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Philip J, Bajaj AK, Sharma S, Kushwaha N, Kumar S, Kumar Biswas A. Allogeneic Peripheral Blood Stem Cell Transplant: Correlation of Donor Factors with Yield, Engraftment, Chimerism, and Outcome: Retrospective Review of a Single Institute During a 3-Year Period. Lab Med 2020; 51:362-369. [PMID: 31758694 DOI: 10.1093/labmed/lmz069] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Donor factors have a variable correlation with cluster of differentiation (CD)34+ cell dose in allogeneic peripheral blood stem cell (PBSC) harvests. CD34+ cell dose affects the speed of hematopoietic recovery and percentage of donor chimerism in the recipient. METHODS A total of 25 allogeneic PBSC transplants performed during a 3-year period were included. All donors underwent mobilization with filgrastim. Leukapheresis, flowcytometric CD34+ cell enumeration, and chimerism analysis were performed and correlated with recipient outcome. RESULTS Besides age, all other donor parameters had a positive correlation with CD34+ cell count. Engraftment kinetics and chimerism had a positive correlation with the CD34+ yield of the PBSC product. Acute graft-vs-host disease (GVHD) was observed in patients with complete chimerism at day 30 after transplantation. CONCLUSION Adequate CD34+ cell yield happens in healthy donors, independent of donor demographic patterns with G-CSF only. A diverse population of donors can thus be approached for Matched Unrelated Donor (MUD) transplants. An accurate quantitative analysis of early donor chimerism in the recipient (at day 30) is an excellent tool for post-transplant monitoring for acute GvHD.
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Affiliation(s)
- Joseph Philip
- Department of Immunohematology & Blood Transfusion (IH & BT), Armed Forces Medical College (AFMC), Pune, India
| | - Anantpreet Kaur Bajaj
- Department of Immunohematology & Blood Transfusion (IH & BT), Armed Forces Medical College (AFMC), Pune, India
| | | | - Neerja Kushwaha
- Department of Immunohematology & Blood Transfusion (IH & BT), Armed Forces Medical College (AFMC), Pune, India
| | - Sudeep Kumar
- Department of Immunohematology & Blood Transfusion (IH & BT), Armed Forces Medical College (AFMC), Pune, India
| | - Amit Kumar Biswas
- Department of Immunohematology & Blood Transfusion (IH & BT), Armed Forces Medical College (AFMC), Pune, India
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Liu Y, Yuan HL, Duan XL, Xu JL, Qu JH, Chen G, Shi J, Han CX, Ding LL, Jiang M. [Clinical research of HLA-haploidentical peripheral hematopoietic stem cell transplantation following reduced intensity conditioning regimen with hematological malignancy patients over 50 years old]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:667-672. [PMID: 31495134 PMCID: PMC7342871 DOI: 10.3760/cma.j.issn.0253-2727.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 分析减低剂量预处理单倍型外周血造血干细胞移植(RIC-haplo-PBSCT)治疗50岁以上恶性血液肿瘤患者的疗效。 方法 18例50岁以上恶性血液肿瘤患者纳入研究,男8例,女10例,中位年龄52(50~66)岁;急性髓系白血病(AML)8例,慢性髓性白血病(CML)2例,骨髓增生异常综合征(MDS)5例,急性淋巴细胞白血病(ALL)2例,急性NK细胞白血病(ANKL)1例;采用FAB+ATG(氟达拉滨+阿糖胞苷+白消安+兔抗人胸腺细胞免疫球蛋白)减低剂量预处理方案,输注供者高剂量非去T细胞外周血造血干细胞(PBSC),应用强化移植物抗宿主病(GVHD)预防方案及感染防控措施。 结果 16例患者在移植后15 d获得完全供者嵌合,其中1例在移植后1个月发生移植排斥,其余2例在移植后15 d为混合嵌合并于移植后1个月发生移植排斥。急性GVHD发生率为61.1%(95%CI 49.6%~72.6%),Ⅱ~Ⅳ度急性GVHD发生率为35.4%(95%CI 21.1%~49.7%),Ⅲ/Ⅳ度急性GVHD发生率为13.8%(95%CI 4.7%~22.9%)。2年慢性GVHD累积发生率为38.2%(95%CI 25.5%~50.9%),未发生广泛型慢性GVHD。中位随访14.5(3~44)个月,2年总生存率、无病生存率分别为72.6%(95%CI 60.1%~85.1%)、63.7%(95%CI 49.2%~78.2%),2年累积复发率为31.2%(95%CI 16.5%~45.9%),2年非复发死亡率为12.5%(95%CI 4.2%~20.8%)。 结论 RIC-haplo-PBSCT治疗50岁以上恶性血液肿瘤患者可获得较好的疗效。
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Affiliation(s)
- Y Liu
- Hematologic Disease Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China; Xinjiang Uygur Autonomous Region Research Institute of Hematology, Urumqi 830061, China
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Campidelli A, Qian C, Laroye C, Decot V, Reppel L, D'aveni M, Bensoussan D. Adenovirus-specific T-lymphocyte efficacy in the presence of methylprednisolone: An in vitro study. Cytotherapy 2018; 20:524-531. [PMID: 29496461 DOI: 10.1016/j.jcyt.2017.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 12/16/2022]
Abstract
Virus-specific T-cell (VST) infusion becomes a promising alternative treatment for refractory viral infections after hematopoietic stem cell transplantation (HSCT). However, VSTs are often infused during an immunosuppressive treatment course, especially corticosteroids, which are a first-line curative treatment of graft-versus-host disease (GVHD). We were interested in whether corticosteroids could affect adenovirus (ADV)-VST functions. After interferon (IFN)-γ based immunomagnetic selection, ADV-VSTs were in vitro expanded according to three different culture conditions: without methylprednisolone (MP; n = 7), with a final concentration of MP 1 µg/mL (n = 7) or MP 2 µg/mL (n = 7) during 28 ± 11 days. Efficacy and alloreactivity of expanded ADV-VSTs was controlled in vitro. MP transitorily inhibited ADV-VST early expansion. No impairment of specific IFN-γ secretion capacity and cytotoxicity of ADV-VSTs was observed in the presence of MP. However, specific proliferation and alloreactivity of ADV-VSTs were decreased in the presence of MP. Altogether, these results and the preliminary encouraging clinical experiences of co-administration of MP 1 mg/kg and ADV-VSTs will contribute to safe and efficient use of anti-viral immunotherapy.
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Affiliation(s)
- Arnaud Campidelli
- CHRU de Nancy, Unité de Thérapie cellulaire et Tissus and FR 3209, Vandoeuvre-Lès-Nancy, France; CHRU de Nancy, Unité de Transplantation Médullaire Allogénique, Vandoeuvre-Lès-Nancy, France
| | - Chongsheng Qian
- CHRU de Nancy, Unité de Thérapie cellulaire et Tissus and FR 3209, Vandoeuvre-Lès-Nancy, France; Université de Lorraine, UMR 7365 and FR 3209 CNRS-INSERM-UL-CHRU, Vandoeuvre-Lès-Nancy, France; Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Caroline Laroye
- CHRU de Nancy, Unité de Thérapie cellulaire et Tissus and FR 3209, Vandoeuvre-Lès-Nancy, France; Université de Lorraine, UMR 7365 and FR 3209 CNRS-INSERM-UL-CHRU, Vandoeuvre-Lès-Nancy, France; Université de Lorraine, Faculté de Pharmacie, Département de Microbiologie-Immunologie, Nancy, France
| | - Véronique Decot
- CHRU de Nancy, Unité de Thérapie cellulaire et Tissus and FR 3209, Vandoeuvre-Lès-Nancy, France; Université de Lorraine, UMR 7365 and FR 3209 CNRS-INSERM-UL-CHRU, Vandoeuvre-Lès-Nancy, France
| | - Loïc Reppel
- CHRU de Nancy, Unité de Thérapie cellulaire et Tissus and FR 3209, Vandoeuvre-Lès-Nancy, France; Université de Lorraine, UMR 7365 and FR 3209 CNRS-INSERM-UL-CHRU, Vandoeuvre-Lès-Nancy, France; Université de Lorraine, Faculté de Pharmacie, Département de Microbiologie-Immunologie, Nancy, France
| | - Maud D'aveni
- CHRU de Nancy, Unité de Transplantation Médullaire Allogénique, Vandoeuvre-Lès-Nancy, France; Université de Lorraine, UMR 7365 and FR 3209 CNRS-INSERM-UL-CHRU, Vandoeuvre-Lès-Nancy, France
| | - Danièle Bensoussan
- CHRU de Nancy, Unité de Thérapie cellulaire et Tissus and FR 3209, Vandoeuvre-Lès-Nancy, France; Université de Lorraine, UMR 7365 and FR 3209 CNRS-INSERM-UL-CHRU, Vandoeuvre-Lès-Nancy, France; Université de Lorraine, Faculté de Pharmacie, Département de Microbiologie-Immunologie, Nancy, France
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Impact of antithymocyte globulin doses in reduced intensity conditioning before allogeneic transplantation from matched sibling donor for patients with acute myeloid leukemia: a report from the acute leukemia working party of European group of Bone Marrow Transplantation. Bone Marrow Transplant 2018; 53:431-437. [DOI: 10.1038/s41409-017-0043-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 11/12/2022]
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Tandra A, Covut F, Cooper B, Creger R, Brister L, McQuigg B, Caimi P, Malek E, Tomlinson B, Lazarus HM, Otegbeye F, Kolk M, de Lima M, Metheny L. Low dose anti-thymocyte globulin reduces chronic graft-versus-host disease incidence rates after matched unrelated donor transplantation. Leuk Lymphoma 2017; 59:1644-1651. [PMID: 29199482 DOI: 10.1080/10428194.2017.1390234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Anti-thymocyte globulin (ATG) is often added to hematopoietic stem cell transplant conditioning regimens to prevent graft rejection and reduce graft-versus-host disease (GVHD). Doses used in retrospective and prospective clinical trials have ranged from 2.5 to 20 mg/kg with rates of grade II-IV acute GVHD and chronic GVHD up to 40 and 60%, respectively. We retrospectively compared outcomes in recipients of matched unrelated donor (MUD) grafts given low dose rabbit ATG IV 3 mg/kg (n = 52) versus recipients of matched related donor (MRD) grafts (n = 48) without ATG. One year cumulative incidence of chronic GVHD was 25.2% in the MUD group versus 33.3% in the MRD group (p = .5). One-year cumulative incidence of extensive chronic GVHD was 9.6% in the MUD group versus 26.6% in the MRD group (p = .042). Our analysis supports the use of low dose ATG in MUD transplantation as an effective therapy to prevent chronic GVHD.
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Affiliation(s)
- Anand Tandra
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Fahrettin Covut
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Brenda Cooper
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Richard Creger
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Lauren Brister
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Bernadette McQuigg
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Paolo Caimi
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Ehsan Malek
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Ben Tomlinson
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Hillard M Lazarus
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Folashade Otegbeye
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Merle Kolk
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Marcos de Lima
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
| | - Leland Metheny
- a Stem Cell Transplant Program , University Hospitals Cleveland Medical Center and Case Western Reserve University , Cleveland , OH , USA
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Byun HK, Yoon HI, Cho J, Kim HJ, Min YH, Lyu CJ, Cheong JW, Kim JS, Kim HS, Kim SJ, Yang AJ, Lee BM, Lee WH, Lee J, Ahn KJ, Suh CO. Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation. Radiat Oncol J 2017; 35:257-267. [PMID: 29037020 PMCID: PMC5647754 DOI: 10.3857/roj.2017.00290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/05/2022] Open
Abstract
Purpose Pulmonary toxicities, including infectious pneumonia (IP) and idiopathic pneumonia syndrome (IPS), are serious side effects of total body irradiation (TBI) used for myeloablative conditioning. This study aimed to evaluate clinical factors associated with IP and IPS following TBI. Materials and Methods Fifty-eight patients with hematologic malignancies who underwent TBI before allogeneic hematopoietic stem cell transplantation between 2005 and 2014 were reviewed. Most patients (91%) received 12 Gy in 1.5 Gy fractions twice a day. Pulmonary toxicities were diagnosed based on either radiographic evidence or reduced pulmonary function, and were subdivided into IP and IPS based on the presence or absence of concurrent infection. Results Pulmonary toxicities developed in 36 patients (62%); 16 (28%) had IP and 20 (34%) had IPS. IP was significantly associated with increased treatment-related mortality (p = 0.028) and decreased survival (p = 0.039). Multivariate analysis revealed that the risk of developing IPS was significantly higher in patients who received stem cells from a matched unrelated donor than from a matched sibling donor (p = 0.021; hazard ratio [HR] = 12.67; 95% confidence interval [CI], 1.46–110.30). Combining other conditioning agents with cyclophosphamide produced a higher tendency to develop IP (p = 0.064; HR = 6.19; 95% CI, 0.90–42.56). Conclusion IP and IPS involve different risk factors and distinct pathogeneses that should be considered when planning treatments before and after TBI.
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Affiliation(s)
- Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ju Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Hong Min
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hemato-oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| | - June-Won Cheong
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Sun Kim
- Division of Pediatric Hemato-oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Jeong Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Andrew Jihoon Yang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Min Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Won Hee Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Joongyo Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jung Ahn
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Gjaerde LI, Moser C, Sengeløv H. Epidemiology of bloodstream infections after myeloablative and non-myeloablative allogeneic hematopoietic stem cell transplantation: A single-center cohort study. Transpl Infect Dis 2017; 19. [PMID: 28561378 DOI: 10.1111/tid.12730] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/15/2017] [Accepted: 03/19/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients who undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT) often develop bloodstream infections (BSI). We aimed to describe the etiologies and antibiotic resistance patterns of BSI after allo-HSCT, and, as knowledge about the impact of conditioning regimen is limited, we looked at the incidence, timing, risk factors, and mortality of BSI separately for myeloablative (MA)- and non-myeloablative (NMA)-conditioned patients. METHODS All 460 patients (207 MA- and 253 NMA-conditioned) who underwent their first allo-HSCT at our center from 2008 to 2013 were included in a historical cohort. BSI were registered from initiation of conditioning to day 360 after transplantation. RESULTS BSI occurred in 34% (95% confidence interval [CI]: 28%, 41%) of MA-conditioned patients and in 17% (95% CI: 12%, 22%) of NMA-conditioned patients. Of all isolates, 68% were gram-positive bacteria (GPB), 23% gram-negative bacteria (GNB), and 9% fungi. The GPB/GNB ratio declined from 2008 to 2014 (P for trend <.01). Of all GNB, 47% were multidrug resistant (MDR), but the proportion declined over the study period. In a multivariate Cox regression model, only acute graft-versus-host disease was associated with a higher hazard of first BSI (hazard ratio 2.50, 95% CI: 1.48, 4.21). Overall 30-day survival after a BSI was higher for MA-conditioned patients than for NMA-conditioned patients (89% vs 74%, P=.04). CONCLUSION MA-conditioned patients experience BSI more often than NMA-conditioned patients in the year after allo-HSCT. While BSI are increasingly caused by GNB, the rate of MDR GNB is declining.
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Affiliation(s)
- Lars I Gjaerde
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Sengeløv
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
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Qian C, Campidelli A, Wang Y, Cai H, Venard V, Jeulin H, Dalle JH, Pochon C, D'aveni M, Bruno B, Paillard C, Vigouroux S, Jubert C, Ceballos P, Marie-Cardine A, Galambrun C, Cholle C, Clerc Urmes I, Petitpain N, De Carvalho Bittencourt M, Decot V, Reppel L, Salmon A, Clement L, Bensoussan D. Curative or pre-emptive adenovirus-specific T cell transfer from matched unrelated or third party haploidentical donors after HSCT, including UCB transplantations: a successful phase I/II multicenter clinical trial. J Hematol Oncol 2017; 10:102. [PMID: 28482908 PMCID: PMC5421327 DOI: 10.1186/s13045-017-0469-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (HSCT), the most widely used potentially curable cellular immunotherapeutic approach in the treatment of hematological malignancies, is limited by life-threatening complications: graft versus host disease (GVHD) and infections especially viral infections refractory to antiviral drugs. Adoptive transfer of virus-specific T cells is becoming an alternative treatment for infections following HSCT. We report here the results of a phase I/II multicenter study which includes a series of adenovirus-specific T cell (ADV-VST) infusion either from the HSCT donor or from a third party haploidentical donor for patients transplanted with umbilical cord blood (UCB). METHODS Fourteen patients were eligible and 11 patients received infusions of ADV-VST generated by interferon (IFN)-γ-based immunomagnetic isolation from a leukapheresis from their original donor (42.9%) or a third party haploidentical donor (57.1%). One patient resolved ADV infection before infusion, and ADV-VST could not reach release or infusion criteria for two patients. Two patients received cellular immunotherapy alone without antiviral drugs as a pre-emptive treatment. RESULTS One patient with adenovirus infection and ten with adenovirus disease were infused with ADV-VST (mean 5.83 ± 8.23 × 103 CD3+IFN-γ+ cells/kg) up to 9 months after transplantation. The 11 patients showed in vivo expansion of specific T cells up to 60 days post-infusion, associated with adenovirus load clearance in ten of the patients (91%). Neither de novo GVHD nor side effects were observed during the first month post-infusion, but GVHD reactivations occurred in three patients, irrespective of the type of leukapheresis donor. For two of these patients, GVHD reactivation was controlled by immunosuppressive treatment. Four patients died during follow-up, one due to refractory ADV disease. CONCLUSIONS Adoptive transfer of rapidly isolated ADV-VST is an effective therapeutic option for achieving in vivo expansion of specific T cells and clearance of viral load, even as a pre-emptive treatment. Our study highlights that third party haploidentical donors are of great interest for ADV-VST generation in the context of UCB transplantation. (N° Clinical trial.gov: NCT02851576, retrospectively registered).
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Affiliation(s)
- Chongsheng Qian
- Unité de Thérapie cellulaire et Tissus and FR 3209, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France.,UMR 7365 and FR 3209 CNRS-UL-CHU, Université de Lorraine, Vandoeuvre-Lès-Nancy, F54511, France
| | - Arnaud Campidelli
- Unité de Thérapie cellulaire et Tissus and FR 3209, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France
| | - Yingying Wang
- Unité de Thérapie cellulaire et Tissus and FR 3209, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France.,UMR 7365 and FR 3209 CNRS-UL-CHU, Université de Lorraine, Vandoeuvre-Lès-Nancy, F54511, France
| | - Huili Cai
- Laboratoire d'Immunologie and Plateforme Nancytomique, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France
| | - Véronique Venard
- Laboratoire de Virologie, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France
| | - Hélène Jeulin
- Laboratoire de Virologie, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France
| | - Jean Hugues Dalle
- Immuno-Hématologie pédiatrique, Hôpital Robert Debré, Paris, F75935, France
| | - Cécile Pochon
- Unité de Transplantation Médullaire Allogénique, CHRU de Nancy, Vandoeuvre-lès-Nancy, F54511, France
| | - Maud D'aveni
- Unité de Transplantation Médullaire Allogénique, CHRU de Nancy, Vandoeuvre-lès-Nancy, F54511, France
| | - Benedicte Bruno
- Hématologie pédiatrique, Hôpital Jeanne de Flandres CHU de Lille, Lille cedex, F59037, France
| | | | - Stéphane Vigouroux
- Groupe hospitalier Sud Hôpital Haut-Lévêque, Hématologie clinique et thérapie cellulaire, Pessac Cedex, F33604, France
| | - Charlotte Jubert
- Hématologie Oncologie Pédiatrique, Hôpital des Enfants Pellegrin, Bordeaux, F33000, France
| | - Patrice Ceballos
- Hématologie Clinique, Hôpital St Eloi, Montpellier, Cedex 5, F34295, France
| | - Aude Marie-Cardine
- Hématologie et Oncologie Pédiatrique, Hôpital Charles Nicolle-CHU de Rouen, Rouen, F76031, France
| | - Claire Galambrun
- Immuno-hématologie Pédiatrique, CHU de la Timone, Marseille, F13385, France
| | - Clément Cholle
- Faculté de Pharmacie, Département de Microbiologie-Immunologie, Université de Lorraine, Nancy, F54001, France
| | - Isabelle Clerc Urmes
- Plateform of Clinical Research Facility PARC, Unit of Methodology, Data Management and Statistics, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France
| | - Nadine Petitpain
- Centre Régional de Pharmacovigilance de Lorraine, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France
| | | | - Véronique Decot
- Unité de Thérapie cellulaire et Tissus and FR 3209, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France.,UMR 7365 and FR 3209 CNRS-UL-CHU, Université de Lorraine, Vandoeuvre-Lès-Nancy, F54511, France
| | - Loïc Reppel
- Unité de Thérapie cellulaire et Tissus and FR 3209, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France.,UMR 7365 and FR 3209 CNRS-UL-CHU, Université de Lorraine, Vandoeuvre-Lès-Nancy, F54511, France
| | - Alexandra Salmon
- Unité de Transplantation Médullaire Allogénique, CHRU de Nancy, Vandoeuvre-lès-Nancy, F54511, France
| | - Laurence Clement
- Unité de Transplantation Médullaire Allogénique, CHRU de Nancy, Vandoeuvre-lès-Nancy, F54511, France
| | - Danièle Bensoussan
- Unité de Thérapie cellulaire et Tissus and FR 3209, CHRU de Nancy, Vandoeuvre-Lès-Nancy, F54511, France. .,UMR 7365 and FR 3209 CNRS-UL-CHU, Université de Lorraine, Vandoeuvre-Lès-Nancy, F54511, France. .,Faculté de Pharmacie, Département de Microbiologie-Immunologie, Université de Lorraine, Nancy, F54001, France.
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9
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Kim TW, Lee SE, Lim JY, Ryu DB, Jeon YW, Yoon JH, Cho BS, Eom KS, Kim YJ, Kim HJ, Lee S, Cho SG, Kim DW, Lee JW, Min WS, Min CK. Clinical significance of pre-transplant circulating CD3 + CD4 + CD161 + cell frequency on the occurrence of neutropenic infections after allogeneic stem cell transplantation. Transpl Infect Dis 2017; 19. [PMID: 27910184 DOI: 10.1111/tid.12643] [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: 05/29/2016] [Revised: 08/13/2016] [Accepted: 09/04/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Few studies have been performed to identify factors that are associated with an increased risk of infections during the neutropenic period in patients undergoing allogeneic stem cell transplantation (allo-SCT). The aim of this study was to identify the host immune cells responsible for infections before engraftment. METHODS A total of 282 patients who underwent allo-SCT were enrolled. Peripheral blood samples were collected before conditioning therapy. Expression of CD161-expressing T cells, natural killer cells, and immature myeloid cells was analyzed by flow cytometry. Microbially and clinically defined infections and fevers of unknown origin as proposed by the Immunocompromised Host Society were included in this study. RESULTS The median age was 45 years (range, 16-68 years). Patients had various hematologic disorders and were transplanted from human leukocyte antigen (HLA)-matched siblings, unrelated donors, and familial HLA-mismatched donors. In univariate analysis, younger age and a familial HLA-mismatched donor were risk factors for the occurrence of infections. After adjusting for potential variables in univariate analysis, multivariate analyses revealed that a lower frequency of CD3+ CD4+ CD161+ cells was significantly associated with the occurrence of neutropenic infections. An age of 35 years or younger and allografting from familial HLA-mismatched donors showed a trend toward higher infection rates. CONCLUSION Our data indicated that a lower frequency of CD3+ CD4+ CD161+ T cells in peripheral blood before conditioning therapy was associated with a higher incidence of infection during the neutropenic period. These results suggest that recipient innate T cells with expression of C-type lectin CD161 can guard against infections before engraftment.
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Affiliation(s)
- Tae Woo Kim
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Eun Lee
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Young Lim
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Da-Bin Ryu
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Woo Jeon
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Ho Yoon
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Sik Cho
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Ki-Seong Eom
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Yoo-Jin Kim
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Seok Lee
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Seok-Goo Cho
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Wook Kim
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Jong Wook Lee
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo-Sung Min
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
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10
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Clavert A, Peric Z, Brissot E, Malard F, Guillaume T, Delaunay J, Dubruille V, Le Gouill S, Mahe B, Gastinne T, Blin N, Harousseau JL, Moreau P, Milpied N, Mohty M, Chevallier P. Late Complications and Quality of Life after Reduced-Intensity Conditioning Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2017; 23:140-146. [DOI: 10.1016/j.bbmt.2016.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/12/2016] [Indexed: 12/14/2022]
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11
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Mohty M, Malard F, Blaise D, Milpied N, Socié G, Huynh A, Reman O, Yakoub-Agha I, Furst S, Guillaume T, Tabrizi R, Vigouroux S, Peterlin P, El-Cheikh J, Moreau P, Labopin M, Chevallier P. Sequential regimen of clofarabine, cytosine arabinoside and reduced-intensity conditioned transplantation for primary refractory acute myeloid leukemia. Haematologica 2016; 102:184-191. [PMID: 27561720 DOI: 10.3324/haematol.2016.150326] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/18/2016] [Indexed: 11/09/2022] Open
Abstract
The prognosis of patients with acute myeloid leukemia in whom primary treatment fails remains very poor. In order to improve such patients' outcome, we conducted a phase 2, prospective, multicenter trial to test the feasibility of a new sequential regimen, combining a short course of intensive chemotherapy and a reduced intensity-conditioning regimen, before allogeneic stem-cell transplantation. Twenty-four patients (median age, 47 years) with acute myeloid leukemia in primary treatment failure were included. Cytogenetic risk was poor in 15 patients (62%) and intermediate in nine (38%). The sequential regimen consisted of clofarabine (30 mg/m2/day) and cytosine arabinoside (1 g/m2/day) for 5 days, followed, after a 3-day rest, by reduced-intensity conditioning and allogeneic stem-cell transplantation combining cyclophosphamide (60 mg/kg), intravenous busulfan (3.2 mg/kg/day) for 2 days and anti-thymocyte globulin (2.5 mg/kg/day) for 2 days. Patients in complete remission at day +120 received prophylactic donor lymphocyte infusion. Eighteen patients (75%) achieved complete remission. With a median follow-up of 24.6 months, the Kaplan-Meier estimate of overall survival was 54% (95% CI: 33-71) at 1 year and 38% (95% CI: 18-46) at 2 years. The Kaplan-Meier estimate of leukemia-free survival was 46% (95% CI: 26-64) at 1 year and 29% (95% CI: 13-48) at 2 years. The cumulative incidence of non-relapse mortality was 8% (95% CI: 1-24) at 1 year and 12% (95% CI: 3-19) at 2 years. Results from this phase 2 prospective multicenter trial endorsed the safety and efficacy of a clofarabine-based sequential reduced-toxicity conditioning regimen, which warrants further investigation. This study was registered at www.clinicaltrials.gov, identifier number: NCT01188174.
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Affiliation(s)
- Mohamad Mohty
- Hematology Department, Centre Hospitalier et Universitaire (CHU) de Nantes, France .,Centre d'Investigation Clinique en Cancérologie (CI2C), CHU de Nantes, France.,Centre de Recherche Saint-Antoine, INSERM, UMRS 938, France.,Université Pierre et Marie Curie, Paris, France.,Hematology Department, AP-HP, Université Paris 6, Hôpital Saint Antoine, France
| | - Florent Malard
- Hematology Department, Centre Hospitalier et Universitaire (CHU) de Nantes, France.,Centre de Recherche Saint-Antoine, INSERM, UMRS 938, France.,Université Pierre et Marie Curie, Paris, France.,Hematology Department, AP-HP, Université Paris 6, Hôpital Saint Antoine, France
| | - Didier Blaise
- Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France
| | - Noel Milpied
- Hematology Department, CHU Haut-Lévêque, Bordeaux, France
| | - Gérard Socié
- Service de Greffe de Moelle, AP-HP, Université Paris 7, Hôpital Saint Louis, France
| | - Anne Huynh
- Hematology Department, IUCT Oncopole, Toulouse, France
| | - Oumédaly Reman
- Institut d'hématologie de Basse Normandie, CHU, Côte de Nacre 14000 Caen, France
| | | | - Sabine Furst
- Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France
| | - Thierry Guillaume
- Hematology Department, Centre Hospitalier et Universitaire (CHU) de Nantes, France
| | - Resa Tabrizi
- Hematology Department, CHU Haut-Lévêque, Bordeaux, France
| | | | - Pierre Peterlin
- Hematology Department, Centre Hospitalier et Universitaire (CHU) de Nantes, France
| | - Jean El-Cheikh
- Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France
| | - Philippe Moreau
- Hematology Department, Centre Hospitalier et Universitaire (CHU) de Nantes, France.,Centre d'Investigation Clinique en Cancérologie (CI2C), CHU de Nantes, France
| | - Myriam Labopin
- Hematology Department, AP-HP, Université Paris 6, Hôpital Saint Antoine, France
| | - Patrice Chevallier
- Hematology Department, Centre Hospitalier et Universitaire (CHU) de Nantes, France.,Centre d'Investigation Clinique en Cancérologie (CI2C), CHU de Nantes, France
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12
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Larger number of invariant natural killer T cells in PBSC allografts correlates with improved GVHD-free and progression-free survival. Blood 2016; 127:1828-35. [PMID: 26903546 DOI: 10.1182/blood-2015-12-688739] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/13/2016] [Indexed: 12/18/2022] Open
Abstract
We studied the impact of a set of immune cells contained within granulocyte colony-stimulating factor-mobilized peripheral blood stem cell grafts (naïve and memory T-cell subsets, B cells, regulatory T cells, invariant natural killer T cells [iNKTs], NK cells, and dendritic cell subsets) in patients (n = 80) undergoing allogeneic stem cell transplantation (SCT), using the composite end point of graft-versus-host disease (GVHD)-free and progression-free survival (GPFS) as the primary end point. We observed that GPFS incidences in patients receiving iNKT doses above and below the median were 49% vs 22%, respectively (P= .007). In multivariate analysis, the iNKT dose was the only parameter with a significant impact on GPFS (hazard ratio = 0.48; 95% confidence interval, 0.27-0.85;P= .01). The incidences of severe grade III to IV acute GVHD and National Institutes of Health grade 2 to 3 chronic GVHD (12% and 16%, respectively) were low and associated with the use of antithymocyte globulin in 91% of patients. No difference in GVHD incidence was reported according to the iNKT dose. In conclusion, a higher dose of iNKTs within the graft is associated with an improved GPFS. These data may pave the way for prospective and active interventions aiming to manipulate the graft content to improve allo-SCT outcome.
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13
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Wanquet A, Crocchiolo R, Furst S, Granata A, Faucher C, Devillier R, Harbi S, Lemarie C, Calmels B, Vey N, Weiller PJ, Chabannon C, Castagna L, Blaise D, El-Cheikh J. The efficacy and safety of a new reduced-toxicity conditioning with 4 days of once-daily 100 mg/m(2) intravenous busulfan associated with fludarabine and antithymocyte globulins prior to allogeneic stem cell transplantation in patients with high-risk myelodysplastic syndrome or acute leukemia. Leuk Lymphoma 2016; 57:2315-20. [PMID: 26885686 DOI: 10.3109/10428194.2016.1146948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The optimal intensity of myeloablation associated with a reduced-toxicity conditioning (RTC) regimen in order to decrease the relapse rate without increasing non-relapse mortality (NRM), is not well established yet. This retrospective analysis was done on 30 patients with hematological malignancies. The aim was to assess the safety of a RTC regimen based on the busulfan at a dose of 100 mg/m(2)/d intravenously for 4 d, fludarabine at a dose of 30 mg/m(2)/d for 5 d, and anti-thymoglobulins at a dose of 2.5 mg/kg/d for 2 d. The cumulative incidences of grade 2-4 acute graft-versus-host disease (GVHD) and all grades chronic GVHD were 37% and 42%, respectively. Median 1-year overall survival and disease-free survival were 66% and 50%, respectively. At 1 year, the cumulative incidence of relapse/disease progression was 33%. NRM was 3% and 17% at day 100 and 1 year, respectively. This RTC conditioning regimen can lead to a long-term disease control. Moreover, it appears to be safe with a low NRM rate among high-risk patients.
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Affiliation(s)
- Anne Wanquet
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Roberto Crocchiolo
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Sabine Furst
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Angela Granata
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Catherine Faucher
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Raynier Devillier
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Samia Harbi
- c Centre de Thérapie Cellulaire , Institut Paoli-Calmettes , Marseille , France
| | - Claude Lemarie
- c Centre de Thérapie Cellulaire , Institut Paoli-Calmettes , Marseille , France
| | - Boris Calmels
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Norbert Vey
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Pierre Jean Weiller
- c Centre de Thérapie Cellulaire , Institut Paoli-Calmettes , Marseille , France
| | - Christian Chabannon
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Luca Castagna
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Didier Blaise
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Jean El-Cheikh
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
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14
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Hematopoietic stem cell transplantation for patients with AML in first complete remission. Blood 2016; 127:62-70. [DOI: 10.1182/blood-2015-07-604546] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/07/2015] [Indexed: 12/31/2022] Open
Abstract
Abstract
Postremission therapy in patients with acute myeloid leukemia (AML) may consist of continuing chemotherapy or transplantation using either autologous or allogeneic stem cells. Patients with favorable subtypes of AML generally receive chemotherapeutic consolidation, although recent studies have also suggested favorable outcome after hematopoietic stem cell transplantation (HSCT). Although allogeneic HSCT (alloHSCT) is considered the preferred type of postremission therapy in poor- and very-poor-risk AML, the place of alloHSCT in intermediate-risk AML is being debated, and autologous HSCT is considered a valuable alternative that may be preferred in patients without minimal residual disease after induction chemotherapy. Here, we review postremission transplantation strategies using either autologous or allogeneic stem cells. Recent developments in the field of alternative donors, including cord blood and haploidentical donors, are highlighted, and we discuss reduced-intensity alloHSCT in older AML recipients who represent the predominant category of patients with AML who have a high risk of relapse in first remission.
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15
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Effect of graft source on unrelated donor hemopoietic stem cell transplantation in adults with acute myeloid leukemia after reduced-intensity or nonmyeloablative conditioning: a study from the Société Francaise de Greffe de Moelle et de Thérapie Cellulaire. Biol Blood Marrow Transplant 2015; 21:1059-67. [PMID: 25708220 DOI: 10.1016/j.bbmt.2015.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/14/2015] [Indexed: 01/09/2023]
Abstract
This retrospective report compared the 4-year outcomes of allogeneic stem cell transplantation (allo-SCT) in 651 adult patients with acute myeloid leukemia receiving a reduced-intensity (RIC) or nonmyeloablative conditioning (NMA) regimen according to the type of unrelated donors. These were either umbilical cord blood (UCB, n = 205), a 9/10 mismatched unrelated donor (MisMUD, n = 99), or a 10/10 matched unrelated donor (MUD, n = 347) graft. Neutrophil recovery was slower in UCB (74.5% by day 42) compared with MisMUD (94.8%) and MUD (95.6%) (P < .001). There was no significant difference in nonrelapse mortality between UCB and both MUD (hazard ratio [HR], 1.05; 95% confidence interval [CI], .62 to 1.78; P = .85) and MisMUD (HR, 1.58; 95% CI, .88 to 2.83; P = .13) The relapse/progression was similar between UCB and MisMUD (HR, .62; 95% CI, .37 to 1.03; P = .07), but was significantly lower in MUD compared with UCB (HR, .60; 95% CI, .39 to .92; P = .02). The rate of extensive chronic graft-versus-host disease (GVHD) was similar between UCB and both MUD (HR, 2.15; 95% CI, .93 to 4.97; P = .08) and MisMUD (HR, 1.84; 95% CI, .68 to 4.95; P = .23). The rate of severe grade III and IV acute GVHD was significantly increased in MisMUD compared with UCB (HR, 2.61; 95% CI, 1.30 to 5.23; P = .007). There was no significant difference in overall survival between UCB and both MisMUD (HR, .98; 95% CI, .66 to 1.45; P = .92) and MUD (HR, .74; 95% CI, .52 to 1.03; P = .08). These data suggest that in the setting of RIC/NMA, allo-SCT UCB is a valid alternative graft source, with significantly less chronic GVHD, compared with MisMUD, when there is no MUD available or when urgent transplantation is needed.
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16
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The association between donor and recipient statin use and infections after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2015; 50:444-8. [PMID: 25599167 DOI: 10.1038/bmt.2014.279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/09/2014] [Accepted: 11/01/2014] [Indexed: 12/13/2022]
Abstract
Recent studies have reported that statin use may be associated with improved outcomes in patients with sepsis or respiratory viral infections. In the setting of allogeneic hematopoietic cell transplantation (HCT), it has been shown that donor and recipient statin use is associated with reduced risks of GVHD. We assessed in retrospective analysis whether donor or recipient statin use impacts infection risk after allogeneic HCT (n=1191). Although recipient statin use was associated with the increased incidence of Gram-negative bacteremia (adjusted hazard ratio (aHR) 2.22, (95% confidence interval (CI) 1.2-4.2), P=0.01) without affecting mortality, donor statin use was associated with an increased incidence of respiratory viral infections in recipients (aHR 2.84 (95% CI 1.3-6.0), P=0.007). The overall incidence of invasive fungal infections and CMV reactivation and CMV disease were not impacted by recipient or donor statin use. In conclusion, this study suggests that recipient or donor statin use may be associated with an increased incidence of some infections without adversely affecting mortality.
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17
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Mohty M, Malard F, Blaise D, Milpied N, Furst S, Tabrizi R, Guillaume T, Vigouroux S, El-Cheikh J, Delaunay J, Le Gouill S, Moreau P, Labopin M, Chevallier P. Reduced-toxicity conditioning with fludarabine, once-daily intravenous busulfan, and antithymocyte globulins prior to allogeneic stem cell transplantation: results of a multicenter prospective phase 2 trial. Cancer 2014; 121:562-9. [PMID: 25283774 DOI: 10.1002/cncr.29087] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/07/2014] [Accepted: 07/21/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND The optimal intensity of myeloablation delivered as part of a reduced-intensity/toxicity conditioning (RIC/RTC) regimen to decrease the recurrence rate, without increasing nonrecurrence mortality (NRM), remains to be established. METHODS The current phase 2, prospective, multicenter trial aimed to assess the efficacy and safety of an RIC/RTC regimen based on busulfan at a dose of 130 mg/m(2) /day intravenously for 3 days, fludarabine at a dose of 30 mg/m(2) /day for 5 days, and antithymocyte globulins at a dose of 2.5 mg/kg/day for 2 days. A total of 80 patients (median age, 53 years; range, 25-64 years) with hematological malignancies were included. RESULTS With a median follow-up of 21 months (range, 12-36.5 months), the Kaplan-Meier estimates of overall and disease-free survival at 2 years were 62% (95% confidence interval [95% CI], 51%-73%) and 50% (95% CI, 33%-57%), respectively. The cumulative incidences of grade 2 to 4 acute graft-versus-host disease (GVHD) and chronic GVHD (all grades) were 29% (95% CI, 19%-39%) and 35% (95% CI, 24%-46%), respectively. At 2 years, the cumulative incidence of recurrence/disease progression and NRM were 44% (95% CI, 31%-56%) and 11% (95% CI, 6%-19%), respectively. Patient age, diagnosis, donor type, sex, presence of comorbidities, and the Hematopoietic cell transplantation-specific comorbidities index did not appear to have any statistically significant impact on NRM, recurrence/disease progression, disease-free survival, or overall survival. CONCLUSIONS The RIC/RTC regimen used in the current study appeared to be safe, with a low NRM rate at 2 years noted among high-risk patients, and efficient disease control, warranting prospective phase 3 trials.
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Affiliation(s)
- Mohamad Mohty
- Hematology Department, Nantes University Medical Center, Nantes, France; Cancerologie Reserch Center Nantes Angers, INSERM 892, CNRS 6299, University of Nantes School of Medicine, Nantes, France; Center for Clinical Investigation of Cancer, Nantes University Medical Center, Nantes, France; Hematology Department, AP-HP, Paris University 6, Saint Antoine Hospital, Paris, France
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18
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Feucht J, Leibold J, Halder A, Kayser S, Hartl L, Rammensee HG, Handgretinger R, Feuchtinger T. Differential expression of THELPER 1 cytokines upon antigen stimulation predicts ex vivo proliferative potential and cytokine production of virus-specific T cells following re-stimulation. Transpl Infect Dis 2014; 16:713-23. [PMID: 25200928 DOI: 10.1111/tid.12281] [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: 01/23/2014] [Revised: 04/28/2014] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Cytomegalovirus (CMV) and human adenovirus (ADV) infections are causes of morbidity after stem cell transplantation. Antigen (Ag)-specific T cells are essential for the control of viral infections. However, in vivo expansion potential of T-cell subpopulations is hardly predictable in humans. Furthermore, ex vivo identification of human T cells with repopulating capacity for adoptive T-cell transfer has been difficult. METHODS We analyzed Ag-specific T-cell populations, subdivided according to the expression of different THELPER- 1 (Th1) cytokines. Isolation by flow cytometry was based on interferon-gamma (IFN)-γ, interleukin (IL)-2, or tumor necrosis factor-alpha (TNF-α) secretion of T cells after ex vivo stimulation with the Ags hexon (for ADV) and pp65 (for CMV). Isolated T cells were expanded and examined for functional characteristics, expansion/differentiation potential, and naïve, effector memory, central memory, and late effector phenotypes. RESULTS Isolation based on IFN-γ production provides a T-cell population with a mixture of early, central memory, and effector memory T cells, high expansion potential, and effective cytokine production. Selection of T cells with Ag-specific expression of IL-2 or TNF-α, however, results in a T-cell population with reduced proliferation and lower effector potential after expansion. CONCLUSION We conclude that the exclusive secretion of IFN-γ in the human antiviral T-cell responses preferentially leads to higher repopulation capacities of antiviral T cells, compared to IL-2 or TNF-α secreting T-cell populations.
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Affiliation(s)
- J Feucht
- Department of Pediatric Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
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Stable long-term pulmonary function after fludarabine, antithymocyte globulin and i.v. BU for reduced-intensity conditioning allogeneic SCT. Bone Marrow Transplant 2014; 49:622-7. [PMID: 24535125 DOI: 10.1038/bmt.2014.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/13/2013] [Accepted: 09/13/2013] [Indexed: 01/22/2023]
Abstract
Lung function decline is a well-recognized complication following allogeneic SCT (allo-SCT). Reduced-intensity conditioning (RIC) and in vivo T-cell depletion by administration of antithymocyte globulin (ATG) may have a protective role in the occurrence of late pulmonary complications. This retrospective study reported the evolution of lung function parameters within the first 2 years after allo-SCT in a population receiving the same RIC regimen that included fludarabine and i.v. BU in combination with low-dose ATG. The median follow-up was 35.2 months. With a median age of 59 years at the time of transplant, at 2 years, the cumulative incidences of non-relapse mortality was as low as 9.7%. The cumulative incidence of relapse was 33%. At 2 years, the cumulative incidences of extensive chronic GVHD (cGVHD) and of pulmonary cGVHD were 23.1% and 1.9%, respectively. The cumulative incidences of airflow obstruction and restrictive pattern were 3.8% and 9.6%, respectively. Moreover, forced expiratory volume (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio remained stable from baseline up to 2 years post transplantation (P=0.26, P=0.27 and P=0.07, respectively). These results correspond favorably with the results obtained with other RIC regimens not incorporating ATG, and suggest that ATG may have a protective pulmonary role after allo-SCT.
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20
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Castagnola E, Faraci M. Management of bacteremia in patients undergoing hematopoietic stem cell transplantation. Expert Rev Anti Infect Ther 2014; 7:607-21. [DOI: 10.1586/eri.09.35] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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21
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22
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18F-FDG PET/CT for the assessment of gastrointestinal GVHD: results of a pilot study. Bone Marrow Transplant 2013; 49:131-7. [PMID: 24076550 DOI: 10.1038/bmt.2013.144] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/31/2013] [Accepted: 08/07/2013] [Indexed: 01/25/2023]
Abstract
This prospective pilot study aimed to evaluate the predictive value of (18)F-FDG PET/CT for early diagnosis of acute gastrointestinal GVHD (GI-GVHD). In all, 42 consecutive patients who received allo-SCT were included. (18)F-FDG PET/CT was systematically performed at a median of 28 (range, 24-38) days after allo-SCT. (18)F-FDG PET/CT data review was positive in 15 cases (36%) (9 true positive (TP) cases and 6 false positive (FP) cases) and negative in 27 cases (64%; 26 true negative (TN) cases and 1 false negative (FN) case) at visual analysis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of (18)F-FDG PET/CT for the diagnosis of acute GI-GVHD were, respectively, 81%, 90%, 60%, 96% and 83%. There were no significant differences of SUVmax values between grade 1-2 GI-GVHD and severe grade 3-4 GI-GVHD. Overall, these preliminary findings suggested that the inflammatory activity of the gastrointestinal tract associated with acute GI-GVHD could be assessed by (18)F-FDG PET/CT suggesting that noninvasive (18)F-FDG PET/CT could become a valuable examination to be performed shortly before endoscopy to map acute GI-GVHD lesions, guide the biopsy sites and choose the appropriate endoscopic procedure, especially in those asymptomatic patients with a positive (18)F-FDG PET/CT.
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Goker H, Ozdemir E, Uz B, Buyukasik Y, Turgut M, Serefhanoglu S, Aksu S, Sayinalp N, Haznedaroglu IC, Tekin F, Karacan Y, Unal S, Eliacik E, Isik A, Ozcebe OI. Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic hematopoietic stem cell transplantation for acute leukemia patients: a single center experience. Transfus Apher Sci 2013; 49:590-9. [PMID: 23981652 DOI: 10.1016/j.transci.2013.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/29/2013] [Indexed: 12/01/2022]
Abstract
Due to the high transplant related morbidity and mortality (TRM), relatively younger acute leukemia patients that have a good performance status and no comorbidity are eligible for myeloablative conditioning (MAC) followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). The outcomes of 84 consecutive adult patients with ALL (n=38) or AML (n=46) who underwent allo-HSCT from their HLA-identical siblings were evaluated retrospectively. The median age at transplantation was 34 (17-58 years) for the whole patient population. Of these, 24 patients received a MAC and 60 patients received a fludarabine-based reduced intensity conditioning regimen (RIC). After a median follow-up of 32 months (range, 1-119), for the entire group, the 3-year estimated overall survival (OS) was 57.5% and the disease-free survival (DFS) was 51.5%. The OS for ALL and AML patients were 53.9% vs 62.1%: and DFS were 50.5% and 53.4%, respectively. The 3-year estimated OS for RIC and MAC patients were 63.2% and 41.7%; and DFS were 57.1% and 34.7%, respectively. In ALL patients, conditioning regimens (RIC vs MAC) led to similar OS and DFS; however, in AML patients both OS (70.1% vs 21.4%) and DFS (59.3% vs 42.9%) were found to be higher in RIC patients compared to MAC recipients. Overall, the TRM at day 100 was 1.7% and has increased up to 5.1% at 1st year. In multivariate analysis, the diagnosis (p=0.03) and RIC regimen (p=0.027) were the prognostic variables for prolonged OS in all patients; and RIC regimen (p=0.031) was the only prognostic factor for prolonged OS in AML patients. The first complete remission (CR1) was correlated with a prolonged DFS as an independent variable for all patients (p=0.09). Eleven of the RIC patients (18.3%) and 6 of the MAC patients (25%) developed acute graft-versus-host disease (GvHD). Seventeen of the RIC patients (33.3%) and 4 of the MAC patients (16.7%) developed chronic GvHD. In conclusion, RIC conditioning regimens may provide a longer OS and DFS, especially in patients with AML who are in first CR, not eligible for MAC conditioning.
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Affiliation(s)
- Hakan Goker
- Division of Hematology, Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey
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24
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Malard F, Fürst S, Loirat M, Chevallier P, El-Cheikh J, Guillaume T, Delaunay J, Le Gouill S, Moreau P, Blaise D, Mohty M. Effect of graft source on mismatched unrelated donor hemopoietic stem cell transplantation after reduced intensity conditioning. Leukemia 2013; 27:2113-7. [PMID: 23752174 DOI: 10.1038/leu.2013.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/04/2013] [Accepted: 05/24/2013] [Indexed: 11/09/2022]
Abstract
This retrospective report compared the results of graft source on outcome after allogeneic stem cell transplantation (allo-SCT) in patients with hematologic malignancies receiving a reduced intensity conditioning (RIC) regimen. A total of 152 patients received either a RIC allo-SCT using a 9/10 mismatched unrelated donor (MisMUD, n=42) or a double unrelated umbilical cord blood (dUCB, n=110) graft. With a median follow-up of 30.3 months, the cumulative incidence of non-relapse mortality was 26% in the dUCB group versus 24% in the MisMUD group (P=0.95). Grade 3-4 acute graft-versus-host disease (GVHD) incidence was 19.7% in the dUCB group versus 21.4% in the MisMUD group (P=0.83). The cumulative incidence of extensive chronic GVHD at 2 years was 6.4% in the dUCB group versus 21.4% in the MisMUD group (P=0.02). The Kaplan-Meier estimate of overall survival at 2 years was comparable between both groups (52.3% (95% confidence interval (CI), 42.1-61.5%) in the dUCB group versus 47.9% (95% CI, 31.6-62.4%) in the MisMUD group, P=0.55). Progression-free survival at 2 years was 43.3% (95% CI, 33.7-52.5%) in the dUCB group versus 38.3% (95% CI, 23.2-53.3%) in the MisMUD group (P=0.55). These data suggest that dUCB is a valid alternative graft source with significantly less chronic GVHD compared with MisMUD in the setting of RIC allo-SCT.
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Affiliation(s)
- F Malard
- 1] Centre Hospitalier et Universitaire (CHU) de Nantes, Service d'Hématologie Clinique, Nantes, France [2] INSERM CRNCA UMR 892, Université de Nantes, Faculté de Médecine, Nantes, France
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25
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Itonaga H, Taguchi J, Fukushima T, Tsushima H, Sato S, Ando K, Sawayama Y, Matsuo E, Yamasaki R, Onimaru Y, Imanishi D, Imaizumi Y, Yoshida S, Hata T, Moriuchi Y, Honda S, Miyazaki Y. Distinct clinical features of infectious complications in adult T cell leukemia/lymphoma patients after allogeneic hematopoietic stem cell transplantation: a retrospective analysis in the Nagasaki transplant group. Biol Blood Marrow Transplant 2013; 19:607-15. [PMID: 23333533 DOI: 10.1016/j.bbmt.2013.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/15/2013] [Indexed: 11/16/2022]
Abstract
Although allogeneic hematopoietic stem cell transplantation (allo-SCT) is performed as a curative option in adult T cell leukemia-lymphoma (ATL) patients, its high transplantation-related mortality raises a serious issue. The clinical features of infectious complications after transplantation are not well known. To analyze the impact of infections after allo-SCT for ATL, we retrospectively compared infectious complications in 210 patients at 3 institutions in Nagasaki prefecture between 1997 and 2009. There were 91 patients with acute myeloid leukemia (AML), 51 with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL), and 68 with ATL. No patient received ganciclovir or foscarvir as prophylaxis, and most patients received antifungal prophylaxis with fluconazole or itraconazole. The cumulative incidence of cytomegalovirus (CMV) infection at 3 years was 69.2% in ATL patients versus 54.4% in AML patients (P = .0255). Cumulative infection-related mortality was significantly higher in ATL patients than in the 2 other groups (ATL versus AML, P = .0496; ATL versus ALL/LBL, P = .0075), and most death-causing pathogens were bacteria and fungus. The appearance of CMV infection was negatively associated with infectious mortality in ATL patients, but the P value for this association was near the borderline of significance (P = .0569). In multivariate analysis, transplantation using unrelated bone marrow and episodes of CMV infection were associated with worse overall survival in ATL patients, but were not in either AML or ALL/LBL patients. Collectively, the impact of infectious complications after transplantation in ATL patients was different from that in AML and ALL/LBL patients, suggesting that a more intensive strategy for infection control in ATL patients is required to reduce infectious mortality.
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Affiliation(s)
- Hidehiro Itonaga
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
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26
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El-Cheikh J, Vazquez A, Crocchiolo R, Furst S, Calmels B, Castagna L, Lemarie C, Granata A, Ladaique P, Oudin C, Faucher C, Chabannon C, Blaise D. Acute GVHD is a strong predictor of full donor CD3+ T cell chimerism after reduced intensity conditioning allogeneic stem cell transplantation. Am J Hematol 2012; 87:1074-8. [PMID: 22911907 DOI: 10.1002/ajh.23319] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 07/18/2012] [Accepted: 07/23/2012] [Indexed: 11/12/2022]
Abstract
The monitoring of chimerism is a standard procedure to assess engraftment and achievement of full donor lymphoid cells after reduced intensity conditioning (RIC) stem cell transplantation (Allo-SCT). However, there is no consensus on when and how often to monitor post-transplant chimerism. We retrospectively analyzed our experience regarding the impact of acute graft versus host disease (GVHD) for the prediction of allograft chimerism. One-hundred-and-fifteen patients transplanted between 2001 and 2010 were identified. This group included 57 females and 58 males with a median age of 50 years (range: 26-68). Patients evaluated in this study were adult patients with hematologic malignancies, who received transplants from an HLA-matched sibling donor or matched unrelated donor (MUD) at allele level so-called 10/10, and received the RIC regimen including fludarabine/busulfan and anti-thymoglobulin (ATG). Mixed T-cell chimerism was defined as between 5 and 94% recipient cells, and full chimerism was defined as the presence of more than 95% donor T-cell chimerism (TCC). Full donor TCC was achieved in 93 patients (81%) at a median of 77 days (range: 30-120) post-transplant. The cumulative incidence of Grade 2-4 GVHD in our population was 25% (95% CI 17-34). The analysis of the population of patients with acute GVHD grade ≥2 showed that at day 120 after Allo-SCT they all had a total full donor TCC. On the other hand, 78 (68%) patients without acute GVHD grade ≥2 presented with mixed chimerism (p = 0.002) on day 120 post-transplant. Interestingly, patients who received ATG 5 mg/kg obtained a higher probability of complete chimerism compared with those receiving 2.5 mg/kg (p = 0.03). In conclusion, our study demonstrates that acute GVHD was predictive of full donor TCC after RIC Allo-SCT. Therefore, our data may challenge the concept of the frequent or close monitoring of donor chimerism in some patients with ongoing acute GVHD. However, chimerism testing could represent an attractive modality for minimal residual disease detection or for impeding relapse warranting further prospective studies.
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Affiliation(s)
- Jean El-Cheikh
- Unité de Transplantation et de Thérapie Cellulaire (U2T), Département d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
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27
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Icheva V, Kayser S, Wolff D, Tuve S, Kyzirakos C, Bethge W, Greil J, Albert MH, Schwinger W, Nathrath M, Schumm M, Stevanovic S, Handgretinger R, Lang P, Feuchtinger T. Adoptive transfer of epstein-barr virus (EBV) nuclear antigen 1-specific t cells as treatment for EBV reactivation and lymphoproliferative disorders after allogeneic stem-cell transplantation. J Clin Oncol 2012; 31:39-48. [PMID: 23169501 DOI: 10.1200/jco.2011.39.8495] [Citation(s) in RCA: 200] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Reactivation of Epstein-Barr virus (EBV) after allogeneic stem-cell transplantation (SCT) can lead to severe life-threatening infections and trigger post-transplantation lymphoproliferative disease (PTLD). Since EBV-specific T cells could prevent PTLD, cellular immunotherapy has been a promising treatment option. However, generation of antigen-specific T-cell populations has been difficult within a short time frame. PATIENTS AND METHODS To improve availability in urgent clinical conditions, we developed a rapid protocol for isolation of polyclonal EBV nuclear antigen 1 (EBNA-1) -specific T cells by using an interferon gamma (IFN-γ) capture technique. RESULTS We report on the use of adoptive transfer of EBNA-1-specific T cells in 10 pediatric and adult patients with EBV viremia and/or PTLD after SCT. No acute toxicity or graft-versus-host disease (GVHD) of more than grade 2 occurred as a result of adoptive T-cell transfer. In vivo expansion of transferred EBNA-1-specific T cells was observed in eight of 10 patients after a median of 16 days following adoptive transfer that was associated with clinical and virologic response in seven of them (70%). None of the responders had EBV-associated mortality. Within clinical responders, three patients were disease free by the day of last follow-up (2 to 36 months), three patients died of other infectious complications, and one patient died as a result of relapse of malignancy. EBV-related mortality was observed in two of 10 patients, and another patient had ongoing viremia without clinical symptoms at last follow-up. CONCLUSION Adoptive ex vivo transfer of EBNA-1-specific T cells is a feasible and well-tolerated therapeutic option, representing a fast and efficient procedure to achieve reconstitution of antiviral T-cell immunity after SCT.
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Affiliation(s)
- Vanya Icheva
- University Children's Hospital, Tübingen, Germany
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Clavert A, Chevallier P, Guillaume T, Delaunay J, Le Gouill S, Mahe B, Dubruille V, Gastinne T, Blin N, Moreau P, Mohty M. Safety and efficacy of rituximab in steroid-refractory chronic GVHD. Bone Marrow Transplant 2012; 48:734-6. [PMID: 23085828 DOI: 10.1038/bmt.2012.203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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El Cheikh J, Castagna L, Wang L, Esterni B, Faucher C, Furst S, Duran S, Berger P, Ranque S, Mohty M, Blaise D. Once-weekly liposomal amphotericin B for prophylaxis of invasive fungal infection after graft-versus-host disease in allogeneic hematopoietic stem cell transplantation: a comparative retrospective single-center study. Hematol Oncol Stem Cell Ther 2012; 3:167-73. [PMID: 21150235 DOI: 10.5144/1658-3876.2010.167] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The liposomal formulation of amphotericin B (LAmB) has been shown to cause few and mild infusion-related reactions, while achieving high plasma and tissue concentrations compared with conventional amphotericin B. We investigated the efficacy and safety of high-dose LAmB (7.5 mg/kg once weekly) prophylaxis of fungal infections in allogeneic stem-cell transplanted (allo-SCT) patients with graft-versus-host disease (GvHD). DESIGN AND SETTING Retrospective, comparative, single-center. METHODS Forty-two patients receiving high-dose prednisone for GvHD after allo-SCT had LAmB prophylaxis; 83 patients in the control group received other antifungal prophylaxis. RESULTS In the LAmB prophylaxis group, the median duration of treatment was 7 weeks. The cumulative incidence of invasive fungal infection was 8% at 1 year after transplantation, 8% at 2 years and 16% at 3 years in the LAmB group vs. 36% at 1 year, 44% at 2 years and 49% at 3 years in the other prophylaxis group (P=.008). Fungal infection-related mortality after transplantation was observed in none of the patients in the LAmB prophylaxis group vs. 12 patients (14%) at 1 year, 14 patients (17%) at 2 years and 16 patients (19%) at 3 years in the control group (P=.005). The tolerance of the treatment was good with only 5 patients (12%) having a reversible nephrotoxicity leading to temporary treatment discontinuation. CONCLUSIONS High-dose LAmB prophylaxis seems effective and well tolerated in this short series of allo-SCT patients with GvHD. Prospective clinical studies are required to confirm these results.
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Facchini L, Martino R, Ferrari A, Piñana JL, Valcárcel D, Barba P, Granell M, Delgado J, Briones J, Sureda A, Brunet S, Sierra J. Degree of mucositis and duration of neutropenia are the major risk factors for early post-transplant febrile neutropenia and severe bacterial infections after reduced-intensity conditioning. Eur J Haematol 2011; 88:46-51. [DOI: 10.1111/j.1600-0609.2011.01724.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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31
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Goussetis E, Peristeri I, Kitra V, Vessalas G, Paisiou A, Theodosaki M, Petrakou E, Dimopoulou MN, Graphakos S. HLA-matched sibling stem cell transplantation in children with β-thalassemia with anti-thymocyte globulin as part of the preparative regimen: the Greek experience. Bone Marrow Transplant 2011; 47:1061-6. [DOI: 10.1038/bmt.2011.219] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Malard F, Cahu X, Clavert A, Brissot E, Chevallier P, Guillaume T, Delaunay J, Ayari S, Dubruille V, Mahe B, Gastinne T, Blin N, Harousseau JL, Moreau P, Miplied N, Le Gouill S, Mohty M. Fludarabine, Antithymocyte Globulin, and Very Low-Dose Busulfan for Reduced-Intensity Conditioning before Allogeneic Stem Cell Transplantation in Patients with Lymphoid Malignancies. Biol Blood Marrow Transplant 2011; 17:1698-703. [DOI: 10.1016/j.bbmt.2011.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 04/25/2011] [Indexed: 12/11/2022]
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Topcuoglu P, Arat M, Ozcan M, Arslan O, Ilhan O, Beksac M, Gurman G. Case-matched comparison with standard versus reduced intensity conditioning regimen in chronic myeloid leukemia patients. Ann Hematol 2011; 91:577-86. [PMID: 21971669 DOI: 10.1007/s00277-011-1349-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 09/26/2011] [Indexed: 01/01/2023]
Abstract
This retrospective case-matched study evaluated the efficacy of reduced intensity conditioning (RIC) regimen on early and late allogeneic transplant outcome in chronic myeloid leukemia (CML) patients. Twenty-eight patients conditioned with RIC regimen were matched to 56 patients who received a myeloablative conditioning (MAC) regimen. The main criteria for case matching among our CML allotransplant cohort were the Gratwohl scoring system. The median score was 2 (1-4) in each group. The pretransplant disease status was first chronic phase (CP1, n = 20), CP2 (n = 2), and advanced phase (n = 6) in RIC, and CP1 (n = 46), CP2 (n = 3), and advanced phase (n = 7) in MAC. The duration of neutropenia and thrombocytopenia was shorter in RIC than MAC. The grade and duration of mucositis were less in RIC. The need for total parenteral nutrition (21% vs. 77%, p < 0.0001) and febrile neutropenic episodes (50% vs. 95%, p < 0.0001) were observed less frequently in RIC compared with MAC-given patients. Acute or chronic graft versus host diseases (GvHD) were not affected by the intensity of conditioning regimen. The incidence of transplant-related mortality was higher in MAC (7% vs. 14%, p = 0.01). Although more relapse/progression was observed in the RIC group, the probability of 5- and 10-year leukemia-free- and overall survival were similar regardless of conditioning regimen intensity (p > 0.05). In early first CP, the pair of female donor-male recipient and the development of chronic GvHD prolonged both leukemia-free survival and overall survival in multivariate analysis. According to our single-center matched-pair analysis, the use of RIC regimens in patients with low-risk CML results with toxicities less, responses later, and relapses more frequent than the MAC regimens.
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Affiliation(s)
- Pervin Topcuoglu
- Stem Cell Transplantation Unit, Department of Hematology, Faculty of Medicine, Ankara University, Cebeci Campus, 06590 Ankara, Turkey.
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Secondary Antifungal Prophylaxis in Hematopoietic Stem Cell Transplantation (HSCT)/Acute Leukemia Patients. Curr Infect Dis Rep 2011; 13:528-35. [PMID: 21931981 DOI: 10.1007/s11908-011-0214-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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35
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Kashiwazaki H, Matsushita T, Sugita J, Shigematsu A, Kasashi K, Yamazaki Y, Kanehira T, Kondo T, Endo T, Tanaka J, Hashino S, Nishio M, Imamura M, Kitagawa Y, Inoue N. A comparison of oral mucositis in allogeneic hematopoietic stem cell transplantation between conventional and reduced-intensity regimens. Support Care Cancer 2011; 20:933-9. [PMID: 21494780 DOI: 10.1007/s00520-011-1164-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 04/04/2011] [Indexed: 11/28/2022]
Abstract
Severe oral mucositis developed in allogeneic hematopoietic stem cell transplantation (HSCT) accompanies intolerable pain and risk for systemic bacteremia infection. Conventional stem cell transplantation (CST) and reduced-intensity regimens for allogeneic HSCT (RIST) may differently affect the occurrence and severity of oral mucositis. Here, we comparatively examined oral mucositis in patients undergoing CST and that in RIST patients to search for measures to alleviate oral mucositis. We retrospectively analyzed the data of 130 consecutive patients undergoing HSCT (conventional, 60; RIST, 70). Oral mucositis was evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. We also investigated the risk factors for severe oral mucositis in each regimen. The incidence of oral mucositis was not significantly different between RIST and CST patients. The use of opioid analgesics to control pain due to oral mucositis was significantly less in patients undergoing RIST compared with those receiving CST. The risk factors for severe oral mucositis, determined by univariate and multivariate analyses, were "younger age (<40)" in CST and "longer duration of neutropenia (≥ 14 days)" in RIST. Although the incidences of oral mucositis were almost the same, the need for opioid analgesics and the risk factors for severe oral mucositis differed between CST and RIST patients.
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Affiliation(s)
- Haruhiko Kashiwazaki
- Gerodontology, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine, Kita-13 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8586, Japan.
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36
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Allogreffes de cellules souches hématopoïétiques. Transfus Clin Biol 2011; 18:235-45. [DOI: 10.1016/j.tracli.2011.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/28/2011] [Indexed: 02/02/2023]
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37
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Peric Z, Cahu X, Chevallier P, Brissot E, Malard F, Guillaume T, Delaunay J, Ayari S, Dubruille V, Le Gouill S, Mahé B, Gastinne T, Blin N, Saulquin B, Harousseau JL, Moreau P, Coste-Burel M, Imbert-Marcille BM, Mohty M. Features of EBV reactivation after reduced intensity conditioning unrelated umbilical cord blood transplantation. Bone Marrow Transplant 2011; 47:251-7. [PMID: 21441959 DOI: 10.1038/bmt.2011.64] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This single centre study assessed the incidence, kinetics and predictive factors of EBV reactivation and EBV-related lymphoproliferative diseases (LPD) in 33 consecutive patients who received a reduced intensity conditioning (RIC) before umbilical cord blood transplantation (UCBT). During the first 6 months after UCBT, weekly all patients were DNA-PCR screened in the peripheral blood for EBV reactivation and were clinically monitored for clinical features attributable to EBV. The cumulative incidences of EBV reactivation (defined as an EBV load >1000 EBV copies per 10(5) cells measured at least once during follow-up) at 6 months and 2 years after UCBT were 9 (95% confidence interval (CI), 2-22%) and 17% (95% CI, 6-33%), respectively. In 28 patients (85%), the EBV load remained negative at all times, and none of these patients experienced any sign of LPD. Five patients (15%) experienced at least one EBV reactivation episode. EBV reactivation was observed at a median of 132 days (range, 85-438) after UCBT. Two patients developed EBV-related LPD (cumulative incidence, 6% at 3 years). With a median follow-up of 468 days (range, 92-1277) post UCBT, the OS was 62% at 3 years. Five patients died of disease progression and seven patients died of transplant-related complications, including one case of EBV-related LPD. Univariate analysis did not identify any significant risk factor associated with EBV reactivation. We conclude that patients undergoing RIC UCBT are at risk for EBV reactivation, with the need for close EBV monitoring and the use of preemptive rituximab treatment as some cases may progress to life-threatening LPD.
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Affiliation(s)
- Z Peric
- Service d'Hématologie Clinique, Centre Hospitalier et Universitaire (CHU) de Nantes, Nantes, France
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38
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Hamadani M, Craig M, Phillips GS, Abraham J, Tse W, Cumpston A, Gibson L, Remick SC, Bunner P, Leadmon S, Elder P, Hofmeister C, Penza S, Efebera Y, Andritsos L, Garzon R, Benson DM, Blum W, Devine SM. Higher busulfan dose intensity does not improve outcomes of patients undergoing allogeneic haematopoietic cell transplantation following fludarabine, busulfan-based reduced toxicity conditioning. Hematol Oncol 2011; 29:202-10. [PMID: 21360728 DOI: 10.1002/hon.985] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 01/30/2011] [Indexed: 01/02/2023]
Abstract
We evaluated the impact of busulfan dose intensity in patients undergoing reduced toxicity/intensity conditioning allogeneic transplantation in a multicenter retrospective study of 112 consecutive patients. Seventy-five patients were conditioned with busulfan (0.8 mg/kg/dose IV × 8 doses), fludarabine (30 mg/m(2) /day, days -7 to -3), and 6 mg/kg of ATG [reduced intensity conditioning (RIC) group], while 37 patients received a more-intense conditioning with busulfan (130 mg/m(2) /day IV, days -6 to -3), fludarabine (40 mg/m(2) /day, days -6 to -3) and 6 mg/kg of ATG [reduced toxicity conditioning (RTC) group]. At baseline both groups were matched for median age, unrelated donor allografts, and human leukocyte antigen-mismatched allografts. More patients in RIC group had high-risk disease, and higher median comorbidity index. There were no graft rejections. Median time to neutrophil (17 days vs. 15 days; p = 0.003) and platelet engraftment (16 days vs. 11 days; p < 0.001) was significantly longer in the RIC group. RTC group had significantly more bacterial (62.2% vs. 32%; p = 0.004) and fungal infections (13.5% vs. 1.3% p = 0.01). For RIC and RTC groups rates of grades II-IV acute GVHD (34% vs. 40%; p-value = 0.54), and chronic GVHD (45% vs. 57%; p-value = 0.30) were not significantly different. In similar order at 1 year the cumulative-incidence of non-relapse mortality (NRM; 12% vs. 21%; p-value = 0.21) and relapse rates (38% vs. 39%; p = 0.96) were not significantly different. Patients in RIC and RTC groups had similar 1-year overall survival (61% vs. 50%, p = 0.11) and progression-free survival (50% vs. 36%, p-value = 0.39). Our data suggest that the merits of higher busulfan dose intensity in the context of fludarabine/busulfan-based RTC may be offset by higher early morbidity.
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Affiliation(s)
- Mehdi Hamadani
- Osborn Hematopoietic Malignancy and Transplantation Program, MBRCC, West Virginia University, Morgantown, USA.
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39
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Features of Epstein-Barr Virus (EBV) reactivation after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation. Leukemia 2011; 25:932-8. [PMID: 21350556 DOI: 10.1038/leu.2011.26] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This single centre study assessed the incidence, kinetics and predictive factors of Epstein-Barr Virus (EBV) reactivation and EBV-related lymphoproliferative diseases (LPDs) in 175 consecutive patients who received a reduced-intensity conditioning (RIC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT). The cumulative incidence of EBV reactivation at 6 months after allo-HSCT defined as an EBV PCR load above 1000 copies of EBV DNA/10(5) cells was 15%, and none of these patients experienced any sign or symptom of LPD. A total of 17 patients, who had EBV DNA levels exceeding 1000 copies/10(5) cells on two or more occasions, were pre-emptively treated with rituximab. With a median follow-up of 655 (range, 92-1542) days post allo-HSCT, there was no statistically significant difference in term of outcome between those patients who experienced an EBV reactivation and those who did not. In multivariate analysis, the use of antithymocyte globulin as part of the RIC regimen was the only independent risk factor associated with EBV reactivation (relative risk=4.9; 95% confidence interval, 1.1-21.0; P=0.03). We conclude that patients undergoing RIC allo-HSCT using anti-thymocyte globulin as part of the preparative regimen are at higher risk for EBV reactivation. However, this did not impact on outcome, as quantitative monitoring of EBV viral load by PCR and preemptive rituximab therapy allowed for significantly reducing the risk of EBV-related LPD.
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40
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Busca A, Locatelli F, Flonta SE, Ciccone G, Baldi I, D'Ardia S, Allione B, Falda M. In vivo T-cell depletion with pretransplant low-dose antithymocyte globulin is associated with reduced transplant-related mortality and improved clinical outcome in patients receiving allogeneic hematopoietic stem cell transplantation from unrelated and partially matched related donors. Am J Hematol 2011; 86:214-7. [PMID: 21264911 DOI: 10.1002/ajh.21907] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Graft versus host disease (GVHD) represents one of the major limiting factors to the successful applicability of hematopoietic stem cells transplantation (HSCT). In particular, allogeneic HSCT from alternative donors with unmanipulated graft results in an increased risk of both acute and chronic GVHD compared with matched sibling donor transplants [1]. At the present, none of the GVHD prophylactic strategies currently in use, including calcineurin inhibitors [2], T-lymphocyte depletion, and monoclonal antibodies [3,4], have been proven to be of superior efficacy over another.
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Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Center, Ematologia II, AOU San Giovanni Battista, Turin, Italy
| | - Franco Locatelli
- Stem Cell Transplant Center, Ematologia II, AOU San Giovanni Battista, Turin, Italy
| | - Simona Emilia Flonta
- Stem Cell Transplant Center, Ematologia II, AOU San Giovanni Battista, Turin, Italy
| | - Gianni Ciccone
- Unit of Cancer Epidemiology, AOU San Giovanni Battista, CPO Piemonte, Turin, Italy
| | - Ileana Baldi
- Unit of Cancer Epidemiology, AOU San Giovanni Battista, CPO Piemonte, Turin, Italy
| | - Stefano D'Ardia
- Stem Cell Transplant Center, Ematologia II, AOU San Giovanni Battista, Turin, Italy
| | - Bernardino Allione
- Stem Cell Transplant Center, Ematologia II, AOU San Giovanni Battista, Turin, Italy
| | - Michele Falda
- Stem Cell Transplant Center, Ematologia II, AOU San Giovanni Battista, Turin, Italy
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41
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Gaber AO, Monaco AP, Russell JA, Lebranchu Y, Mohty M. Rabbit antithymocyte globulin (thymoglobulin): 25 years and new frontiers in solid organ transplantation and haematology. Drugs 2010; 70:691-732. [PMID: 20394456 DOI: 10.2165/11315940-000000000-00000] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The more than 25 years of clinical experience with rabbit antithymocyte globulin (rATG), specifically Thymoglobulin, has transformed immunosuppression in solid organ transplantation and haematology. The utility of rATG has evolved from the treatment of allograft rejection and graft-versus-host disease to the prevention of various complications that limit the success of solid organ and stem cell transplantation. Today, rATG is being successfully incorporated into novel therapeutic regimens that seek to reduce overall toxicity and improve long-term outcomes. Clinical trials have demonstrated the efficacy and safety of rATG in recipients of various types of solid organ allografts, recipients of allogeneic stem cell transplants who are conditioned with both conventional and nonconventional regimens, and patients with aplastic anaemia. Over time, clinicians have learnt how to better balance the benefits and risks associated with rATG. Advances in the understanding of the multifaceted mechanism of action will guide research into new therapeutic areas and future applications.
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Affiliation(s)
- A Osama Gaber
- Department of Surgery, The Methodist Hospital, Houston, Texas 77030, USA.
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42
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Shigematsu A, Yamamoto S, Sugita J, Kondo T, Onozawa M, Kahata K, Endo T, Shiratori S, Ota S, Yamaguchi K, Wakasa K, Takahata M, Goto H, Ito S, Takemura R, Tanaka J, Hashino S, Nishio M, Koike T, Asaka M, Imamura M. Increased risk of bacterial infection after engraftment in patients treated with allogeneic bone marrow transplantation following reduced-intensity conditioning regimen. Transpl Infect Dis 2010; 12:412-20. [PMID: 20738830 DOI: 10.1111/j.1399-3062.2010.00560.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although bacterial infection is a major cause of death even after reduced-intensity conditioning (RIC) for allogeneic stem cell transplantation (SCT), little is known about the epidemiology and risk factors. The incidence of bacterial infection in 43 patients who received allogeneic bone marrow transplantation (BMT) using a RIC regimen was compared with that in 68 patients who received BMT using a myeloablative conditioning regimen, and risk factors for bacterial infection were identified. Before engraftment, incidences of febrile neutropenia (FN) and documented infections (DI) were significantly decreased in RIC patients (FN: 59.5% vs. 89.6%, P<0.01, DI: 4.8% vs. 17.9%, P<0.01). However, incidence of bacterial infection was significantly increased in RIC patients in the post-engraftment phase (53.8% vs. 11.1%, log-rank, P<0.01). Blood stream was the most frequent focus of infection in both groups. In multivariate analysis, RIC and acute graft-versus-host disease were revealed to be significant risk factors for bacterial infection in this phase. In summary, risk of bacterial infection after engraftment was significantly higher in RIC patients, although infection was decreased before engraftment, and we need to develop a RIC-specific strategy against bacterial infection after RIC SCT.
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Affiliation(s)
- A Shigematsu
- Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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43
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Schaenman JM, Shashidhar S, Rhee C, Wong J, Navato S, Wong RM, Ho DY, Arai S, Johnston L, Brown JM. Early CMV viremia is associated with impaired viral control following nonmyeloablative hematopoietic cell transplantation with a total lymphoid irradiation and antithymocyte globulin preparative regimen. Biol Blood Marrow Transplant 2010; 17:693-702. [PMID: 20736077 DOI: 10.1016/j.bbmt.2010.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
The reconstitution of immune function after hematopoietic cell transplant (HCT) plays an important role in the control of viral infections. Both donor and recipient cytomegalovirus (CMV) serostatus has been shown to contribute to effective immune function; however, the influence of a nonmyeloablative preparative (NMA) regimen using total lymphoid irradiation (TLI) and antithymocyte globulin (ATG) on antiviral immune reconstitution has not yet been described. In 117 recipients of NMA HCT patients following ATG and TLI, not unexpectedly, CMV viremia was seen in approximately 60% of the seropositive patients regardless of donor serostatus, and recipient seropositivity significantly increased the odds of CMV viremia after transplant in a multivariate analysis. The administration of ATG and TLI resulted in a strikingly earlier viremia in the posttransplant period when compared to the previously reported timing of viremia following myeloablative preparative regimens, especially for transplant recipients who were seropositive for CMV with seronegative donors. Furthermore, early viremia in the setting of a CMV naïve donor was associated with a delay in functional antiviral control. These observations demonstrate the dynamic nature of immunity in relation to CMV antigen exposure in the complex environment resulting from NMA conditions where both donor and residual recipient immune response affect viral control.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, Stanford University Medical Center, Stanford, California 94305-5623, USA.
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El-Cheikh J, Castagna L, Wang L, Esterni B, Faucher C, Fürst S, Pierre B, Mohty M, Blaise D. Impact of prior invasive aspergillosis on outcome in patients receiving reduced-intensity conditioning allogeneic hematopoietic stem cell transplant. Leuk Lymphoma 2010; 51:1705-10. [DOI: 10.3109/10428194.2010.500433] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Adoptive transfer of pp65-specific T cells for the treatment of chemorefractory cytomegalovirus disease or reactivation after haploidentical and matched unrelated stem cell transplantation. Blood 2010; 116:4360-7. [PMID: 20625005 DOI: 10.1182/blood-2010-01-262089] [Citation(s) in RCA: 343] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cytomegalovirus (CMV) disease and infection refractory to antiviral treatment after allogeneic stem cell transplantation (allo-SCT) is associated with a high mortality. Adoptive transfer of CMV-specific T cells could reconstitute viral immunity after SCT and could protect from CMV-related complications. However, logistics of producing virus-specific T-cell grafts limited the clinical application. We treated 18 patients after allo-SCT from human leukocyte antigen-mismatched/haploidentical or human leukocyte antigen-matched unrelated donors with polyclonal CMV-specific T cells generated by ex vivo stimulation with pp65, followed by isolation of interferon-γ-producing cells. Patients with CMV disease or viremia refractory to antiviral chemotherapy or both were eligible for adoptive T-cell transfer and received a mean of 21 × 10³/kg pp65-specific T cells. In 83% of cases CMV infection was cleared or viral burden was significantly reduced, even in cases of CMV encephalitis (n = 2). Viral control was associated with in vivo expansion of CMV-specific T lymphocytes in 12 of 16 evaluable cases, resulting in reconstitution of antiviral T-cell responses, without graft-versus-host disease induction or acute side effects. Our findings indicate that the infusion of low numbers of CMV-specific T cells is safe, feasible, and effective as a treatment on demand for refractory CMV infection and CMV disease after allo-SCT.
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46
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Clavert A, Le Gouill S, Brissot E, Dubruille V, Mahe B, Gastinne T, Blin N, Chevallier P, Guillaume T, Delaunay J, Ayari S, Saulquin B, Moreau A, Moreau P, Harousseau JL, Milpied N, Mohty M. Reduced-intensity conditioning allogeneic stem cell transplant for relapsed or transformed aggressive B-cell non-Hodgkin lymphoma. Leuk Lymphoma 2010; 51:1502-8. [DOI: 10.3109/10428194.2010.497981] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Schmidt-Hieber M, Schwarck S, Stroux A, Ganepola S, Reinke P, Thiel E, Uharek L, Blau IW. Immune reconstitution and cytomegalovirus infection after allogeneic stem cell transplantation: the important impact of in vivo T cell depletion. Int J Hematol 2010; 91:877-85. [PMID: 20490728 DOI: 10.1007/s12185-010-0597-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 04/23/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
We analyzed cytomegalovirus (CMV) infection risk factors and immune reconstitution kinetics in 89 patients after allogeneic stem cell transplantation (allo-SCT). The use of alemtuzumab for in vivo T cell depletion (TCD) had, besides the donor/recipient CMV serostatus, the strongest influence on the CMV infection risk in univariate and multivariate analyses. In comparison to without use of in vivo TCD, the CMV infection risk [hazard ratio (HR)] was 4.82-fold after TCD with alemtuzumab, but only 1.40-fold after TCD with antithymocyte globulin (ATG). Alemtuzumab strongly depressed CD4(+) and CD8(+) T cell reconstitution, whereas ATG only delayed CD4(+) T cell reconstitution. Considering the reconstitution kinetics of CD4(+) and CD8(+) T cells, CMV-specific CD8(+) T cells, NK cells and the IgG concentration, only a low day +60 NK cell count (< or =161 versus >161/microl) was significantly associated with CMV infection development (HR 2.92, p = 0.034). CMV-specific CD8(+) T cells were detected in 57% of patients with a CMV-seropositive donor, but in none of the patients with a CMV-seronegative donor on day +30 (p = 0.01). Our data indicate that the type of in vivo TCD (alemtuzumab or ATG) differentially influences both the CMV infection risk and CD4(+)/CD8(+) T cell reconstitution kinetics in patients after allo-SCT.
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Affiliation(s)
- Martin Schmidt-Hieber
- Medical Department III (Hematology, Oncology and Transfusion Medicine), Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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48
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Blood stream infection (BSI) and acute GVHD after hematopoietic SCT (HSCT) are associated. Bone Marrow Transplant 2010; 46:300-7. [PMID: 20479711 PMCID: PMC3049187 DOI: 10.1038/bmt.2010.112] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BSI and acute GVHD (aGVHD) are serious complications of HSCT. We hypothesized that the two events were not independent of one another. We studied (1) associations between BSI and aGVHD; (2) the impact of BSI and/or aGVHD on death within 100 days after HSCT, employing a retrospective cohort analysis. Risk factor analysis was performed using multivariable Cox proportional hazards analyses. Of 211 subjects undergoing allogeneic HSCT from 1/00–12/05 (58% of whom underwent reduced intensity transplantation), 82 (39%) developed BSI. In 49 patients (23%), grades (gr) 2–4 aGVHD occurred. Early BSI was independently associated with an increased occurrence of subsequent aGVHD gr 2–4. Cytomegalovirus seropositivity was independently associated with decreased occurrence of aGVHD. Acute GVHD gr 2–4 independently predicted subsequent first BSI. Both BSI and aGVHD gr 2–4 were significant independent predictors of death within 100 days after HSCT. There is a strong, independent association between BSI and aGVHD. Potential explanations include the elaboration of cytokines during BSI favoring the development of aGVHD and/or the immunosuppressive treatment of aGVHD favoring the development of BSI. Future studies should be directed at mechanistic investigations of this association.
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49
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Infektionen und Immuntherapie. Monatsschr Kinderheilkd 2010. [DOI: 10.1007/s00112-009-2142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Buyck HC, Prentice HGF, Griffiths PD, Emery VC. The risk of early and late CMV DNAemia associated with Campath use in stem cell transplant recipients. Bone Marrow Transplant 2009; 45:1212-9. [PMID: 19966846 PMCID: PMC4829098 DOI: 10.1038/bmt.2009.329] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The risks associated with in vivo and ex vivo use of Campath-1H and -1G in a cohort of 206 stem cell transplant recipients for human CMV (HCMV) DNAemia have been quantified. DNAemia showed a biphasic incidence pattern with an inflexion at day 60. The first phase had a linear risk rate for HCMV DNAemia of 0.3% per day, whereas the second phase had a substantially lower risk rate of 0.058% per day. In multivariable analyses, risk factors for early DNAemia were HCMV serostatus, radiotherapy-based conditioning and CD34 stem cell dose, with the use of in vivo Campath-1H having the most significant risk (hazards ratio=3.68; 95% CI=2.02-6.72; P<0.001). Ex vivo use of Campath was not associated with an increased risk for HCMV DNAemia. Patients receiving either in vivo Campath-1H or -1G experienced HCMV DNAemia earlier (27 and 33 days, respectively) compared with patients receiving no Campath (time to DNAemia, 51 days; P=0.0006). Multivariable analysis of risk factors for HCMV DNAemia occurring beyond 100 days after transplant were older age, acute GVHD>grade II and a lower CD34 stem cell dose, whereas Campath-1H use was not associated with late HCMV DNAemia.
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Affiliation(s)
- H C Buyck
- Department of Infection, Centre for Virology, UCL, London, UK
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