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Yao Y, Tang Y, Qi J, Li X, Zhang R, Xu X, Pan T, Han Y. Efficacy and safety of thrombopoietin receptor agonists in the treatment of thrombocytopenia after hematopoietic stem cell transplantation: a meta-analysis and systematic review. Expert Rev Hematol 2021; 14:1041-1048. [PMID: 34844489 DOI: 10.1080/17474086.2021.2009337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Thrombocytopenia is a tough complication after hematopoietic stem cell transplantation (HSCT) with elusive pathogenesis and lack of well-established therapies. Thrombopoietin receptor agonists (TPO-RAs) have been used for thrombocytopenia post HSCT in recent years, but the outcomes remain debatable. We conducted this meta-analysis and systematic-review to evaluate the efficacy and safety of TPO-RAs for platelet recovery after HSCT. We searched PubMed, EMBASE, and Cochrane databases for studies on the application of TPO-RAs (eltrombopag and romiplostim) in the settings of primary or secondary thrombocytopenia after HSCT by 17 March 2021. Efficacy outcomes included response rate and survival rate, and adverse events were also evaluated. A total of 19 studies involving 378 patients were included. The pooled response rate was 73% (95%CI: 68-78%), which was significantly higher than recombinant human thrombopoietin (rhTPO) (27.8%). The pooled survival rate was 66% (95%CI: 54-77%), and infection was found to be the main cause of death. In addition, the pooled rate of adverse events was 3% (95%CI: 1-7%), with no severe adverse events reported. TPO-RAs could effectively and safely promote the recovery of platelets in patients after HSCT.
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Affiliation(s)
- Yifang Yao
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yaqiong Tang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Department of Hematology Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - JiaQian Qi
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Department of Hematology Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Xueqian Li
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Rui Zhang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaoyan Xu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Tingting Pan
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Department of Hematology Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Yue Han
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Department of Hematology Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China.,State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
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A phase I/II trial of intrabone marrow cord blood transplantation and comparison of the hematological recovery with the Japanese nationwide database. Bone Marrow Transplant 2017; 52:574-579. [PMID: 28067880 DOI: 10.1038/bmt.2016.319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/25/2016] [Accepted: 09/29/2016] [Indexed: 02/08/2023]
Abstract
Intrabone marrow cord blood transplantation (IB-CBT) was proposed as a promising treatment modality to improve hematological recovery. However, clinical advantages of IB-CBT over conventional IV CBT have been unclear. We conducted a prospective single-center trial of IB-CBT to evaluate its safety and superiority in terms of hematological recovery. Fifteen adults with hematological malignancies were enrolled. A thawed and unwashed single cord blood unit was injected into the bilateral superior-posterior iliac crests under local anesthesia. Engraftments of neutrophils and platelets were achieved in 13 cases, with medians of 17 and 45 days, respectively. For the control, we extracted data from the Japanese nationwide database and compared the hematological recovery of contemporaneously transplanted 1135 CBT cases. Multivariate analysis revealed that IB-CBT enhanced platelet recovery (hazard ratio, 2.13; P=0.007), but neutrophil recovery did not differ significantly (hazard ratio, 1.70; P=0.19). Better donor chimerism was seen in the bone marrow of the ilium than of the sternum on day 14, suggesting that the local hematopoiesis at the injected site was established earlier than that at the remote bone marrow site. Collectively, IB-CBT was well tolerated and may enhance local engraftment, which promotes prompter platelet recovery than does IV-CBT.
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Smagur A, Mitrus I, Ciomber A, Panczyniak K, Fidyk W, Sadus-Wojciechowska M, Holowiecki J, Giebel S. Comparison of the cryoprotective solutions based on human albumin vs. autologous plasma: its effect on cell recovery, clonogenic potential of peripheral blood hematopoietic progenitor cells and engraftment after autologous transplantation. Vox Sang 2015; 108:417-24. [DOI: 10.1111/vox.12238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 10/15/2014] [Accepted: 11/29/2014] [Indexed: 12/30/2022]
Affiliation(s)
- A. Smagur
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - I. Mitrus
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - A. Ciomber
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - K. Panczyniak
- Analytics and Clinical Biochemistry Department; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - W. Fidyk
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - M. Sadus-Wojciechowska
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - J. Holowiecki
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
| | - S. Giebel
- Department of Bone Marrow Transplantation and Oncohematology; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch; Gliwice Poland
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Fry LJ, Giner SQ, Gomez SG, Green M, Anderson S, Horder J, McArdle S, Rees R, Madrigal JA. Avoiding room temperature storage and delayed cryopreservation provide better postthaw potency in hematopoietic progenitor cell grafts. Transfusion 2012; 53:1834-42. [DOI: 10.1111/trf.12006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/27/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
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Intrabone transplant of cord blood stem cells establishes a local engraftment store: a functional PET/FDG study. J Biomed Biotechnol 2012; 2012:767369. [PMID: 23093864 PMCID: PMC3471032 DOI: 10.1155/2012/767369] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/31/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite advancements in comprehension of molecular mechanisms governing bone marrow (BM) homing of hematopoietic stem cells, cord blood transplant (CBT) suffers from a slow rate of hematopoietic recovery. Intrabone (i.b.) injection has been proposed as a method able to improve speed of BM engraftment with respect to conventional i.v. protocols. However, the mechanisms underlying this benefit are largely unknown. AIM To verify whether i.b.-CBT determines a local engraftment able to predict the reconstitution of recipient hematopoiesis. DESIGN AND METHODS Twenty-one patients with hematologic malignancies received i.b. injection into both iliac crests of 3.2 ± 0.68 ∗ 107/kg cord blood cells. One month following i.b.-CBT, PET-CT imaging was performed. Maximal standardized uptake values (SUVs) were assessed in BM of both iliac crests and in all lumbar vertebrae. RESULTS Maximal SUV within iliac crests was higher than in lumbar vertebrae (4.1 ± 1.7 versus 3.2 ± 0.7, resp., P = 0.01). However, metabolic activity in these two different BM districts was significantly correlated (r = 0.7, P < 0.001). Moreover, FDG uptake values within the injection site closely predicted platelet recovery 100 days after i.b.-CBT (r = 0.72, P < 0.01). CONCLUSIONS The metabolic activity of injected BM predicts the subsequent rate of hematopoietic recovery after i.b.-CBT, suggesting a pivotal role of the local engraftment in the reconstitution of recipient hematopoiesis.
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