1
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Nagler A, Labopin M, Kröger N, Schroeder T, Gedde-Dahl T, Eder M, Franke GN, Blau IW, Salmenniemi U, Socie G, Schetelig J, Stelljes M, Ciceri F, Mohty M. The role of anti-thymocyte globulin in allogeneic stem cell transplantation (HSCT) from HLA-matched unrelated donors (MUD) for secondary AML in remission: a study from the ALWP /EBMT. Bone Marrow Transplant 2023; 58:1339-1347. [PMID: 37660157 DOI: 10.1038/s41409-023-02095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Abstract
We compared outcomes, of 1609 patients with secondary acute myeloid leukemia (sAML) undergoing allogeneic transplantation (HSCT) in first complete remission (CR1) from matched unrelated donors (MUD) from 2010 to 2021, receiving or not receiving anti-thymocyte globulin (ATG) (ATG-1308, no ATG-301). Median age was 60.9 (range, 18.5-77.8) and 61.1 (range, 21.8-75.7) years, (p = 0.3). Graft versus host disease (GVHD) prophylaxis was cyclosporin-A with methotrexate (41%) or mycophenolate mofetil (38.2%), without significant differences between groups. Day 28, engraftment (ANC > 0.5 × 109/L) was 92.3% vs 95.3% (p = 0.17), respectively. On multivariate analysis, ATG was associated with lower incidence of grade II-IV and grade III-IV acute GVHD (p = 0.002 and p = 0.015), total and extensive chronic GVHD (p = 0.008 and p < 0.0001), and relapse incidence (RI) (p = 0.039), while non-relapse mortality (NRM) did not differ (p = 0.51). Overall survival (OS), and GVHD-free, relapse-free survival (GRFS) were significantly higher in the ATG vs no ATG group, HR = 0.76 (95% CI 0.61-0.95, p = 0.014) and HR = 0.68 (95% CI 0.57-0.8, p < 0.0001), with a tendency for better leukemia-free survival (LFS), HR = 0.82 (95% CI 0.67-1, p = 0.051). The main causes of death were the original disease, infection, and GVHD. In conclusion, ATG reduces GVHD and improves LFS, OS, and GRFS in sAML patients without increasing the RI, despite sAML being a high-risk disease.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Myriam Labopin
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital, Sorbonne University, INSERM UMR 938, Paris, France
- Sorbonne University, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Paris, France
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany
| | - Thomas Schroeder
- University Hospital, Department of Bone Marrow Transplantation, Essen, Germany
| | - Tobias Gedde-Dahl
- Oslo University Hospital, Rikshospitalet Clinic for Cancer Medicine, Hematology Department, Section for Stem Cell Transplantation, Oslo, Norway
| | - Matthias Eder
- Hannover Medical School, Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | - Georg-Nikolaus Franke
- Medical Clinic and Policinic 1, Hematology and Cellular Therapy University hospital Leipzig, Leipzig, Germany
| | - Igor Wolfgang Blau
- Charité, University medicine Berlin, Department of Hematology, BMT Unit, Berlin, Germany
| | - Urpu Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Gerard Socie
- Hopital St. Louis, Department of Hematology-BMT, Paris, France
| | - Johannes Schetelig
- Universitaetsklinikum Dresden Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Matthias Stelljes
- University of Muenster Department of Hematol. /Oncol., Muenster, Germany
| | - Fabio Ciceri
- Hematology & Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital, Sorbonne University, INSERM UMR 938, Paris, France
- Sorbonne University, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Paris, France
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2
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Araie H, Arai Y, Kida M, Aoki J, Uchida N, Doki N, Fukuda T, Tanaka M, Ozawa Y, Sawa M, Katayama Y, Matsuo Y, Onizuka M, Kanda Y, Kawakita T, Kanda J, Atsuta Y, Yanada M. Poor outcome of allogeneic transplantation for therapy-related acute myeloid leukemia induced by prior chemoradiotherapy. Ann Hematol 2023; 102:2879-2893. [PMID: 37477669 PMCID: PMC10492731 DOI: 10.1007/s00277-023-05356-6] [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: 02/02/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
Therapy-related acute myeloid leukemia (t-AML) is a therapeutic challenge as a late complication of chemotherapy (CHT) and/or radiotherapy (RT) for primary malignancy. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) presents itself as a curative approach. To establish the optimal allo-HSCT strategy for t-AML, we evaluated the relationship between characteristics of primary malignancy and allo-HSCT outcomes. Patients with t-AML or de novo acute myeloid leukemia (AML) who underwent first allo-HSCT in Japan from 2011 to 2018 were identified using a nationwide database. The detailed background of t-AML was obtained by additional questionnaires. Multivariate analysis and propensity score matching (PSM) analysis were performed to detect the prognostic factors associated with t-AML and compare outcomes with de novo AML. We analyzed 285 t-AML and 6761 de novo AML patients. In patients with t-AML, receiving both CHT and RT for primary malignancy was an independent poor-risk factor for relapse and overall survival (OS) (hazard ratio (HR) 1.62; p = 0.029 and HR 1.65; p = 0.009, reference: CHT alone group), whereas other primary malignancy-related factors had no effect on the outcome. Compared to the CHT alone group, complex karyotypes were significantly increased in the CHT + RT group (86.1% vs. 57.5%, p = 0.007). In the PSM cohort, t-AML patients with prior CHT and RT had significantly worse 3-year OS than those with de novo AML (25.2% and 42.7%; p = 0.009). Our results suggest that prior CHT and RT for primary malignancy may be associated with increased relapse and worse OS of allo-HSCT in t-AML.
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Affiliation(s)
- Hiroaki Araie
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiko Kida
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Jun Aoki
- 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
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Yayoi Matsuo
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Makoto Onizuka
- Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masamitsu Yanada
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
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3
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Nagler A, Labopin M, Blaise D, Raiola AM, Corral LL, Bramanti S, Sica S, Kwon M, Koc Y, Pavlu J, Kulagin A, Busca A, Rodríguez AB, Reményi P, Schmid C, Brissot E, Sanz J, Bazarbachi A, Giebel S, Ciceri F, Mohty M. Non-T-depleted haploidentical transplantation with post-transplant cyclophosphamide in patients with secondary versus de novo AML in first complete remission: a study from the ALWP/EBMT. J Hematol Oncol 2023; 16:58. [PMID: 37248463 PMCID: PMC10226209 DOI: 10.1186/s13045-023-01450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
We compared outcomes of adult patients with secondary acute myeloid leukemia (sAML) versus de novo AML after non-T-depleted haploidentical stem cell transplant (HaploSCT) with post-transplant cyclophosphamide (PTCy). Seventeen hundred and eleven AML patients (sAML-231, de novo-1480) in first complete remission transplanted from 2010 to 2021, were included. Patients with de novo AML were younger, median age 55.8 versus 60.8 years, p < 0.0001, had better transplantation comorbidity index (HCT-CI) ≥ 3 21.3% versus 40.8%, p < 0.0001 and Karnofsky performance status (KPS) with KPS ≥ 90 in 78% versus 68.5%, respectively, p = 0.002. The two patient groups did not differ with respect to gender, cytomegalovirus serostatus, and cell source. Median time from diagnosis to HaploSCT was 5.2 versus 4.9 months, respectively, p = 0.005. Fewer sAML patients received myeloablative conditioning 35.1% versus 50.1%, p < 0.0001. Two hundred and eleven sAML and 410 de novo AML patients were included in the matched-pair analysis matching two de novo AML with each sAML. No significant difference was observed in any transplantation outcome parameter between the sAML versus de novo AML groups. Two-year non-relapse mortality and relapse incidence did not differ with HaploSCT for de novo versus sAML; 21.4% versus 21%, hazard ratio (HR) = 0.98, p = 0.9 and 23.4% versus 20.6%, HR = 0.92, p = 0.67, respectively. Two-year leukemia-free survival, overall survival, and graft-versus-host disease (GVHD)-free, relapse-free survival were also not different between the de novo AML and sAML groups 55.2% versus 58.4%, HR = 0.95, p = 0.67; 61.4% versus 66.4%, HR = 0.91, p = 0.51 and 46.3% versus 48.2%, HR = 0.92, p = 0.48, respectively. Similarly, the incidence of engraftment as well as acute and chronic GVHD was similar between the 2 cohorts. In conclusion, HaploSCT with PTCy may be able to overcome the bad prognosis of sAML as results are not significantly different to those of HaploSCT in de novo AML.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Stefania Bramanti
- Transplantation Unit Department of Oncology and Haematology, Istituto Clinico Humanitas, Milan, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mi Kwon
- Hematology Hospital GU Gregorio Marañon, Instituto de Investigacion Sanitaria Gregorio Marañon, Medicina UCM, Madrid, Spain
| | - Yener Koc
- Bone Marrow Transplant Unit, Medicana International Hospital Istanbul, Istanbuls, Turkey
| | - Jiri Pavlu
- Department of Haematology, Hammersmith Hospital, Imperial College, London, UK
| | - Alexander Kulagin
- Raisa Gorbacheva Memorial, Research Institute for Paediatric Oncology, Hematology, and Transplantation, First State Pavlov Medical University of St. Petersburg, St. Petersburg, Russia
| | - Alessandro Busca
- SSD Trapianto di Cellule Staminali, AOU Citta' Della Salute e della Scienza, Turin, Italy
| | | | - Péter Reményi
- Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Department Hematology and Stem Cell Transplant, Budapest, Hungary
| | - Christoph Schmid
- Department of Hematology and Oncology, Augsburg University Hospital, Augsburg, Germany
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Sorbonne University, and INSERM UMRs 938, Paris, France
| | - Jaime Sanz
- Hematology Department, Hospital Universitari Politècnic La Fe, Valencia, Spain
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Fabio Ciceri
- Ospedale San Raffaele, Haematology and BMT, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
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4
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DeFilipp Z, Ciurea SO, Cutler C, Robin M, Warlick ED, Nakamura R, Brunner AM, Dholaria B, Walker AR, Kröger N, Bejanyan N, Atallah E, Tamari R, Solh MM, Percival ME, de Lima M, Scott B, Oran B, Garcia-Manero G, Hamadani M, Carpenter P, DeZern AE. Hematopoietic Cell Transplantation in the Management of Myelodysplastic Syndrome: An Evidence-Based Review from the American Society for Transplantation and Cellular Therapy Committee on Practice Guidelines. Transplant Cell Ther 2023; 29:71-81. [PMID: 36436780 DOI: 10.1016/j.jtct.2022.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
The sole curative therapy for myelodysplastic syndrome (MDS) is allogeneic hematopoietic cell transplantation (HCT). Here this therapeutic modality is reviewed and critically evaluated in the context of the evidence. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the recommendations. A panel of MDS experts comprising transplantation and nontransplantation physicians developed consensus treatment recommendations. This review summarizes the standard MDS indications for HCT and addresses areas of controversy. Recent prospective trials have confirmed that allogeneic HCT confers survival benefits in patients with advanced or high-risk MDS compared with nontransplantation approaches, and the use of HCT is increasing in older patients with good performance status. However, patients with high-risk cytogenetic or molecular mutations remain at high risk for relapse. It is unknown whether administration of novel therapies before or after transplantation may decrease the risk of disease relapse in selected populations. Ongoing and future studies will investigate revised approaches to disease risk stratification, patient selection, and post-transplantation approaches to optimize allogeneic HCT outcomes for patients with MDS.
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Affiliation(s)
- Zachariah DeFilipp
- Hematopoieitic Cell Transplant and Cell Therapy Program, Massachusetts General Hospital, Boston, Massachusetts.
| | - Stefan O Ciurea
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, California
| | - Corey Cutler
- Division of Stem Cell Transplantation and Cellular Therapy, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Marie Robin
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, APHP, Université de Paris-Cité, Paris, France
| | - Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Andrew M Brunner
- Center for Leukemia, Massachusetts General Hospital, Boston, Massachusetts
| | - Bhagirathbhai Dholaria
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alison R Walker
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplant Centre, Hamburg, Germany
| | - Nelli Bejanyan
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Ehab Atallah
- Division of Hematology and Oncology, Medical College of Wisconsin, Cancer Center-Froedtert Hospital, Milwaukee, Wisconsin
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melhem M Solh
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Mary-Elizabeth Percival
- Fred Hutchinson Cancer Research Center, Clinical Research Division and University of Washington, Seattle, Washington
| | - Marcos de Lima
- The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | - Bart Scott
- Fred Hutchinson Cancer Research Center, Clinical Research Division and University of Washington, Seattle, Washington
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Mehdi Hamadani
- Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul Carpenter
- Fred Hutchinson Cancer Research Center, Clinical Research Division and University of Washington, Seattle, Washington
| | - Amy E DeZern
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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5
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Association between Prior Cytotoxic Therapy, Antecedent Hematologic Disorder, and Outcome after Allogeneic Hematopoietic Cell Transplantation in Adult Acute Myeloid Leukemia. Cancers (Basel) 2023; 15:cancers15020352. [PMID: 36672303 PMCID: PMC9856876 DOI: 10.3390/cancers15020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
(1) Background: Secondary acute myeloid leukemia (AML), i.e., AML arising from prior therapy (therapy-related) and/or an antecedent hematologic disorder (AHD) is generally associated with worse outcomes compared to de novo AML. However, recognizing the prognostic importance of genetic characteristics rather than clinical history, secondary AML is now considered a diagnostic qualifier rather than a separate disease entity. (2) Methods: To assess the association between clinical history and AML outcomes in the context of allogeneic hematopoietic cell transplantation (HCT), we retrospectively analyzed 759 patients with de novo AML, 115 with AHD AML, and 105 with therapy-related AML who received first allografts while in first or second remission. (3) Results: At the time of HCT, these three cohorts differed significantly regarding many patient and disease-specific characteristics, including age (p < 0.001), gender (p < 0.001), disease risk (p = 0.005), HCT-CI score (p < 0.001), blood count recovery (p = 0.003), first vs. second remission (p < 0.001), remission duration (p < 0.001), measurable residual disease (MRD; p < 0.001), and conditioning intensity (p < 0.001). Relative to patients with de novo AML, relapse rates were similar for patients with AHD (hazard ratio [HR] = 1.07, p = 0.7) and therapy-related AML (HR = 0.86, p = 0.4) after multivariable adjustment, as were relapse-free survival (HR = 1.20, p = 0.2, and HR = 0.89, p = 0.5) and overall survival (HR = 1.19, p = 0.2, and HR = 0.93, p = 0.6). Non-relapse mortality was higher for AHD AML (HR = 1.59, p = 0.047). (4) Conclusions: These data suggest that the clinical history by itself contains limited prognostic value for adults with AML undergoing allografting, supporting the most recent approach to use this information as a diagnostic qualifier rather than a disease entity.
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6
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Trends in outcome of transplantation in patients with secondary acute myeloid leukemia: an analysis from the Acute Leukemia Working Party (ALWP) of the EBMT. Bone Marrow Transplant 2022; 57:1788-1796. [DOI: 10.1038/s41409-022-01825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/08/2022]
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7
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Itonaga H, Kida M, Hamamura A, Uchida N, Ozawa Y, Fukuda T, Ueda Y, Kataoka K, Katayama Y, Ota S, Matsuoka KI, Kondo T, Eto T, Kanda J, Ichinohe T, Atsuta Y, Miyazaki Y, Ishiyama K. Outcome of therapy-related myelodysplastic syndrome and oligoblastic acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation: A propensity score matched analysis. Hematol Oncol 2022; 40:752-762. [PMID: 35299289 DOI: 10.1002/hon.2991] [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: 12/15/2021] [Revised: 02/26/2022] [Accepted: 03/16/2022] [Indexed: 11/11/2022]
Abstract
Therapy-related myelodysplastic syndromes (t-MDS) are generally progressive and associated with poorer outcomes than de novo MDS (d-MDS). To evaluate the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for t-MDS, we conducted a propensity score matched-pair analysis of patients with t-MDS and d-MDS using a nationwide database. A total of 178 patients with t-MDS underwent allo-HSCT between 2001 and 2018, and 178 out of 3,123 patients with d-MDS were selected. The probability of 3-year overall survival rate was 40.0% and 50.0% in the t-MDS and d-MDS groups, respectively (P=0.032). The 3-year transplant-related mortality was 30.9% and 19.0% in the t-MDS and d-MDS groups, respectively (P=0.005). The 3-year cumulative incidence of relapse was 32.8% and 33.0% in the t-MDS and d-MDS groups, respectively (P=0.983). A multivariate analysis identified four adverse factors for overall survival in the t-MDS group: age ≥55 years (hazard ratio [HR], 2.09; 95% CI, 1.11-3.94; P=0.023), the poor cytogenetic risk group (HR, 2.19; 95% CI, 1.40-4.19; P=0.019), performance status at allo-HSCT 2-4 (HR, 2.14; 95% CI, 1.19-3.86; P=0.011), and a shorter interval from diagnosis to transplantation (<8 months) (HR, 1.61; 95% CI, 1.00-2.57; P=0.048). The most frequent cause of transplant-related death was the infectious complications (21.6%) in t-MDS group and organ failure (12.5%) in d-MDS group. In conclusion, allo-HSCT potentially provides long-term remission in patients with t-MDS; however, further efforts to reduce transplant-related death are needed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hidehiro Itonaga
- Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan
| | - Michiko Kida
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Atsushi Hamamura
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yasunori Ueda
- Department of Hematology/Oncology and Transfusion and Hemapheresis Center, Kurashiki Central Hospital, Okayama, 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
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Hokkaido, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Tadakazu Kondo
- Department of Hematology, Kyoto University Hospital, Kyoto, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan.,Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Aichi, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan.,Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Ken Ishiyama
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan
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8
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Kuno M, Yamasaki S, Fujii N, Ishida Y, Fukuda T, Kataoka K, Uchida N, Katayama Y, Sato M, Onai D, Miyamoto T, Ota S, Yoshioka S, Ara T, Hangaishi A, Hashii Y, Onizuka M, Ichinohe T, Atsuta Y, Inamoto Y. Characterization of myeloid neoplasms following allogeneic hematopoietic cell transplantation. Am J Hematol 2022; 97:185-193. [PMID: 34738245 DOI: 10.1002/ajh.26401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
We compared characteristics of myeloid neoplasms (MNs) following allogeneic hematopoietic cell transplantation (HCT) versus autologous HCT using a Japanese HCT registry database. Among 43 788 patients who underwent allogeneic (n = 18 874) or autologous HCT (n = 24 914) for non-myeloid malignancies or non-malignant diseases, 352 developed MNs. The cumulative incidence of MNs was lower after allogeneic HCT than after autologous HCT (0.3% vs. 1.8% at 10 years, respectively, p < .001). Compared with autologous HCT, MNs following allogeneic HCT developed in younger patients (median, 42 vs. 57 years old, respectively) and sooner after HCT (median, 16 vs. 33 months, respectively). Approximately half of MNs following allogeneic HCT were donor-derived and occurred later than recipient-derived MNs (median, 26 vs. 6 months, respectively, p = .003). In multivariate analysis, reduced-intensity conditioning and cord blood transplantation were associated with MN development after allogeneic HCT. Overall survival was similar in patients who developed MNs following allogeneic versus autologous HCT (18% vs. 22% at 5 years, respectively, p = .48). Patient age ≥ 55 years, the presence of previous HCT, AML subtype, and chromosome 5 or 7 abnormalities were adverse factors for overall survival after MN diagnosis. Further research is warranted to elucidate the mechanisms of MN development following allogeneic HCT.
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Affiliation(s)
- Masatomo Kuno
- Department of Hematology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Satoshi Yamasaki
- Department of Internal Medicine Kyushu University Beppu Hospital Beppu Japan
| | - Nobuharu Fujii
- Division of Blood Transfusion Okayama University Hospital Okayama Japan
| | - Yasushi Ishida
- Pediatric Medical Center Ehime Prefectural Central Hospital Ehime Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation National Cancer Center 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
| | | | - Yuta Katayama
- Department of Hematology Hiroshima Red Cross Hospital & Atomic‐bomb Survivors Hospital Hiroshima Japan
| | - Maho Sato
- Department of Hematology/Oncology Osaka Women's and Children's Hospital Osaka Japan
| | - Daishi Onai
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo Japan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic Science Kyushu University Graduate School of Medical Sciences Fukuoka Japan
| | - Shuichi Ota
- Department of Hematology Sapporo Hokuyu Hospital Hokkaido Japan
| | - Satoshi Yoshioka
- Department of Hematology Kobe City Medical Center General Hospital Hyogo Japan
| | - Takahide Ara
- Department of Hematology Hokkaido University Hospital Hokkaido Japan
| | - Akira Hangaishi
- Department of Hematology National Center for Global Health and Medicine Tokyo Japan
| | - Yoshiko Hashii
- Department of Pediatrics Osaka International Cancer Institute Osaka Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology Tokai University School of Medicine Kanagawa Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine Hiroshima University Hiroshima Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation Aichi Japan
- Department of Registry Science for Transplant and Cellular Therapy Aichi Medical University School of Medicine Aichi Japan
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation National Cancer Center Hospital Tokyo Japan
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9
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Sharma A, Huang S, Li Y, Brooke RJ, Ahmed I, Allewelt HB, Amrolia P, Bertaina A, Bhatt NS, Bierings MB, Bies J, Brisset C, Brondon JE, Dahlberg A, Dalle JH, Eissa H, Fahd M, Gassas A, Gloude NJ, Goebel WS, Goeckerman ES, Harris K, Ho R, Hudspeth MP, Huo JS, Jacobsohn D, Kasow KA, Katsanis E, Kaviany S, Keating AK, Kernan NA, Ktena YP, Lauhan CR, López-Hernandez G, Martin PL, Myers KC, Naik S, Olaya-Vargas A, Onishi T, Radhi M, Ramachandran S, Ramos K, Rangarajan HG, Roehrs PA, Sampson ME, Shaw PJ, Skiles JL, Somers K, Symons HJ, de Tersant M, Uber AN, Versluys B, Cheng C, Triplett BM. Outcomes of pediatric patients with therapy-related myeloid neoplasms. Bone Marrow Transplant 2021; 56:2997-3007. [PMID: 34480120 PMCID: PMC9260859 DOI: 10.1038/s41409-021-01448-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 11/09/2022]
Abstract
Long-term outcomes after allogeneic hematopoietic cell transplantation (HCT) for therapy-related myeloid neoplasms (tMNs) are dismal. There are few multicenter studies defining prognostic factors in pediatric patients with tMNs. We have accumulated the largest cohort of pediatric patients who have undergone HCT for a tMN to perform a multivariate analysis defining factors predictive of long-term survival. Sixty-eight percent of the 401 patients underwent HCT using a myeloablative conditioning (MAC) regimen, but there were no statistically significant differences in the overall survival (OS), event-free survival (EFS), or cumulative incidence of relapse and non-relapse mortality based on the conditioning intensity. Among the recipients of MAC regimens, 38.4% of deaths were from treatment-related causes, especially acute graft versus host disease (GVHD) and end-organ failure, as compared to only 20.9% of deaths in the reduced-intensity conditioning (RIC) cohort. Exposure to total body irradiation (TBI) during conditioning and experiencing grade III/IV acute GVHD was associated with worse OS. In addition, a diagnosis of therapy-related myelodysplastic syndrome and having a structurally complex karyotype at tMN diagnosis were associated with worse EFS. Reduced-toxicity (but not reduced-intensity) regimens might help to decrease relapse while limiting mortality associated with TBI-based HCT conditioning in pediatric patients with tMNs.
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Affiliation(s)
- Akshay Sharma
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Sujuan Huang
- Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ying Li
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Russell J. Brooke
- Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ibrahim Ahmed
- Pediatric Hematology, Oncology and BMT, Children’s Mercy Hospital Kansas City, Kansas City, MO, USA
| | | | - Persis Amrolia
- Department of Bone Marrow Transplant, Great Ormond St Children’s Hospital, London, UK
| | - Alice Bertaina
- Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - Neel S. Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marc B. Bierings
- Stem cell transplantation, Princess Maxima Centre for Pediatric Oncology, Utrecht, Netherlands
| | - Joshua Bies
- Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Claire Brisset
- Hemato-immunology Department, Robert Debré Hospital, GHU APHP Nord - Université de Paris, Paris, France
| | - Jennifer E. Brondon
- Pediatric Transplant and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Ann Dahlberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jean-Hugues Dalle
- Hemato-immunology Department, Robert Debré Hospital, GHU APHP Nord - Université de Paris, Paris, France
| | - Hesham Eissa
- Blood and Marrow Transplant and Cellular Therapeutics, Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Aurora, CO, USA
| | - Mony Fahd
- Hemato-immunology Department, Robert Debré Hospital, GHU APHP Nord - Université de Paris, Paris, France
| | - Adam Gassas
- Department of Haematology and Oncology, Royal Hospital for Children, Bristol, UK
| | - Nicholas J. Gloude
- Pediatrics, University of California San Diego, Rady Children’s Hospital San Diego, San Diego, CA, USA
| | - W Scott Goebel
- Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Erika S. Goeckerman
- Pediatric Transplant and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Katherine Harris
- Blood and Marrow Transplantation, Children’s National Hospital, Washington, DC, USA
| | - Richard Ho
- Pediatric Hematology, Oncology and BMT, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michelle P. Hudspeth
- Pediatric Hematology and Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey S. Huo
- Pediatric Cellular Therapies, Cancer and Blood Disorders, Atrium Health Levine Children’s Hospital, Charlotte, NC, USA
| | - David Jacobsohn
- Blood and Marrow Transplantation, Children’s National Hospital, Washington, DC, USA
| | | | | | - Saara Kaviany
- Pediatric Hematology, Oncology and BMT, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy K. Keating
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nancy A. Kernan
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Yiouli P. Ktena
- Pediatric Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Colette R. Lauhan
- Pediatrics, University of California San Diego, Rady Children’s Hospital San Diego, San Diego, CA, USA
| | - Gerardo López-Hernandez
- Bone Marrow Transplant and Cell therapy Department, National Institute of Pediatrics, Ciudad de Mexico, Coyoacan, Mexico
| | - Paul L. Martin
- Pediatric Transplant and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Kasiani C. Myers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Swati Naik
- Center for Cell and Gene Therapy, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Alberto Olaya-Vargas
- Bone Marrow Transplant and Cell therapy Department, National Institute of Pediatrics, Ciudad de Mexico, Coyoacan, Mexico
| | - Toshihiro Onishi
- Center for Cell and Gene Therapy, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mohamed Radhi
- Pediatric Hematology, Oncology and BMT, Children’s Mercy Hospital Kansas City, Kansas City, MO, USA
| | - Shanti Ramachandran
- Oncology, Haematology, Blood and Marrow Transplantation, Child and Adolescent Health Services, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Kristie Ramos
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | - Hemalatha G. Rangarajan
- Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Philip A. Roehrs
- Pediatric Cellular Therapies, Cancer and Blood Disorders, Atrium Health Levine Children’s Hospital, Charlotte, NC, USA
| | - Megan E. Sampson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Peter J. Shaw
- Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jodi L. Skiles
- Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katherine Somers
- Oncology, Haematology, Blood and Marrow Transplantation, Child and Adolescent Health Services, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Heather J. Symons
- Pediatric Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Marie de Tersant
- Hemato-immunology Department, Robert Debré Hospital, GHU APHP Nord - Université de Paris, Paris, France
| | - Allison N. Uber
- Pediatric Hematology and Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Birgitta Versluys
- Stem cell transplantation, Princess Maxima Centre for Pediatric Oncology, Utrecht, Netherlands
| | - Cheng Cheng
- Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Brandon M. Triplett
- Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, USA
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10
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Yanada M, Mizuno S, Yamasaki S, Harada K, Konuma T, Tamaki H, Shingai N, Uchida N, Ozawa Y, Tanaka M, Onizuka M, Sawa M, Nakamae H, Shiratori S, Matsuoka KI, Eto T, Kawakita T, Maruyama Y, Ichinohe T, Kanda Y, Atsuta Y, Aoki J, Yano S. Difference in outcomes following allogeneic hematopoietic cell transplantation for patients with acute myeloid leukemia and myelodysplastic syndromes. Leuk Lymphoma 2021; 62:3411-3419. [PMID: 34348554 DOI: 10.1080/10428194.2021.1961242] [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: 10/20/2022]
Abstract
To evaluate whether outcomes following allogeneic hematopoietic cell transplantation differ according to disease type, a three-way comparison for patients with de novo acute myeloid leukemia (AML) (n = 3318), AML evolving from myelodysplastic syndromes (MDS) (n = 208), and MDS with excess blasts (MDS-EB) (n = 994) was performed. The 5-year probabilities of overall survival (OS) for de novo AML, AML evolving from MDS, and MDS-EB were 60%, 42%, and 41% (p < 0.001), respectively. Multivariate analysis revealed that, compared to de novo AML, AML evolving from MDS was associated with a higher risk of NRM (p = 0.030) and MDS-EB with a higher risk of relapse (p < 0.001), both leading to lower OS (p = 0.010 and p < 0.001, respectively). These findings demonstrate inter-disease differences in post-transplant outcomes and highlight the needs to reduce NRM for AML evolving from MDS and to reduce relapse for MDS-EB.
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Affiliation(s)
| | | | | | - Kaito Harada
- Tokai University School of Medicine, Isehara, Japan
| | - Takaaki Konuma
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | | | - Naoki Shingai
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | | | | | | | | | | | - Hirohisa Nakamae
- Graduate School of Medicine, Osaka City University, Osaka, Japan
| | | | | | | | - Toshiro Kawakita
- National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | | | - Tatsuo Ichinohe
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | | | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Aoki
- National Cancer Center Hospital, Tokyo, Japan
| | - Shingo Yano
- The Jikei University School of Medicine, Tokyo, Japan
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