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Worel N, Ljungman P, Verheggen ICM, Hoogenboom JD, Knelange NS, Eikema DJ, Sánchez-Ortega I, Riillo C, Centorrino I, Averbuch D, Chabannon C, de la Camara R, Kuball J, Ruggeri A. Fresh or frozen grafts for allogeneic stem cell transplantation: conceptual considerations and a survey on the practice during the COVID-19 pandemic from the EBMT Infectious Diseases Working Party (IDWP) and Cellular Therapy & Immunobiology Working Party (CTIWP). Bone Marrow Transplant 2023; 58:1348-1356. [PMID: 37673982 DOI: 10.1038/s41409-023-02099-w] [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: 02/26/2023] [Revised: 08/12/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
The COVID-19 pandemic has had a significant impact on medical practices, including the delivery of allogeneic hematopoietic cell transplantation (HCT). In response, transplant centers have made changes to their procedures, including an increased use of cryopreservation for allogeneic haematopoietic progenitor cell (HPC) grafts. The use of cryopreserved grafts for allogeneic HCT has been reviewed and analysed in terms of potential benefits and drawbacks based on existing data on impact on cell subsets, hematological recovery, and clinical outcomes of approximately 2000 patients from different studies. A survey of European Society for Blood and Marrow Transplantation centers was also conducted to assess changes in practice during the pandemic and any unnecessary burdens on HPC donors. Before the pandemic, only 7.4% of transplant centers were routinely cryopreserving HPC products, but this percentage increased to 90% during the pandemic. The results of this review and survey suggest that cryopreservation of HPC grafts is a viable option for allogeneic HCT in certain situations, but further research is needed to determine long-term effects and ethical discussions are required to balance the needs of donors and patients when using frozen allografts.
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Affiliation(s)
- N Worel
- Medical University Vienna; Department. of Transfusion Medicine and Cell Therapy, Vienna, Austria.
| | - P Ljungman
- Department. of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge and Div. of Hematology, Department. of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - D-J Eikema
- EBMT Statistical Unit, Leiden, Netherlands
| | | | - C Riillo
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | - I Centorrino
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | - D Averbuch
- Faculty of Medicine, Hebrew University of Jerusalem; Hadassah Medical Center, Jerusalem, Israel
| | - C Chabannon
- Institut Paoli-Calmettes, Centre de Lutte Contre le Cancer; Centre d'Investigations Cliniques en Biothérapie, Université d'Aix-Marseille, Inserm CBT, 1409, Marseille, France
| | | | - J Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | - A Ruggeri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milan, Italy
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2
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Nijssen K, Westinga K, Stuut A, Janssen A, van Rhenen A, van der Wagen L, Daenen LGM, Oostvogels R, de Witte MA, Kuball J. Graft engineering: how long can you wait, how low can you go, and pandemic readiness. Bone Marrow Transplant 2023; 58:820-822. [PMID: 37012417 PMCID: PMC10069722 DOI: 10.1038/s41409-023-01976-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Klaartje Nijssen
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kasper Westinga
- Cell Therapy Facility, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anniek Stuut
- Center for Translational Immunology, Utrecht, the Netherlands
| | - Anke Janssen
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
- Center for Translational Immunology, Utrecht, the Netherlands
| | - Anna van Rhenen
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lotte van der Wagen
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laura G M Daenen
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rimke Oostvogels
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Moniek A de Witte
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
- Center for Translational Immunology, Utrecht, the Netherlands
| | - Jürgen Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands.
- Center for Translational Immunology, Utrecht, the Netherlands.
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3
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Thibodeaux SR, Coble D, Day V, Fontaine MJ, Gabelli M, Gardiner N, Geach T, Schwartz J, Vasovic LV, Wyre R, Girdlestone J. Assessing deviations for HPCs obtained during COVID-19 (ADHOC): Evaluating impact of the COVID-19 pandemic on cellular therapy products and processes, the BEST collaborative study. Transfusion 2023; 63:782-790. [PMID: 36924403 DOI: 10.1111/trf.17311] [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: 11/20/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND The success of allogeneic hematopoietic stem cell transplantation is dependent on a world-wide network of collection centers providing donations that predominantly have been infused as fresh cells. The logistics chain that supports the just-in-time delivery model for stem cell and immunotherapy products was severely stressed by the COVID pandemic, and in early 2020 a number of national and international bodies recommended that cells should be cryopreserved at the collection or transplant center to avoid interruptions in their acquisition or delivery to patients who had started conditioning. STUDY DESIGN To assess the potential consequences of such pandemic-related deviations to normal practice, we surveyed nine international laboratories to determine if the characteristics or transplant outcomes of allogeneic stem cell donations differed in the immediate periods before and after the switch to routine cryopreservation. RESULTS Nine centers on two continents provided data for 72 HSC donations just before, and 71 just after, switching to cryopreservation for allogeneic HSC products. No statistically significant differences between the period before and after cryopreservation were noted for time from product collection to receipt, product temperature at receipt, or CD34+ cell viability at receipt. There was an indication of slower absolute neutrophil count recovery after cryopreservation was required (mean time of 15 vs. 17.6 days). DISCUSSION While there were no apparent changes to most parameters studied, there was an indication of slower neutrophil engraftment that will need to be examined in larger, longer term studies.
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Affiliation(s)
- Suzanne R Thibodeaux
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dean Coble
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Victoria Day
- National Health Service Blood and Transplant, Barnsley, UK
| | - Magali J Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Maria Gabelli
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, UK
| | - Nicola Gardiner
- Cryobiology Laboratory Stem Cell Facility, St. James's Hospital, Dublin, Ireland
| | - Tamara Geach
- Cell Therapy and Transplant Program, The London Clinic, London, UK
| | - Joseph Schwartz
- Department of Pathology, Molecular and Cell-Based Medicine, Mount Sinai Health System, New York, New York, USA
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Rachael Wyre
- Stem Cells and Immunotherapies, National Health Service Blood and Transplant, Southampton, UK
| | - John Girdlestone
- Stem Cells and Immunotherapies, National Health Service Blood and Transplant, The John Radcliffe Hospital, Oxford, UK
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4
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Guo M, Liu J, Clark P, Ahmad S, Patel R, Varela JC, Mori S. Cryopreserved versus fresh peripheral blood allogeneic stem cell transplantation outcomes in patients receiving post-transplant cyclophosphamide for graft-versus-host prophylaxis during the COVID-19 pandemic: a single center experience. Int J Hematol 2023; 117:428-437. [PMID: 36378406 PMCID: PMC9664429 DOI: 10.1007/s12185-022-03493-8] [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: 04/21/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVE Cryopreservation of grafts is not common practice in allogeneic hematopoietic stem cell transplant (HSCT) recipients. However, our center had to use cryopreserved cells for allogeneic HSCT during the COVID-19 pandemic to avoid delays in transplantation due to uncertainty regarding patient and donor exposures. STUDY DESIGN We retrospectively evaluated post-transplant engraftment and survival outcomes of adult patients who received cryopreserved versus fresh allografts during the COVID-19 pandemic. RESULTS Fifty-five patients with hematologic malignancies received either cryopreserved (n = 34) or fresh (n = 21) allogeneic HSCT using peripheral blood stem cells between January 2020 and December 2020. At a median follow-up time of 15 months, cryopreserved allograft recipients had significantly lower overall survival (OS) (p = 0.02). They also experienced significantly delayed neutrophil (p = 0.01) and platelet engraftments (p < 0.0001), as well as higher red blood cell transfusion-dependence after day + 60 (67.6% vs. 28.6%; p = 0.01). Significantly more cryopreserved allograft recipients received donor lymphocyte infusion than fresh allograft recipients (35.3% vs. 4.8%, p = 0.01). Neither relapse-free survival nor non-relapse mortality differed significantly between the two groups. CONCLUSION Cryopreservation of allografts in combination with post-transplant cyclophosphamide may negatively affect engraftment and OS outcomes in HSCT recipients.
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Affiliation(s)
- Mengni Guo
- grid.414935.e0000 0004 0447 7121Department of Internal Medicine AdventHealth, Orlando, FL 32804 USA
| | - Jieying Liu
- grid.414935.e0000 0004 0447 7121Department of Internal Medicine AdventHealth, Orlando, FL 32804 USA
| | - Pamela Clark
- grid.414938.30000 0004 0415 6213Blood and Marrow Transplant Center, AdventHealth Cancer Institute, AHMG2415 N. Orange Ave., Suite 601, Orlando, FL 32804 USA
| | - Sarfraz Ahmad
- grid.414938.30000 0004 0415 6213Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL 32804 USA
| | - Rushang Patel
- grid.414938.30000 0004 0415 6213Blood and Marrow Transplant Center, AdventHealth Cancer Institute, AHMG2415 N. Orange Ave., Suite 601, Orlando, FL 32804 USA
| | - Juan Carlos Varela
- grid.414938.30000 0004 0415 6213Blood and Marrow Transplant Center, AdventHealth Cancer Institute, AHMG2415 N. Orange Ave., Suite 601, Orlando, FL 32804 USA
| | - Shahram Mori
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, AHMG2415 N. Orange Ave., Suite 601, Orlando, FL, 32804, USA.
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Koo J, Auletta JJ, Hartley DM, Huber J, Jaglowski S, Kapadia M, Kusnier K, Lehmann L, Maakaron J, Myers KC, Pai A, Parker L, Phelan R, Sper C, Rotz SJ, Dandoy CE. Secondary Impact of the Coronavirus Disease 19 Pandemic on Patients and the Cellular Therapy Healthcare Ecosystem. Transplant Cell Ther 2022; 28:737-746. [PMID: 35902050 PMCID: PMC9313529 DOI: 10.1016/j.jtct.2022.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has significantly impacted global health and healthcare delivery systems. To characterize the secondary effects of the COVID-19 pandemic and mitigation strategies used in the delivery of hematopoietic stem cell transplantation (HSCT) care, we performed a comprehensive literature search encompassing changes in specific donor collection, processing practices, patient outcomes, and patient-related concerns specific to HSCT and HSCT-related healthcare delivery. In this review, we summarize the available literature on the secondary impacts the COVID-19 pandemic on the fields of HSCT and cellular therapy. The COVID-19 pandemic has had numerous secondary impacts on patients undergoing HSCT and the healthcare delivery systems involved in providing complex care to HSCT recipients. Institutions must identify these influences on outcomes and adjust accordingly to maintain and improve outcomes for the transplantation and cellular therapy community.
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Affiliation(s)
- Jane Koo
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
| | - Jeffrey J Auletta
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - David M Hartley
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John Huber
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Samantha Jaglowski
- Division of Hematology-Oncology and Transplantation; Department of Pediatrics, Ohio State University Medical Center, Columbus, Ohio
| | - Malika Kapadia
- Division of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard University Medical School, Boston, Massachusetts
| | - Katilyn Kusnier
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Leslie Lehmann
- Division of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard University Medical School, Boston, Massachusetts
| | - Joseph Maakaron
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kasiani C Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Ahna Pai
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Loretta Parker
- Division of Hematology/Oncology, Department of Pediatrics, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Rachel Phelan
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin
| | - Christine Sper
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
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6
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Impact of Cryopreservation of Peripheral Blood Stem Cells (PBSC) in Transplantation from Matched Unrelated Donor (MUD). J Clin Med 2022; 11:jcm11144114. [PMID: 35887878 PMCID: PMC9320435 DOI: 10.3390/jcm11144114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Cryopreservation of PBSC for allogenic hematopoietic stem cell transplantation (allo-HSCT) was implemented due to the current Coronavirus 2019 pandemic. The impact of match unrelated donor (MUD) graft freezing on the outcome of allo-HSCT in terms of hematological recovery, graft versus host disease (GVHD), and survival are still controversial. Methods: In this study, we compared graft composition, clinical characteristics, and outcome of 31 allo-HSCT from MUD cryopreserved PBSC (Cryo Group) with 23 matched-pair allo-HSCT from fresh MUD PBSC (Fresh Group) performed in our center between January 2020 and July 2021. Results: No significant differences were recognized in clinical characteristics of patients, donors, and transplants between the Cryo and Fresh groups except for a better prognostic comorbidity index (HCT-CI) of the Cryo group. In the Cryo Group, the median time from apheresis to cryopreservation was 46.0 h (range 23.8−53.5), while the median time from cells collection and reinfusion was 13.9 days (range 5.8−28.1). In the Fresh Group, median time from apheresis to reinfusion was 35.6 h (range 21.4−51.2). The number of viable (7-AAD negative) CD34+ cells per kg patient infused was significantly lower in the Cryo Group (5.2 ± 1.9 × 106/kg vs. 7.0 ± 1.3 × 106/kg; p < 0.001). Indeed, there was a 36% (11−70) median loss of viable CD34+/kg cells after freezing. All patients engrafted: median time to neutrophil engraftment (>0.5 × 109/L) was 13.5 days (range 12−15) for Cryo Group and 14 days (range 13−16) days for Fresh Group (p = 0.522), while the median time to platelet engraftment (>20 × 109/L) was, respectively, 14 (range 12−18) and 15 (range 12−17) days (p = 0.904). The incidence of grade ≥ 2 acute GVHD was similar in the two groups (56.5% Cryo Group vs. 60.0% Fresh Group; p = 0.832) and no differences in terms of OS (p = 0.090), PFS (p = 0.200) and TRM (p = 0.970) were observed between the Cryo and Fresh groups. Conclusions: In our series, no differences between the Cryo and Fresh groups were found in engraftment, grade ≥ 2 acute GVHD incidence, OS, PFS, and TRM despite a lower CD34+ infused dose in the Cryo Group. Frozen PBSCs could be considered a safe option also for allo-HSCT from MUD but a higher amount of PBSC should be collected to warrant an adequate viable CD34+ post-thawing.
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