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Plotogea M, Zgura A, Mehedințu C, Scurtu F, Petca A, Varlas VN, Bors RG, Edu A, Ionescu OM, Andreescu M, Mateescu RN, Isam AJ. Women's Sexual Dysfunctions Following Stem Cell Transplant and the Impact on Couple Relationship. Life (Basel) 2023; 14:35. [PMID: 38255651 PMCID: PMC10817538 DOI: 10.3390/life14010035] [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: 11/06/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Stem cell transplant proved its efficacy in increasing the survival rate among young patients diagnosed with hematological malignancies. A transplant conditioning regimen is particularly destructive on the genital system, often determining premature ovarian failure, accompanied by vulvovaginal atrophy and sexual dysfunctions. The aims of the present study were, first, to evaluate sexual dysfunctions among transplanted women, using clinical examination and the female sexual function index (FSFI), and second, to determine their impact on a couple's relationship. A prospective observational comparative study was performed and included 38 patients who underwent allogenic stem cell transplant (SCT) procedures for different hematological malignancies and 38 healthy patients (control group). This study included baseline evaluation, one-year, and three-year follow-up visits. In addition to anamnesis and medically obtained information, FSFI was evaluated to determine the impact of gynecological damage in a subjective manner. In the study group, vulvovaginal atrophy was diagnosed in 76.32%, with subsequent sexual dysfunctions in 92.10% of patients, based on FSFI scoring. Even though the results improved throughout the study, at the last visit, mild vulvovaginal atrophy was diagnosed in 81.58% of patients, and the FSFI score was abnormal for 21.05%. When compared to the control group, both sexual dysfunctions and FSFI results were considerably impaired, with statistical significance. There is a confirmed negative impact of sexual dysfunctions and self-declared FSFI on couple/marital status and couple relationships, with statistical significance, at the last visit. In conclusion, anatomical, functional, and psychological difficulties are a reality of long-term survivors after a stem cell transplant. They should be addressed and assessed equally to other medical conditions, as they may determine serious consequences and impact the sexual quality of life and the couple's relationship.
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Affiliation(s)
- Mihaela Plotogea
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Zgura
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Claudia Mehedințu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital, 011179 Bucharest, Romania
| | - Francesca Scurtu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital, 011179 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital, 011179 Bucharest, Romania
| | - Roxana Georgiana Bors
- Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital, 011179 Bucharest, Romania
| | - Antoine Edu
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Oana-Maria Ionescu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Andreescu
- Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
| | - Radu Nicolae Mateescu
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Al Jashi Isam
- Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
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2
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Wu Y, Wang Y, Ji J, Kuang P, Chen X, Liu Z, Li J, Dong T, Li X, Chen Q, Liu T. A pilot study of cord blood-derived natural killer cells as maintenance therapy after autologous hematopoietic stem cell transplantation. Ann Hematol 2023; 102:3229-3237. [PMID: 37775597 DOI: 10.1007/s00277-023-05471-4] [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: 03/14/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
Natural killer (NK) cell based immunotherapy is an emerging strategy in hematologic malignancies because allogeneic NK cells can provide potent antitumor immunity without inducing graft-versus-host disease. Thus, we expanded cord blood-derived NK (CB-NK) cells ex vivo from random (MHC mismatched and KIR mismatched) donors, and investigate the feasibility and efficacy of repeated infusions CB-NK cells as maintenance therapy after autologous hematopoietic stem cell transplantation (ASCT). Thirty-one patients with acute myeloid leukemia and high-risk lymphoma received ASCT and the adoptive CB-NK cell multiple infusions for maintenance therapy. Patients received a median dose of 5.98 × 107/kg (range, 1.87-17.69 × 107/kg) CB-NK cells and 23 patients completed four infusions, 8 patients received three infusions. Only mild infusion reactions occurred in 15.5% of 116 infusions. Compared to a contemporaneous cohort of 90 patients who did not receive NK cell therapy, the adoptive transfer of CB-NK cells as maintenance treatment showed a tendency of difference in decreasing the relapse rate between CB-NK group and control group (9.7% vs 24.4%). The patients who receiving NK cell infusions had a better PFS and OS than controls (4 year PFS, 84.4 ± 8.3% vs 73.5 ± 5.4%; and 4 year OS, 100% vs 78.1 ± 5.4%) . These findings demonstrate safety and validity of maintenance therapy using CB-NK cells multiple infusions after ASCT, and it is worthy of further clinical trial verification.
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Affiliation(s)
- Yuling Wu
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yue Wang
- Sichuan Cord Blood Bank and Sichuan Neo-life Stem Cell Biotech Inc., Chengdu, Sichuan, China
| | - Jie Ji
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Pu Kuang
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xinchuan Chen
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhigang Liu
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jian Li
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tian Dong
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xuelian Li
- Sichuan Cord Blood Bank and Sichuan Neo-life Stem Cell Biotech Inc., Chengdu, Sichuan, China
| | - Qiang Chen
- Sichuan Cord Blood Bank and Sichuan Neo-life Stem Cell Biotech Inc., Chengdu, Sichuan, China
| | - Ting Liu
- Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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3
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Sarmiento M, Rojas P, Gutierrez C, Quezada J, Jara V, Campbell J, Maria G, Vergara M, Triantafilo N, Ocqueteau M. Autologous Stem Cell Transplant in Lymphoma Using a Noncryopreserved Platform: An Adapted Sequential Conditioning Maintaining Dose Intensity Does not Affect Transplantation Outcomes. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023:S2152-2650(23)00126-X. [PMID: 37127472 DOI: 10.1016/j.clml.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Hematopoietic autologous stem cell transplantation (ASCT) is a validated therapeutic strategy for lymphoma treatment and precise well-tolerated conditioning. Several conditioning methods are available, but the most commonly used are CVB, BEAM, and ICE, which are conventionally administered in 6 to 7 days. Since 2015, our program has moved toward noncryopreserved platforms that require concise times; therefore, we have modified the conditioning by reducing it to 4 to 5 days. In this study, we show our experience. METHODS We compared ASCT performed in our program before and after 2015 in lymphoma patients. Between 2000 and 2014 and from 2015 to 2022, we performed 46 and 61 ASCT procedures, respectively. RESULTS Since 2015, we observed a greater number of infused stem cells, fewer episodes of febrile neutropenia (60% vs. 37% P = .008), shorter hospitalizations (30 vs. 18 days P = .001), faster engraftment (20 vs. 14 days P = .001) and better progression-free survival (72 vs. 44 months P = .002). Additionally, a prolonged overall survival was observed at these results, and this prolonged survival is difficult to interpret due to the short follow-up. CONCLUSION In conclusion, conditioning adjusted for a noncryopreserved strategy offers at least similar or even better results than the cryopreserved strategy. Prospective studies are warranted.
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Affiliation(s)
| | - Patricio Rojas
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Veronica Jara
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - James Campbell
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Garcia Maria
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Max Vergara
- Pontificia Universidad Católica de Chile, Santiago, Chile
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[A comparison of C+SCAV and SEAM conditioning regimens in efficacy and safety in autologous hematopoietic stem cell transplantation for non-Hodgkin's lymphoma patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:668-673. [PMID: 36709152 PMCID: PMC9593007 DOI: 10.3760/cma.j.issn.0253-2727.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: This study aimed to compare the efficacy and safety of cladribine, smustine, etoposide, cyclophosphamide, and cytarabine (C+SCAV) and smustine, etoposide, cytarabine, and melphalan (SEAM) conditioning regimens in autologous stem cell transplantation (auto-HSCT) for non-Hodgkin's lymphoma (NHL) . Methods: A retrospective analysis was conducted on 61 NHL patients who received auto-HSCT in the Department of Hematology, the First Affiliated Hospital of Suzhou University, from March 2018 to May 2021. The C + SCAV group and SEAM group had 19 and 42 patients, respectively. Results: ① Among the 61 patients with NHL, 37 were male and 24 were female. The median age was 48 (21-66) years old. There were 19 cases in the C+SCAV group and 42 cases in the SEAM group. There was no significant difference in the baseline characteristics between the two groups (P>0.05) . ② The median time to neutrophil and platelet engraftment in the C+SCAV cohort were 10 (8-15) days and 13 (9-22) days, respectively, which does not differ from the SEAM group (P=0.103, P=0.403) . ③ No differences existed between the two groups in terms of survival. The 1-year progression-free survival (PFS) was (76.5±10.3) % for patients receiving C+SCAV and (78.4±6.8) % for those who received SEAM (P=0.841) . The 1-year overall survival was 100.0% for the C+SCAV group and 95.2±3.3% for the SEAM group (P=0.339) . ④The 1-year PFS of patients with complete remission in the C+SCAV group was similar to those who in the SEAM group [ (92.3±7.4) % vs (82.5±7.2) %, P=0.406]. ⑤ The incidence of non-hematological serious adverse events (≥ grade 3) in the C+SCAV group and SEAM group were 10.5% (2/19) and 40.5% (17/42) (P=0.013) , the incidence of severe mucositis was 5.3% (1/19) and 31.0% (13/42) (P=0.015) , and the incidence of severe infection (≥ grade 3) was 10.5% (2/19) and 19.0% (8/42) (P=0.389) , respectively. Conclusion: C + SCAV conditioning regimen appeared to be no different from the SEAM regimen in terms of survival. It can lower the incidence of SAE and does not increase the risk of severe infection. As a result, it can be used as an alternative conditioning regimen for lymphoma patients undergoing auto-HSCT.
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Shah GL, Boelens JJ, Carlow D, Lin A, Schofield R, Cruz Sitner N, Alperovich A, Ruiz J, Proli A, Dahi P, Tamari R, Giralt SA, Scordo M, Admiraal R. Population Pharmacokinetics of Melphalan in a Large Cohort of Autologous and Allogeneic Hematopoietic Cell Transplantation Recipients: Towards Individualized Dosing Regimens. Clin Pharmacokinet 2022; 61:553-563. [PMID: 34859337 PMCID: PMC9415324 DOI: 10.1007/s40262-021-01093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES High-dose melphalan is an integral part of conditioning chemotherapy prior to both autologous and allogeneic hematopoietic cell transplantation. While underexposure may lead to relapse, overexposure may lead to toxicities include mucositis, diarrhea, bone marrow suppression, and rarely sinusoidal obstruction syndrome. In this study, we describe the population pharmacokinetics of high-dose melphalan as a first step towards individualized dosing. METHODS Melphalan samples were collected in patients receiving an allogeneic or autologous hematopoietic cell transplantation between August 2016 and August 2020 at the Memorial Sloan Kettering Cancer Center. A population-pharmacokinetic model was developed using NONMEM. RESULTS Based on a total of 3418 samples from 452 patients receiving a median cumulative dose of 140 mg/m2, a two-compartment population-pharmacokinetic model was developed. Fat-free mass was a covariate for clearance, central volume of distribution, and inter-compartmental clearance, while glomerular filtration rate predicted clearance. Simulation studies showed that based on fixed body surface area-based dosing, renal impairment has a higher impact in increasing melphalan exposure compared with obesity. CONCLUSIONS The proposed model adequately describes the population pharmacokinetics of melphalan in adult patients receiving a hematopoietic cell transplantation. This model can be used to define the therapeutic window of melphalan, and subsequently to develop individualized dosing regimens aiming for that therapeutic window in all patients.
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Affiliation(s)
- Gunjan L Shah
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jaap Jan Boelens
- Stem Cell Transplantation and Cellular Therapies Program, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pediatrics, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Dean Carlow
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryan Schofield
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy Cruz Sitner
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Alperovich
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josel Ruiz
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony Proli
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Parastoo Dahi
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rick Admiraal
- Pediatric Hematopoeitic Cell Transplantation Program, Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, the Netherlands.
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6
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Lebel E, Vainstein V, Ashkenazi M, Zimran E, Stepensky P, Grisariu S, Avni B. Neutrophil decline rate following autologous transplant for lymphoma is a predictor of patients' outcome. Leuk Lymphoma 2021; 63:1144-1151. [PMID: 34963410 DOI: 10.1080/10428194.2021.2018580] [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: 10/19/2022]
Abstract
Neutropenia postchemotherapy is associated with favorable outcomes, which was attributed to optimal dosing. However, little is known about the neutrophil decline rate as a predictor of cancer outcomes, which may reflect a dynamic marker of chemosensitivity. We assessed the association between the neutrophil decline rate and disease outcomes in a known cohort of 212 lymphoma patients, treated with thiotepa, etoposide, cyclophosphamide, cytarabine, and melphalan (TECAM) conditioning followed by autologous transplant in our center between 2000 and 2013. Slower neutrophil decline rate was correlated with worse overall survival, mediated not by shorter time to progression (TTP), but rather by worse survival post-progression, possibly pointing to chemosensitivity at each line of therapy as the responsible mechanism. The effect was seen across histologies and was independent of stronger predictors of outcome like performance status (PS) and response before transplant. Prospective research is needed to confirm our results and expand their validity to other clinical scenarios.
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Affiliation(s)
- Eyal Lebel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Vainstein
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Maayan Ashkenazi
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Zimran
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Polina Stepensky
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sigal Grisariu
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Batia Avni
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Parody R, Sánchez-Ortega I, Mussetti A, Patiño B, Arnan M, Pomares H, González-Barca E, Mercadal S, Boqué C, Maluquer C, Carro I, Peña M, Clapés V, Verdesoto S, Bustamante G, Oliveira AC, Baca C, Cabezudo E, Talarn C, Escoda L, Ortega S, García N, Isabel González-Medina M, Sánchez-Salmerón M, Fusté C, Villa J, Carreras E, Domingo-Domènech E, Sureda A. A real-life overview of a hematopoietic cell transplant program throughout a four-year period, including prospective registry, exclusion causes and final donor selection. Bone Marrow Transplant 2021; 57:176-182. [PMID: 34711917 DOI: 10.1038/s41409-021-01506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 12/11/2022]
Abstract
Traceability of patients who are candidates for Hematopoietic cell transplant (HCT) is crucial to ensure HCT program quality. Continuous knowledge of both a detailed registry from a HCT program and final exclusion causes can contribute to promoting a real-life vision and optimizing patient and donor selection. We analyzed epidemiological data reported in a 4 year-monocentric prospective registry, which included all patients presented as candidates for autologous (Auto) and/or allogeneic (Allo) HCT. A total of 543 patients were considered for HCT: 252 (42.4%) for Allo and 291 (57.6%) for Auto. A total of 98 (38.9%) patients were excluded from AlloHCT due to basal disease progression more commonly (18.2%). Seventy-six (30.2%) patients had an HLA identical sibling, whereas 147 (58.3%) patients had only Haplo. UD research was performed in 106 (42%) cases, significantly more often in myeloid than lymphoid malignancies (57% vs 28.7%, p < 0.001) but 61.3% were finally canceled, due to donor or disease causes in 72.4%. With respect to Auto candidates, a total of 60 (20.6%) patients were finally excluded; progression was the most common cause (12%). Currently, Haplo is the most frequent donor type. The high cancellation rate of UD research should be revised to optimize further donor algorithms.
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Affiliation(s)
- R Parody
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain. .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain.
| | - I Sánchez-Ortega
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - A Mussetti
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - B Patiño
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - M Arnan
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - H Pomares
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - E González-Barca
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - S Mercadal
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - C Boqué
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - C Maluquer
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - I Carro
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - M Peña
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - V Clapés
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,H. Comarcal d'Alt Penedés, Vilafranca del Penedés, Barcelona, Spain
| | - S Verdesoto
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - G Bustamante
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - A C Oliveira
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Hospital Sant Camil - St. Pere de Ribes, Barcelona, Spain
| | - C Baca
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,H General de Igualada, Barcelona, Spain
| | - E Cabezudo
- EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - C Talarn
- Institut Català d'Oncologia-Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - L Escoda
- Institut Català d'Oncologia-Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - S Ortega
- Banc de Sang i Teixits, Barcelona, Barcelona, Spain
| | - N García
- Banc de Sang i Teixits, Barcelona, Barcelona, Spain
| | | | - Mar Sánchez-Salmerón
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - C Fusté
- REDMO, Fundació Josep Carreras, Barcelona, Spain
| | - J Villa
- REDMO, Fundació Josep Carreras, Barcelona, Spain
| | - E Carreras
- REDMO, Fundació Josep Carreras, Barcelona, Spain
| | - E Domingo-Domènech
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - A Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
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8
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Armenian SH, Iukuridze A, Teh JB, Mascarenhas K, Herrera A, McCune JS, Zain JM, Mostoufi‐Moab S, McCormack S, Slavin TP, Scott JM, Jones LW, Sun C, Forman SJ, Wong FL, Nakamura R. Abnormal body composition is a predictor of adverse outcomes after autologous haematopoietic cell transplantation. J Cachexia Sarcopenia Muscle 2020; 11:962-972. [PMID: 32212263 PMCID: PMC7432567 DOI: 10.1002/jcsm.12570] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/27/2020] [Accepted: 02/25/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The number of patients undergoing autologous haematopoietic cell transplant (HCT) is growing, but little is known about the factors that predict adverse outcomes. Low muscle mass and obesity are associated with disability and premature mortality in individuals with non-malignant diseases and may predict outcomes after autologous HCT. METHODS This was a retrospective cohort study of 320 patients who underwent autologous HCT for Hodgkin or non-Hodgkin lymphoma between 2009 and 2014. Sarcopenia {skeletal muscle index male: <43 cm/m2 [body mass index (BMI) < 25 kg/m2 ] or < 53 cm/m2 [BMI ≥ 25 kg/m2 ] and female: <41 cm/m2 [regardless of BMI]) and obesity [total abdominal adiposity ≥450.0 cm2 (male), ≥396.4 cm2 (female)] were assessed from single-slice abdominal pre-HCT computed tomography images. Length of hospital stay, first unplanned intensive care unit admission, and 30-day unplanned readmission were evaluated based on body composition using multivariable regression analysis, and mortality was evaluated with Kaplan-Meier analysis and Gray's test. RESULTS Median age at HCT was 53.3 years (range, 18.5 to 78.1 years); 26.3% were sarcopenic and an additional 7.8% were sarcopenic obese pre-HCT. Sarcopenic obesity was associated with increased risk of prolonged hospitalization [odds ratio (OR) = 3.6, 95% confidence interval (CI) 1.3-9.8], intensive care unit admission (OR = 4.7, 95% CI 1.5-16.1), and unplanned readmission after HCT (OR = 13.6, 95% CI 2.5-62.8). Patients who were sarcopenic obese also had the highest mortality risk at 1 year [hazard ratio (HR): 3.9, 95% CI 1.1-11.0] and 5 years (HR: 2.5, 95% CI 1.1-5.5), compared with patients with normal body composition. Sarcopenia alone, but not obesity alone, was associated with an increased risk of these outcomes, albeit with a lower magnitude of risk than in patients who were sarcopenic obese. CONCLUSIONS Sarcopenic obesity was an important predictor of outcomes in patients undergoing autologous HCT. These findings could inform targeted prevention strategies in patients at highest risk of complications after HCT.
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Affiliation(s)
| | | | | | | | - Alex Herrera
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
| | | | - Jasmine M. Zain
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
| | - Sogol Mostoufi‐Moab
- Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Shana McCormack
- Department of PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | | | - Jessica M. Scott
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Lee W. Jones
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
- Department of MedicineWeill Cornell Medical CenterNew YorkNYUSA
| | - Can‐Lan Sun
- Department of Supportive Care MedicineCity of HopeDuarteCAUSA
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
| | - F. Lennie Wong
- Department of Population SciencesCity of HopeDuarteCAUSA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell TransplantationCity of HopeDuarteCAUSA
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Kim KH, Kim WS, Kim SJ, Yoon DH, Suh C, Kang HJ, Choi CW, Lee HS, Bae SH, Park J, Park EK, Kwak JY, Lee MH, Kang BW, Park SK, Won JH. Treatment with intravenous busulfan, melphalan, and etoposide followed by autologous stem cell transplantation in patients with non-Hodgkin's lymphoma: a multicenter study from the consortium for improving survival of lymphoma. Transpl Int 2020; 33:1211-1219. [PMID: 32479690 DOI: 10.1111/tri.13664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/21/2019] [Accepted: 05/26/2020] [Indexed: 11/29/2022]
Abstract
Several high-dose therapy (HDT) conditioning regimens have been used to treat non-Hodgkin's lymphoma (NHL), such as bis-chloroethylnitrosourea (BCNU)/etoposide/cytosine arabinoside/melphalan (BEAM), BCNU/etoposide/cytosine arabinoside/cyclophosphamide (BEAC), and cyclophosphamide/BCNU/etoposide (CBV). BCNU is an active drug in HDT of NHL, but the supply is limited in some countries, including Korea. Busulfan has been used in allogeneic and autologous stem cell transplantation (ASCT). This phase II study evaluated the efficacy of busulfan/melphalan/etoposide (BuME) as a conditioning regimen for HDT in relapsed or high-risk NHL. The regimen consisted of intravenous busulfan (3.2 mg/kg/day) on days -8, -7, and -6, etoposide (400 mg/m2 /day) on days -5 and -4, and melphalan (50 mg/m2 /day) on days -3 and -2. A total of 46 patients were included in the study, with 36 (78.3%) achieving a complete response after ASCT. The 2-year progression-free survival (PFS) and overall survival (OS) rates for all patients were 46.7% (95% CI, 31.8-60.4%) and 63.7% (95% CI, 47.7-76.0%), respectively. There was no development of veno-occlusive disease and no treatment-related deaths within 100 days after ASCT. These results indicate that a BuME regimen is well-tolerated and effective for patients with relapsed or high-risk NHL, and may be comparable to some previously used regimens. This regimen may be useful as a substitute for BCNU-containing regimens.
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Affiliation(s)
- Kyoung Ha Kim
- Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Jin Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Korea
| | - Chul Won Choi
- Division of Oncology-Hematology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Ho Sup Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Sung Hwa Bae
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jinny Park
- Division of Hematology, Deparment of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Eun Kyung Park
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae-Yong Kwak
- Division of Hematology/Oncology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Mark Hong Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| | - Byung Woog Kang
- Department Hematology/Oncology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sung-Kyu Park
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon-Si, Gyeonggi-Do, Korea
| | - Jong-Ho Won
- Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, Korea
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