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Kindwall-Keller TL, Ballen KK. Alternative Donor Graft Sources for Adults with Hematologic Malignancies: A Donor for All Patients in 2017! Oncologist 2017; 22:1125-1134. [PMID: 28546462 DOI: 10.1634/theoncologist.2017-0009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/13/2017] [Indexed: 12/21/2022] Open
Abstract
Hematopoietic stem cell transplant (HSCT) is potentially curative for a wide variety of malignant diseases, including acute and leukemias, lymphoma, and myelodysplasia. Choice of a stem cell donor is dependent on donor availability, donor compatibility and health, recipient disease type, and recipient condition. Current sources of stem cell donation for HSCT are matched sibling donors (MSDs), matched unrelated donors (MUDs), 1-antigen mismatched unrelated donors (MMUDs), haploidentical donors (haplo), and umbilical cord blood (UCB) units. Historically, preferred donors for HSCT have been human leukocyte antigen (HLA)-matched sibling donors; however, only about 30% of U.S. patients will have a MSD available. The majority of patients referred for HSCT will require an alternative donor graft: MUD, MMUD, UCB, or haplo. The likelihood of finding a MUD varies depending on the ethnicity of the recipient. White Caucasians of European descent have the greatest chance of finding a MUD. Chances of finding a MUD are significantly less for African-American or Hispanic recipients due to HLA polymorphisms. Therefore, MMUD, UCB, and haplo donor graft sources expand the donor pool for recipients who do not have a MSD or MUD available. Given the variety of different donor stem cell sources available today, nearly every patient who needs an allogeneic HSCT has a potential donor in 2017. All transplant-eligible patients with hematologic malignancies should be evaluated by a transplant center to determine if HSCT is a viable treatment option for their underlying disease process. IMPLICATIONS FOR PRACTICE The goal of this review is to increase the awareness of oncology practitioners to the availability of alternative donor stem cell transplants for patients with hematologic malignancies. Despite new agents, stem cell transplant remains the only curative therapy for many patients with acute and chronic leukemia, myelodysplasia, and lymphoma. Given the variety of different donor stem cell sources available today, nearly every patient who needs an allogeneic stem cell transplant will have a donor.
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Affiliation(s)
- Tamila L Kindwall-Keller
- Department of Medicine, University of Virginia School of Medicine, and Stem Cell Transplant Program, University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Karen K Ballen
- Department of Medicine, University of Virginia School of Medicine, and Stem Cell Transplant Program, University of Virginia Cancer Center, Charlottesville, Virginia, USA
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Low-dose anti-thymocyte globulin reduce severe acute and chronic graft-versus-host disease after allogeneic stem cell transplantation. J Cancer Res Clin Oncol 2017; 143:709-715. [PMID: 28062916 DOI: 10.1007/s00432-016-2329-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/22/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anti-thymocyte globulin (ATG) administered at 5-10 mg/kg can prevent graft-versus-host disease (GVHD). We sought to investigate the potential for lower doses of ATG to decrease non-relapse mortality (NRM). METHODS We consecutively compared the outcomes of patients with hematological diseases who received allogeneic stem cell transplants from allogeneic related or unrelated donors before February 2010 and were not administered ATG (reference arm), with those administered 2.5 mg/kg ATG after March 2010 (treatment arm). RESULTS We recruited 19 patients into each arm (median age 49 years, range 19-64). 16 patients received myeloablative preparation regimens and 22 patients received toxicity-reduced preparation regimens. All but one patient achieved engraftment, and one secondary graft failure was observed. Overall incidence of acute and chronic GVHD were 63.2 and 15.8%, respectively, in the ATG arm (21.1% grade II to IV, and 0.0% grade III/IV acute GVHD), and 57.9 and 47.4%, respectively, in the reference arm (31.6% grade II to IV, and 21.1% grade III/IV acute GVHD). The estimated probability of overall survival (OS) at 6 years and relapse rate 3 years after transplantation were 49.2 and 26.3% for the ATG arm, respectively, and 54.2 and 21.1% for the reference arm, respectively. The rate of NRM was 10.5% in the ATG arm and 26.3% in the reference arm. No patients died as a result of acute or chronic GVHD. CONCLUSIONS Low-dose ATG may suppress severe acute GVHD and chronic GVHD without increasing NRM, and can be used safely for Japanese patients receiving transplants from HLA-matched donors.
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Donor-derived CD4(+)/CCR7(+) T-cell partial selective depletion does not alter acquired anti-infective immunity. Bone Marrow Transplant 2014; 49:611-5. [PMID: 24566708 DOI: 10.1038/bmt.2014.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/16/2013] [Accepted: 11/18/2013] [Indexed: 01/14/2023]
Abstract
In previous studies, we observed that a high proportion of donor-derived CD4(+) T cells expressing the chemokine receptor 7 (CCR7) was a major determinant of acute GVHD, without interfering with the incidence of other post-transplant outcomes, especially relapse and nonrelapse mortality rates. Here, we investigated in vitro the impact of partially selective CD4(+)/CCR7(+) T lymphocytes on acquired anti-infective immune response in 10 donors who underwent G-CSF-primed PBSC collection. Similar quantitative and functional proliferative reactions were observed in lymphocyte cultures in the presence of adenovirus and pp65 Ags with unmanipulated and partially depleted donor samples. No responses were observed in the presence of human T-cell lymphotropic virus type 1 used as a negative control. These results complete the proof of concept needed to build a clinical trial investigating partially selective CD4(+)/CCR7(+) T cell-depleted allo-SCT.
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Ectopic Osteogenesis of Allogeneic Bone Mesenchymal Stem Cells Loading on β-Tricalcium Phosphate in Canines. Plast Reconstr Surg 2014; 133:142e-153e. [DOI: 10.1097/01.prs.0000436841.69752.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Zaimoku Y, Takami A, Sato H, Utsumi M, Nakao S. IgM anti-recipient ABO antibodies predict acute graft-versus-host disease following allogeneic hematopoietic stem cell transplantation. Int J Hematol 2013; 98:96-101. [DOI: 10.1007/s12185-013-1360-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/30/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
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Abstract
The feasibility of stem cell transplantation across the major histocompatibility barrier-as in haploidentical stem cell transplantation-has been proved for some time in several studies. The main limitations include a higher graft failure rate, delayed immune reconstitution after transplantation with high rates of life-threatening infections, a higher incidence of post-transplant lymphoproliferative disease, and severe acute and chronic graft-versus-host disease. In an attempt to reduce the transplant-related morbidity/mortality, several techniques had been evaluated involving conditioning regimen intensity, graft engineering, post-transplant cellular therapy and immunosuppression. This review will describe the current situation. It will also discuss initiatives and strategies to overcome the limitations associated with transplant across the MHC barrier.
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Affiliation(s)
- Amr Ahmed Nassar
- King Abdullah Medical City, Mecca, Western Province, Saudi Arabia.
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Alshemmari S, Ameen R, Gaziev J. Haploidentical hematopoietic stem-cell transplantation in adults. BONE MARROW RESEARCH 2011; 2011:303487. [PMID: 22046559 PMCID: PMC3199934 DOI: 10.1155/2011/303487] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 04/05/2011] [Accepted: 05/18/2011] [Indexed: 11/18/2022]
Abstract
Haploidentical hematopoietic stem-cell transplantation is an alternative transplant strategy for patients without an HLA-matched donor. Still, only half of patients who might benefit from transplantation are able to find an HLA-matched related or unrelated donor. Haploidentical donor is readily available for many patients in need of immediate stem-cell transplantation. Historical experience with haploidentical stem-cell transplantation has been characterised by a high rejection rate, graft-versus-host disease, and transplant-related mortality. Important advances have been made in this field during the last 20 years. Many drawbacks of haploidentical transplants such as graft failure and significant GVHD have been overcome due to the development of new extensive T cell depletion methods with mega dose stem-cell administration. However, prolonged immune deficiency and an increased relapse rate remain unresolved problems of T cell depletion. New approaches such as partial ex vivo or in vivo alloreactive T cell depletion and posttransplant cell therapy will allow to improve immune reconstitution in haploidentical transplants. Results of unmanipulated stem-cell transplantation with using ATG and combined immunosuppression in mismatched/haploidentical transplant setting are promising. This paper focuses on recent advances in haploidentical hematopoietic stem-cell transplantation for hematologic malignancies.
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Affiliation(s)
| | - Reem Ameen
- 2Department of Medical Laboratory Sciences, Faculty of Allied Health, Kuwait
| | - Javid Gaziev
- 3International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- *Javid Gaziev:
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Chung HJ, Lee JH, Kwon SW. Significance of donor-derived isoagglutinins in ABO-Incompatible hematopoietic stem cell transplantation. J Clin Lab Anal 2009; 22:383-90. [PMID: 19021268 DOI: 10.1002/jcla.20269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Changes in isoagglutinin titers may have implications in the occurrence of hematological complications such as pure red cell aplasia or immune-mediated hemolysis. Furthermore, isoagglutinin titers could reflect immunohematological reconstitution after transplantation. The objective of this study was to examine the relationship between donor-derived isoagglutinins (DDIs) and graft-versus-host disease (GVHD). In total, 114 patients who underwent ABO-incompatible allogeneic hematopoietic stem cell transplantation (HSCT) were analyzed. Among these patients, 27.7% demonstrated increased donor-derived isoagglutinins (IDDIs) against red blood cells (RBCs) of the recipient, and 32.8% of the patients showed DDIs that were not against RBCs of the recipient. Patients with acute GVHD and DDIs against RBCs of the recipient tended to have higher incidences of IDDIs that occurred before posttransplant day 60 compared with patients without acute GVHD (17.3 vs. 3.9%, P=0.058). In patients with acute GVHD, IDDIs occurred significantly earlier (mean, day 32 vs. 181, P=0.046), the period of elevation was shorter (mean, day 36 vs. 134, P=0.033), and the donors were younger (mean, 28 vs. 36 years, P=0.01) than those without GVHD. Moreover, significant correlations were found between IDDIs and acute GVHD. Taken together, these data underscore a possible role for humoral immunity in GVHD after HSCT.
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Affiliation(s)
- Hee-Jung Chung
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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BEDAIWY M, SHAHIN A, FALCONE T. Reproductive organ transplantation: advances and controversies. Fertil Steril 2008; 90:2031-55. [DOI: 10.1016/j.fertnstert.2008.08.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 08/05/2008] [Accepted: 08/05/2008] [Indexed: 11/27/2022]
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Luo XH, Chang YJ, Xu LP, Liu DH, Liu KY, Huang XJ. The impact of graft composition on clinical outcomes in unmanipulated HLA-mismatched/haploidentical hematopoietic SCT. Bone Marrow Transplant 2008; 43:29-36. [PMID: 18776927 DOI: 10.1038/bmt.2008.267] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ogawa H, Ikegame K, Kaida K, Yoshihara S, Fujioka T, Taniguchi Y, Tamaki H, Inoue T, Hasei H, Iiboshi Y, Tazuke Y, Kawakami M, Kim EH, Soma T, Inoue T, Kawase I. Unmanipulated HLA 2-3 antigen–mismatched (haploidentical) bone marrow transplantation using only pharmacological GVHD prophylaxis. Exp Hematol 2008; 36:1-8. [DOI: 10.1016/j.exphem.2007.08.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Revised: 07/30/2007] [Accepted: 08/08/2007] [Indexed: 10/22/2022]
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CD3+ Cell Dose and Disease Status Are Important Factors Determining Clinical Outcomes in Patients Undergoing Unmanipulated Haploidentical Blood and Marrow Transplantation after Conditioning Including Antithymocyte Globulin. Biol Blood Marrow Transplant 2007; 13:1515-24. [DOI: 10.1016/j.bbmt.2007.09.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 09/09/2007] [Indexed: 01/14/2023]
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Shenoy S. Has stem cell transplantation come of age in the treatment of sickle cell disease? Bone Marrow Transplant 2007; 40:813-21. [PMID: 17704797 DOI: 10.1038/sj.bmt.1705779] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Currently, hematopoietic SCT (HCT) is the only intervention that can restore normal hematopoiesis to provide a 'cure' in sickle cell disease. Yet, this treatment modality is used sparsely-a total of less than 400 transplants are reported in the Center for International Blood and Marrow Transplant Research database despite 70,000 afflicted in the United States; 88% of transplants are from HLA-matched sibling donors and 84% are <16 years of age at transplant. Overall survival at 3 years is over 90% after HCT in the young but 62% in adult HCT recipients due to increased disease and transplant-related morbidity. The decision and timing of HCT is a dilemma for physicians and families due to the need to consider HCT before severe organ damage in a disease that is generally not fatal in children with adequate supportive care. From the transplant physician's perspective, however, advances in the ability to identify well-matched donors, supportive care and promising conditioning regimens with low toxicity and transplant complications support the development of new HCT trials for sickle cell disease as the risk/benefit ratio can be balanced better. With the recognition of new predictors of early mortality, the anticipation of extensive and expensive life-long medical support, and the poor quality of life despite medical care, the scales tip in favor of HCT. This is prime time for the development of careful unrelated donor HCT trials for sickle cell disease. Research efforts targeting HCT will need to be directed at seeking safe and effective transplant methods applicable to all patients who might derive benefit.
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Affiliation(s)
- S Shenoy
- Division of Pediatric Hematology-Oncology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO 63110, USA.
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Cunningham I. I01 Haploidentical transplantation for acute leukemia. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lu DP, Dong L, Wu T, Huang XJ, Zhang MJ, Han W, Chen H, Liu DH, Gao ZY, Chen YH, Xu LP, Zhang YC, Ren HY, Li D, Liu KY. Conditioning including antithymocyte globulin followed by unmanipulated HLA-mismatched/haploidentical blood and marrow transplantation can achieve comparable outcomes with HLA-identical sibling transplantation. Blood 2006; 107:3065-73. [PMID: 16380454 DOI: 10.1182/blood-2005-05-2146] [Citation(s) in RCA: 405] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe outcomes of 293 patients with leukemia undergoing HLA-identical sibling (n = 158) or related HLA-mismatched (n = 135) hematopoietic cell transplantation (HCT) performed during the same time period were compared. Patients received BUCY2 in HLA-identical sibling HCT or BUCY2 + ATG in mismatched HCT as conditioning regimens, followed by unmanipulated marrow and/or peripheral blood (PB) transplantation. All patients achieved full engraftment. The cumulative incidences of grades II to IV acute graft-versus-host disease (aGVHD) in the matched and mismatched cohorts were 32% (CI, 25%-39%) versus 40% (CI, 32%-48%, P = .13), respectively, with the relative risk (RR) = 0.64 (95% CI, 0.43-0.94), P = .02. The incidence of chronic GVHD did not differ significantly between the cohorts (P = .97). Two-year incidences of treatment-related mortality and relapse for matched versus mismatched were 14% (range, 9%-20%) versus 22% (range, 15%-29%) with P = .10 and 13% (range, 8%-19%) versus 18% (range, 10%-27%) with P = .40, respectively. Two-year adjusted leukemia-free survival (LFS) and overall survival were 71% (range, 63%-78%) versus 64% (range, 54%-73%) with P = .27 and 72% (range, 64%-79%) versus 71% (range, 62%-77%) with P = .72, respectively. Multivariate analyses showed that only advanced disease stage and a diagnosis of acute leukemia had increased risk of relapse, treatment failure, and overall mortality. In summary, HCT performed with related HLA-mismatched donors is a feasible approach with acceptable outcomes.
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Affiliation(s)
- Dao-Pei Lu
- Peking University Institute of Hematology, 11 Xizhimen South Street, Beijing 100044, China.
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