1
|
Zhang X, Li Z, Geng W, Song B, Wan C. Effects and Predictive Factors of Immunosuppressive Therapy Combined with Umbilical Cord Blood Infusion in Patients with Severe Aplastic Anemia. Yonsei Med J 2018; 59:643-651. [PMID: 29869462 PMCID: PMC5990670 DOI: 10.3349/ymj.2018.59.5.643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/24/2017] [Accepted: 01/19/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To investigate the efficacy and safety of umbilical cord blood (UCB) infusion (UCBI) plus immunosuppressive therapy (IST) treatment in comparison to IST treatment, as well as predictive factors for clinical responses, in severe aplastic anemia (SAA) patients. MATERIALS AND METHODS Totally, 93 patients with SAA were enrolled in this cohort study. In the IST group, rabbit antithymocyte globulin (r-ATG) combined with cyclosporine A (CsA) was administered, while in the IST+UBCI group, r-ATG, CsA, and UCB were used. RESULTS After 6 months of treatment, UCBI+IST achieved a higher complete response (CR) rate (p=0.002) and an elevated overall response rate (ORR) (p=0.004), compared to IST. Regarding hematopoietic recovery at month 6, platelet responses in the UCBI+IST group were better than those in the IST group (p=0.002), and UCBI+IST treatment facilitated increasing trends in absolute neutrophil count (ANC) response (p=0.056). Kaplan-Meier curves illuminated UCBI+IST achieved faster ANC response (p<0.001) and platelet response (p<0.001), compared with IST therapy. There was no difference in overall survival (OS) between the two groups (p=0.620). Furthermore, logistic regression analysis demonstrated that UCBI+IST was an independent predicting factor for both CR (p=0.001) and ORR (p<0.001), compared to IST; meanwhile, very severe aplastic anemia (VSAA) and ANC could predict clinical responses as well. However, Cox proportional hazard regression indicated that VSAA (p=0.003), but not UCBI+IST, affected OS. Safety profiles showed that UCBI+IST therapy did not elevate adverse events, compared with IST treatment. CONCLUSION UCBI+IST achieved better clinical responses and hematopoietic recovery than IST, and was well tolerated in SAA patients.
Collapse
Affiliation(s)
- Xia Zhang
- Department of Hematology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan, China
| | - Zhangzhi Li
- Department of Hematology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan, China
| | - Wei Geng
- Department of Hematology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan, China
| | - Bin Song
- Department of Hematology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan, China
| | - Chucheng Wan
- Department of Hematology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan, China.
| |
Collapse
|
2
|
Abstract
Research regarding the use of cord blood (CB) has focused on antigen match and the number of stem cells, with policies and networks related to its use being under researched. This article is based on fieldwork in China from 2013 to 2015 and examines ways that the studied CB bank enhances CB usage in China. This article identifies that in addition to finding a match, CB use is linked to the policies and networks, release fee and public awareness that enable CB usage development.
Collapse
Affiliation(s)
- Hung-Chieh Chang
- Institute of Health Policy & Management, National Taiwan University No. 17, Xu-Zhou Road, Taipei 100, Taiwan
| |
Collapse
|
3
|
Liu HL, Sun ZM, Geng LQ, Wang XB, Ding KY, Tang BI, Tong J, Wang ZY. Unrelated cord blood transplantation for newly diagnosed patients with severe acquired aplastic anemia using a reduced-intensity conditioning: high graft rejection, but good survival. Bone Marrow Transplant 2012; 47:1186-90. [DOI: 10.1038/bmt.2011.251] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
4
|
Kim H, Kim BS, Kim DH, Hyun MS, Kim SH, Bae SH, Choi JH, Sohn SK, Shin HJ, Won JH, Yoon SS, Jo DY, Joo YD, Park JH, Lee KH. Comparison between Matched Related and Alternative Donors of Allogeneic Hematopoietic Stem Cells Transplanted into Adult Patients with Acquired Aplastic Anemia: Multivariate and Propensity Score-Matched Analysis. Biol Blood Marrow Transplant 2011; 17:1289-98. [DOI: 10.1016/j.bbmt.2010.12.715] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/30/2010] [Indexed: 10/18/2022]
|
5
|
Füreder W, Valent P. Treatment of refractory or relapsed acquired aplastic anemia: review of established and experimental approaches. Leuk Lymphoma 2011; 52:1435-45. [DOI: 10.3109/10428194.2011.568646] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
6
|
Meyers G, Maziarz RT. Is it time for a change? The case for early application of unrelated allo-SCT for severe aplastic anemia. Bone Marrow Transplant 2010; 45:1479-88. [PMID: 20603622 DOI: 10.1038/bmt.2010.134] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Severe aplastic anemia (SAA) is a BM failure syndrome in which allo-SCT remains a highly effective curative option. Its application remains limited by donor availability and by the potential for treatment-related morbidity and mortality. The improved outcomes with unrelated transplantation are a result of the advent of molecular donor-recipient matching, generation of effective novel conditioning regimens, improvement of supportive care and expansion of the donor registry. Decision making regarding the earlier use of unrelated transplant procedures is rapidly evolving. This paper reviews critical data relevant to these treatment options and recommends early consideration of related SCT for patients with SAA who show failure of immune suppressive therapy.
Collapse
Affiliation(s)
- G Meyers
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, OR 97229, USA.
| | | |
Collapse
|
7
|
Labussiere H, Peffault de Latour R, Bay JO. [Allogeneic cord blood transplantation for adults: current results and future development]. Bull Cancer 2010; 97:137-48. [PMID: 20018584 DOI: 10.1684/bdc.2009.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hematopoietic stem cell transplantation is the choice treatment of many hematopoietic disorders. However, there is still no related or HLA-matched unrelated donor for one-third of the patients. Cord blood, which contains a lot of hematopoietic progenitors immunologically naive, represents not only an interesting alternative as hematopoietic stem cell source but also allows more HLA incompatibilities than the other sources. Promising results in children lead to develop cord blood transplantation in adults first of all in hematopoietic malignancies (acute leukemias and lymphoid diseases) and in a second time, in non-malignant diseases such as aplastic anaemia. The main problems for the development of this new strategy in adults are the poor number of cells per unit, the delay for hematopoietic recovery in comparison with other hematopoietic stem cell sources and, consequently higher transplant related mortality. In order to improve the results in adults, new strategies emerged. Double cord blood transplantation, expansion methods and intra-bone injection of the graft will be reviewed here, as well as alternative transplantation strategies such as non-myeloablative conditioning.
Collapse
|
8
|
Ruggeri A, de Latour RP, Rocha V, Larghero J, Robin M, Rodrigues CA, Traineau R, Ribaud P, Ferry C, Devergie A, Gluckman E, Socié G. Double cord blood transplantation in patients with high risk bone marrow failure syndromes. Br J Haematol 2008; 143:404-8. [PMID: 18699847 DOI: 10.1111/j.1365-2141.2008.07364.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with bone marrow failure syndromes (BMFS) who reject a first allogeneic transplant or fail immunosuppressive therapy (IST) have an especially grim prognosis. We report 14 patients (eight adults, six children) transplanted with double cord blood transplantation (dUCBT) for BMFS. Neutrophil recovery was observed in eight patients, with full donor chimerism of one unit, and acute GVHD in 10. With a median follow-up of 23 months, the estimated 2 years overall survival was 80 +/- 17% and 33 +/- 16% for patients with acquired and inherited BMFS, respectively. Transplantation of two partially HLA-matched UCB thus enables salvage treatment of high-risk patients with BMFS.
Collapse
Affiliation(s)
- A Ruggeri
- Service d'Hématologie-Greffe, Hôpital Saint Louis, APHP, Paris University 7, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
Umbilical cord blood gifted to non-profit public cord blood banks is now routinely used as an alternative source of haematopoietic stem cells for allogeneic transplantation for children and adults with cancer, bone marrow failure syndromes, haemoglobinopathies and many genetic metabolic disorders. Because of the success and outcomes of public cord banking, many companies now provide private cord banking services. However, in the absence of any published transplant evidence to support autologous and non-directed family banking, commercial cord banks currently offer a superfluous service.
Collapse
Affiliation(s)
- Michael J Sullivan
- Department of Paediatrics, Children's Cancer Research Group, Children's Haematology Oncology Centre, Christchurch School of Medicine, University of Otago, 2 Riccarton Ave, Christchurch 8005, New Zealand.
| |
Collapse
|
10
|
Gunetti M, Ferrero I, Rustichelli D, Berger M, Gammaitoni L, Timeus F, Piacibello W, Aglietta M, Fagioli F. Refreezing of cord blood hematopoietic stem cells for allogenic transplantation: in vitro and in vivo validation of a clinical phase I/II protocol in European and Italian Good Manufacturing Practice conditions. Exp Hematol 2008; 36:235-43. [DOI: 10.1016/j.exphem.2007.08.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 08/29/2007] [Accepted: 08/29/2007] [Indexed: 11/26/2022]
|
11
|
Abstract
Umbilical cord blood has become a valuable alternative source of haematopoietic stem cells for allogeneic transplantation. However, largely because of the impact of cell dose on engraftment, risk of transplant-related mortality and survival, progress in the field has been largely restricted to children. Nevertheless, substantial clinical experience with umbilical cord blood transplantation clearly establishes its safety and effectiveness in young patients with a variety of malignant and non-malignant diseases. Although less well established in adults, new strategies are now being explored to address the obstacle of cell dose. This article reviews the state of the art and future directions with umbilical cord blood as a source of haematopoietic stem cells for transplantation in both children and adults.
Collapse
Affiliation(s)
- Claudio G Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
| | | | | |
Collapse
|
12
|
Tajika K, Mizuki T, Nakayama K, Yamaguchi H, Dan K. Umbilical-cord Blood Cell Transplantation Conditioned with a Reduced Intensity-regimen is a Practical Salvage Therapy for Severe Aplastic Anemia Refractory to Immunosuppressive Therapy with Antithymocyte Globulin/Ciclosporin. J NIPPON MED SCH 2007; 74:424-9. [DOI: 10.1272/jnms.74.424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kenji Tajika
- Department of Pathophysiological Management/Medical Oncology, Graduate School of Medicine, Nippon Medical School
| | - Taro Mizuki
- Department of Pathophysiological Management/Medical Oncology, Graduate School of Medicine, Nippon Medical School
| | - Kazutaka Nakayama
- Department of Pathophysiological Management/Medical Oncology, Graduate School of Medicine, Nippon Medical School
| | - Hiroki Yamaguchi
- Department of Pathophysiological Management/Medical Oncology, Graduate School of Medicine, Nippon Medical School
| | - Kazuo Dan
- Department of Pathophysiological Management/Medical Oncology, Graduate School of Medicine, Nippon Medical School
| |
Collapse
|
13
|
Abstract
Aplastic anemia, an unusual hematologic disease, is the paradigm of the human bone marrow failure syndromes. Almost universally fatal just a few decades ago, aplastic anemia can now be cured or ameliorated by stem-cell transplantation or immunosuppressive drug therapy. The pathophysiology is immune mediated in most cases, with activated type 1 cytotoxic T cells implicated. The molecular basis of the aberrant immune response and deficiencies in hematopoietic cells is now being defined genetically; examples are telomere repair gene mutations in the target cells and dysregulated T-cell activation pathways. Immunosuppression with antithymocyte globulins and cyclosporine is effective at restoring blood-cell production in the majority of patients, but relapse and especially evolution of clonal hematologic diseases remain problematic. Allogeneic stem-cell transplant from histocompatible sibling donors is curative in the great majority of young patients with severe aplastic anemia; the major challenges are extending the benefits of transplantation to patients who are older or who lack family donors. Recent results with alternative sources of stem cells and a variety of conditioning regimens to achieve their engraftment have been promising, with survival in small pediatric case series rivaling conventional transplantation results.
Collapse
Affiliation(s)
- Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute/NIH, 10 Center Drive, Bldg 10/CRC, Rm 3E-5140, Bethesda, MD 20892-1202, USA.
| | | | | |
Collapse
|
14
|
Ohga S, Ichino K, Goto K, Hattori S, Nomura A, Takada H, Nakamura K, Hara T. Unrelated donor cord blood transplantation for childhood severe aplastic anemia after a modified conditioning. Pediatr Transplant 2006; 10:497-500. [PMID: 16712610 DOI: 10.1111/j.1399-3046.2006.00486.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Treatment of severe aplastic anemia (SAA) patients who lack human leukocyte antigen (HLA)-matched donors and failed immunosuppressive therapy (IST) is challenging. Recently, umbilical cord blood transplantation (CBT) after non-myeloablative therapy has been reported in adult but not in childhood SAA. However, most cases resulted in mixed donor chimerism and incomplete hematological recovery. We reported an 11-yr-old girl with recurred SAA 5 yr after IST who underwent unrelated donor CBT after a modified regimen. This patient had renal and cardiac dysfunction, and lacked suitable bone marrow donors. The 3.9 x 10(7)/kg CB cells from an HLA one-locus mismatched unrelated donor were infused after conditioning with total body irradiation (5 Gy), melphalan (120 mg/m(2)), and fludarabin (120 mg/m(2)). Hematological recovery was favorable in complete chimerism. A major complication was only skin graft-versus-host disease (grade I). CB could be an alternate stem cell source for childhood SAA after modified preparative regimen.
Collapse
Affiliation(s)
- Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
Aplastic anaemia (AA) consists of pancytopenia and empty bone marrow. Its incidence varies worldwide but predominates in developing countries. Diverse aetiologies are involved, with autoimmunity at the centre of the picture. For the 70% of patients with the severe and very severe forms of AA and who lack a human leukocyte antigen (HLA)-matched sibling, immunosuppressive therapy (IST) is key in treating the disease, with a remission rate close to 70%, an 80-90% 5-year survival rate in responding patients and a relapse rate close to 10%. For the 30% with a sibling donor available, haematopoietic stem cell transplant (HSCT) from bone marrow or peripheral blood has up to a 90% chance of cure, with a 5-10% graft rejection/failure rate. Patients who fail IST (25-30%) and lack a sibling donor can benefit from CD34(+)-enriched, partially T cell-depleted unrelated stem cell transplants, with a general survival rate up to 37%, the newest source of stem cells for this modality being cord blood. Non-myeloablative, irradiation-free conditioning regimens offer appreciable benefits, and new immunosuppressive agents, such as fludarabine and alemtuzumab, have been incorporated with promising preliminary results. Graft-versus-host disease, graft failure and infections remain significant challenges in HSCT for which innovative treatment strategies are being developed at present.
Collapse
Affiliation(s)
- Jose C Jaime-Perez
- Universidad Autónoma de Nuevo León Servicio de Hematología, Hospital Universitario, Dr José E. González, Edificio Dr Rodrigo Barragán, 2 piso., Avenida Madero y Gonzalitos, Monterrey, Nuevo León, C.P. 64460, Mexico.
| | | | | |
Collapse
|
16
|
Abstract
Early clinical reports outlining outcomes for primarily pediatric patients undergoing UCB transplantation point to delayed time to hematopoietic recovery and favorable incidence and severity of GvHD. Recently, clinical reports in adult patients identified the feasibility of UCB transplantation for those patients lacking an available histocompatible-related or unrelated adult donor Intensive clinical and laboratory research is ongoing focused on strategies to foster UCB allogeneic donor engraftment thereby allowing wider application of this stem cell source for patients requiring allogeneic transplantation.
Collapse
Affiliation(s)
- W Tse
- Medicine and Pathology, Case Western Reserve University, University Hospitals Comprehensive Cancer Center, Cleveland, Ohio, USA
| | | |
Collapse
|