older patients. Only a small percentage of eligible patients between ages 65 and 74 years actually undergo alloSCT, and comprehensive outcome data from the aging population are still lacking. We examined the outcome of older patients who underwent alloSCT using melphalan-based RIC for hematologic malignancies at our institution. We identified 125 patients older than 65 years (median, 69; range, 66 to 77) who underwent matched related donor, matched unrelated donor, or combined haploidentical/umbilical cord alloSCT between 2012 through November, 2017. Among them, 52 (41.6%) and 70 (56%) had, respectively, intermediate and high/very high Center for International Blood and Marrow Transplant Research (CIBMTR) disease risk index (DRI). One hundred six patients (85%) received fludarabine/melphalan-based RIC regimen with either antithymocyte globulin (ATG) or alemtuzumab. The median time to neutrophil engraftment was 13 days (range, 8 to 37) and platelet engraftment 17 days (range, 9 to 169). The cumulative incidence of nonrelapse mortality was 11.5% at 100 days and 30.1% and 34.8% at 1 and 2 years, respectively. The cumulative incidence of relapse was 35% and 40% at 1 and 2 years. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) at day 100 and 6 months was 29.5% and 34.5%, and chronic GVHD at 6, 12, and 24 months was 2.5%, 5.2%, and 6.3%, respectively. With a median follow-up of 32 months, the 1-, 2-, and 3-year progression-free survival (PFS) was 34.6%, 24.4%, and 16.5%, respectively. The graft GVHD-free survival was 24.6%, 16.1%, and 9.3%, respectively. The 1-, 2-, and 3-year overall survival (OS) was 44.5%, 30.7%, and 26.5%, respectively. In multivariable analysis, low albumin was predictive of poor PFS and OS and high hematopoietic cell transplantation-specific comorbidity index, and CIBMTR DRI was predictive of worse graft GVHD-free survival. Among long-term survivors the median Karnofsky performance status was 80. Older patients, even when referred with advanced disease, can benefit from melphalan-based alloSCT with HLA-matched or alternative donor sources without discernible impact of donor source on outcome. Using alemtuzumab- or ATG-based in vivo T cell depletion, the incidence of chronic GVHD is extremely low. Performance status in survivors is excellent. Better predictors for outcome in this patient population need to be identified.
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Affiliation(s)
- Jingmei Hsu
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York.
| | - Zhengming Chen
- Biostatistics and Epidemiology, Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Tsiporah Shore
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
| | - Usama Gergis
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
| | - Sebastian Mayer
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
| | - Adrienne Phillips
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
| | - Danielle Guarner
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
| | - Yen-Michael Hsu
- Department of Pathology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
| | - Melissa M Cushing
- Department of Pathology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
| | - Koen Van Besien
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
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12
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Lyu H, Lu W, Yao J, Xiao X, Li Q, Wang J, Mu J, Qi Y, Zhu H, Jiang Y, Li X, Meng J, Yuan T, He X, Jiang E, Han M, Zhao M. Comparison of outcomes of haploidentical donor hematopoietic stem cell transplantation supported by third-party cord blood with HLA-matched unrelated donor transplantation. Leuk Lymphoma 2019; 61:840-847. [PMID: 31777304 DOI: 10.1080/10428194.2019.1695053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Previous study indicated that co-infusion of cord blood cells may potentially improve the outcome of haploidentical donor (HID) transplantation. In this study, we analyzed the outcomes of patients who underwent HID transplantation supported by cord blood when compared with HLA-matched unrelated donor (URD) transplantation. Starting in 2015, 40 patients with hematopoietic malignancies underwent HID transplantation and 26 patients underwent URD transplantation. Hematopoietic recovery, the incidences of grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD was comparable in the two groups. At two year, the relapse risk in HID group was significantly lower than in URD group (RR 4.630; 95%CI, 1.081-19.839; p = .039). Moreover, HID group have prolonged PFS (RR 2.642; 95%CI, 1.046-6.672; p = .040). In conclusion, HID transplantation supported by cord blood results in better outcomes compared with URD transplantation and it might be a favorable alternative to a HLA-matched URD transplantation.
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Affiliation(s)
- Hairong Lyu
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Wenyi Lu
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Jianfeng Yao
- Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Tianjin, PR China
| | - Xia Xiao
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Qing Li
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Jia Wang
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Juan Mu
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Yao Qi
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Haibo Zhu
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Yili Jiang
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Xin Li
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Juanxia Meng
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Ting Yuan
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Xiaoyuan He
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
| | - Erlie Jiang
- Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Tianjin, PR China
| | - Mingzhe Han
- Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Tianjin, PR China
| | - Mingfeng Zhao
- Department of Hematology, Tianjin First Center Hospital, Tianjin, PR China
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13
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Ustun C, Le-Rademacher J, Wang HL, Othus M, Sun Z, Major B, Zhang MJ, Storrick E, Lafky JM, Chow S, Mrózek K, Attar EC, Nand S, Bloomfield CD, Cripe LD, Tallman MS, Appelbaum F, Larson RA, Marcucci G, Roboz GJ, Uy GL, Stone RM, Jatoi A, Shea TC, de Lima M, Foran JM, Sandmaier BM, Litzow MR, Erba HP, Hurria A, Weisdorf DJ, Artz AS. Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60-75 years in first complete remission (CR1): an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study. Leukemia 2019; 33:2599-2609. [PMID: 31073153 PMCID: PMC6842042 DOI: 10.1038/s41375-019-0477-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 01/21/2023]
Abstract
The preferred post-remission therapy for older patients with acute myeloid leukemia (AML) in first complete remission (CR1) remains uncertain. In this retrospective, multicenter study, we compared the outcomes for older AML patients (age 60-77 years) receiving allogeneic hematopoietic cell transplantation (alloHCT) (n = 431) with those treated on prospective National Clinical Trials Network induction and nontransplantation chemotherapy (CT) consolidation trials (n = 211). AlloHCT patients were younger (median age: 64.2 versus 67.9 years, p < 0.001), but more frequently had high-risk AML (high WBC, secondary AML, and unfavorable cytogenetics). Overall survival (OS) was worse in alloHCT during the first 9 months after CR1 (HR = 1.52, p = 0.02), but was significantly better thereafter (HR = 0.53, p < 0.0001) relative to CT. Treatment-related mortality (TRM) following HCT was worse in the first 9 months (HR = 2.8, 95% CI: 1.5-5.2, p = 0.0009), while post-HCT relapse was significantly less frequent beyond 9 months (HR = 0.42, 95% CI: 0.29-0.61, p < 0.0001). Despite higher early TRM, alloHCT recipients had superior long-term OS [29% (24-34%) versus CT 13.8% (9-21%) at 5 years]. Although this is a retrospective analysis with potential biases, it indicates that alloHCT led to heightened early risks from TRM, yet reduced relapse and superior long-term survival relative to CT in older AML patients in CR1.
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Affiliation(s)
- Celalettin Ustun
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
- Division of Hematology, Oncology and Cellular Therapy, Rush University, Chicago, IL, USA.
| | | | - Hai-Lin Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Zhuoxin Sun
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brittny Major
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mei-Jie Zhang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Selina Chow
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Eyal C Attar
- Massachusetts General Hospital, Boston, MA, USA
- Agios Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Such Nand
- Loyola University Medical Center, Chicago, IL, USA
| | - Clara D Bloomfield
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Larry D Cripe
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | | | - Frederick Appelbaum
- Fred Hutchinson Cancer Research Center and Division of Oncology, University of Washington, Seattle, WA, USA
| | - Richard A Larson
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Guido Marcucci
- Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, Hematologic Malignancies and Stem Cell Transplantation Institute, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Gail J Roboz
- Weill-Cornell Medical College, New York, NY, USA
| | - Geoffrey L Uy
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | | | - Thomas C Shea
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marcos de Lima
- Adult Hematologic Malignancies & Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - James M Foran
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Brenda M Sandmaier
- Fred Hutchinson Cancer Research Center and Division of Oncology, University of Washington, Seattle, WA, USA
| | - Mark R Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Daniel J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew S Artz
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
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14
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Wu X, Liu Q. Prophylaxis and treatment of relapse after haploidentical stem cell transplantation: What is known vs unknown? Semin Hematol 2019; 56:209-214. [PMID: 31202432 DOI: 10.1053/j.seminhematol.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 04/10/2019] [Indexed: 11/11/2022]
Abstract
In recent years, the human leukocyte antigen-haploidentical stem cell transplantation (haplo-SCT) approach is an attractive option for patients who require transplantation, but relapse is still the main reason that affects the curative effect of transplantation. Some studies have shown that haplo-SCT is superior to sibling or unrelated matching donor transplantation in preventing leukemia relapse after transplantation. In this review, we discussed the known and unknown aspects of relapse post haplo-SCT. Encouragingly, haplo-SCT experienced lower or similar incidence of relapse. But there is currently a lack of multicenter prospective studies evaluating the outcomes of different haplo-SCT strategies. The combination of common prophylactic strategies and pre-emptive interventions might help prevent relapse after transplantation. Novel methods such as target drugs therapy and chimeric antigen receptor T cell therapy may be useful in treatment of relapse.
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Affiliation(s)
- Xiuli Wu
- Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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15
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Low-dose anti-thymocyte globulin plus low-dose posttransplant cyclophosphamide as graft-versus-host disease prophylaxis in haploidentical peripheral blood stem cell transplantation combined with unrelated cord blood for patients with hematologic malignancies: a prospective, phase II study. Bone Marrow Transplant 2018; 54:1049-1057. [PMID: 30446741 PMCID: PMC6760546 DOI: 10.1038/s41409-018-0382-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/12/2018] [Accepted: 10/09/2018] [Indexed: 12/18/2022]
Abstract
Nowadays, the most wildly used regimens for graft-versus-host disease (GvHD) prophylaxis in haplo-hematopoietic stem cell transplantation (Haplo-HSCT) are based on in vivo T-cell depletion (TCD) with anti-thymocyte globulin (ATG) or posttransplant cyclophosphamide (PTCy). To improve the efficiency of GvHD prophylaxis in haploidentical peripheral blood stem cell transplantation combined with unrelated cord blood (Haplo-PBSCT-Cord), a novel regimen, which is composed of low dose of ATG (5 mg/kg) and low-dose PTCy (50 mg/kg) for GvHD prophylaxis, was evaluated in a prospective phase II clinical trial (Clinicaltrials.org NCT03395860). Thirty-two patients diagnosed with hematological malignancies were enrolled in this trial. All patients received myeloablative conditioning regimens except for three patients. The cumulative incidences (CIs) of grades II-IV and III-IV acute GvHD were 19.4% (95% CI, 5.5−33.3%) and 6.9% (95% CI, 0−16.3%) by day 100, respectively. The 1-year probability of relapse, disease free survival (DFS) and overall survival (OS) was 25.1% (95% CI, 7.3−42.9%), 59% (95% CI, 33.3−84.7%) and 78.4% (95% CI, 63−93.8%), respectively. The CIs of CMV and EBV reactivation by day 180 were 37.5% (95% CI, 19.8−55.2%) and 40.6% (95% CI, 22.6−58.6%), respectively. The results suggested that low-dose ATG with low-dose PTCy as GvHD prophylaxis in Haplo-PBSCT-Cord had promising activity.
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16
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Gergis U, Frenet EM, Shore T, Mayer S, Phillips A, Hsu JM, Roboz G, Ritchie E, Scandura J, Lee S, Desai P, Samuel M, Ball J, Blanco A, Romeo C, Albano MS, Dobrila L, Scaradavou A, van Besien K. Adoptive Immunotherapy with Cord Blood for the Treatment of Refractory Acute Myelogenous Leukemia: Feasibility, Safety, and Preliminary Outcomes. Biol Blood Marrow Transplant 2018; 25:466-473. [PMID: 30414955 DOI: 10.1016/j.bbmt.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/01/2018] [Indexed: 12/26/2022]
Abstract
Adoptive immunotherapy has shown efficacy in patients with relapsed/refractory acute myelogenous leukemia (AML). We conducted a prospective evaluation of cord blood (CB)-based adoptive cell therapy following salvage chemotherapy in patients with AML or myelodysplastic syndrome (MDS) and describe the safety and early outcomes of this approach. To enhance the antileukemic effect, we selected CB units (CBUs) with a shared inherited paternal antigen (IPA) and/or noninherited maternal antigen (NIMA) match with the recipients. Furthermore, the CBUs had total nucleated cell (TNC) dose <2.5 × 107/kg and were at least 4/6 HLA-matched with the patients; a higher allele-level match was preferred. Heavily pretreated adult patients with AML/MDS were enrolled. CBU searches were performed for 50 patients. CBUs with shared IPA targets were identified for all, and CBUs with NIMA matches were found for 80%. Twenty-one patients underwent treatment (AML, primary induction failure, n = 8; refractory relapse, n = 10, including 7 recipients of previous allogeneic HSCT; blast crisis chronic myelogenous leukemia, n = 1; MDS, n = 2). Most received combination chemotherapy; those not fit for intensive treatment received a hypomethylating agent. Response was defined as <10% residual blasts in hypocellular bone marrow at approximately 2 weeks after treatment. Ten of the 19 evaluable patients responded, including 5 of the 7 recipients of previous transplant. Response was seen in 4 of 4 patients with full CBU-derived chimerism, 2 of 2 of those with partial, low-level chimerism and 4 of 12 of the recipients with no detectable CBU chimerism. The most common adverse events were infections (bacterial, n = 5; viral, n = 2; fungal, n = 5). Grade IV acute graft-versus-host disease (GVHD) developed in 2 patients with full CBU chimerism; 2 other patients had grade 1 skin GVHD. A total of 11 patients died, 7 from disease recurrence and 4 from infections (1 early death; the other 3 in remission at the time of death). Overall, 12 patients proceeded to allogeneic HSCT; of those, 7 had responded to treatment, 3 had not (and had received additional therapy), and 2 had persistent minimal residual disease. In conclusion, the use of CB as adoptive immunotherapy in combination with salvage chemotherapy for patients with refractory AML/MDS is feasible, can induce disease control, can serve as a bridge to allogeneic HSCT, and has an acceptable incidence of adverse events. Alloreactivity was enhanced through the selection of CBUs targeting a shared IPA and/or NIMA match with the patients. CBUs with lower cell doses, already available in the CB bank and unlikely to be adequate grafts for adult transplants, can be used for cell therapy within a short time frame.
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Affiliation(s)
- Usama Gergis
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | | | - Tsiporah Shore
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Sebastian Mayer
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Adrienne Phillips
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Jing-Mei Hsu
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Gail Roboz
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Ellen Ritchie
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Joseph Scandura
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Sangmin Lee
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Pinkal Desai
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Michael Samuel
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Jeffrey Ball
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Anthony Blanco
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Cynthia Romeo
- National Cord Blood Program, New York Blood Center, New York, NY
| | - Maria S Albano
- National Cord Blood Program, New York Blood Center, New York, NY
| | - Ludy Dobrila
- National Cord Blood Program, New York Blood Center, New York, NY
| | | | - Koen van Besien
- Division of Hematology/Oncology, Department of Medicine. Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY.
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17
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Estey EH. Acute myeloid leukemia: 2019 update on risk-stratification and management. Am J Hematol 2018; 93:1267-1291. [PMID: 30328165 DOI: 10.1002/ajh.25214] [Citation(s) in RCA: 240] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 06/26/2018] [Accepted: 07/10/2018] [Indexed: 12/14/2022]
Abstract
Outcome in patients with acute myeloid leukemia (AML) ranges from death within a few days of beginning treatment (treatment related mortality, TRM) to likely cure. The major reason patients are not cured is resistance to treatment, often manifested as relapse from remission, rather than, even in older patients, TRM, whose incidence is decreasing. Knowledge of the pre-treatment mutation status of various genes has improved our ability to assign initial treatment and, of particular importance, knowledge of whether patients ostensibly in remission have measurable residual disease should influence subsequent management. Several new drugs have been approved by the FDA and we discuss their role in treatment.
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Affiliation(s)
- Elihu H. Estey
- Division of Hematology, Clinical Research Division; Fred Hutchinson Cancer Research Center, University of Washington and Member; Seattle Washington
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