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Palaniyandi S, Kumari R, Strattan E, Huang T, Kohler K, Du J, Jabbour N, Kesler M, Hildebrandt GC. Role of Defibrotide in the Prevention of Murine Model Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2023; 29:608.e1-608.e9. [PMID: 37517613 DOI: 10.1016/j.jtct.2023.07.023] [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: 02/03/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Abstract
Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Vascular endothelial cells are entirely exposed and damaged during the pathogenesis of acute GVHD (aGVHD). Defibrotide (DF) is a mixture of single-stranded oligonucleotides that has several pharmacologic effects that contribute to its endothelial protective properties. B10.BR mice were conditioned, followed by the infusion of donor C57BL/6J T cell-depleted bone marrow cells with or without splenocytes. The mice were either treated with DF or appropriate controls daily for the first week and then 3 times per week thereafter. Allogeneic DF-treated recipients demonstrated significantly better survival with reduced clinical GVHD. Significantly reduced organ pathology in the gut was associated with significantly decreased T cell infiltration in the ileum and colon on day +28. Serum cytokine analysis revealed significantly reduced levels of TNF and IL-6 at day +7 and of TNF at day +28 in allogeneic DF-treated recipients. Significantly reduced levels of ICAM-1 and angiopoietin-2 in serum and reduced VCAM-1 and HCAM levels in the ileum and colon of allogeneic DF-treated recipients were observed. Improved survival was seen in the graft-versus-leukemia (GVL) model (C3H.SW into C57BL/6J mice with C1498-luc). Through its anti-inflammatory and endothelial protective effects, DF treatment reduces the severity of aGVHD while not impairing GVL activity.
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Affiliation(s)
- Senthilnathan Palaniyandi
- Division of Hematology and Medical Oncology, Department of Medicine, Ellis Fischel Cancer Center, University of Missouri, Columbia, Missouri; Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Reena Kumari
- Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Ethan Strattan
- Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Timothy Huang
- Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Katharina Kohler
- Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Jing Du
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - Nashwan Jabbour
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - Melissa Kesler
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky
| | - Gerhard C Hildebrandt
- Division of Hematology and Medical Oncology, Department of Medicine, Ellis Fischel Cancer Center, University of Missouri, Columbia, Missouri; Division of Hematology & Blood and Marrow Transplantation, Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, Kentucky.
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Endothelial Dysfunction Syndromes after Allogeneic Stem Cell Transplantation. Cancers (Basel) 2023; 15:cancers15030680. [PMID: 36765638 PMCID: PMC9913851 DOI: 10.3390/cancers15030680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only therapy with a curative potential for a variety of malignant and non-malignant diseases. The major limitation of the procedure is the significant morbidity and mortality mainly associated with the development of graft versus host disease (GVHD) as well as with a series of complications related to endothelial injury, such as sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD), transplant-associated thrombotic microangiopathy (TA-TMA), etc. Endothelial cells (ECs) are key players in the maintenance of vascular homeostasis and during allo-HSCT are confronted by multiple challenges, such as the toxicity from conditioning, the administration of calcineurin inhibitors, the immunosuppression associated infections, and the donor alloreactivity against host tissues. The early diagnosis of endothelial dysfunction syndromes is of paramount importance for the development of effective prophylactic and therapeutic strategies. There is an urgent need for the better understanding of the pathogenetic mechanisms as well as for the identification of novel biomarkers for the early diagnosis of endothelial damage. This review summarizes the current knowledge on the biology of the endothelial dysfunction syndromes after allo-HSCT, along with the respective therapeutic approaches, and discusses the strengths and weaknesses of possible biomarkers of endothelial damage and dysfunction.
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Colella MP, Morini BC, Niemann F, Lopes MR, Vigorito AC, Aranha FJP, Machado-Neto JA, Saad SO, Favaro P. Expression of transforming growth factor β pathway components in chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation. Transpl Immunol 2021; 70:101514. [PMID: 34922025 DOI: 10.1016/j.trim.2021.101514] [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: 03/12/2021] [Revised: 10/27/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
Chronic graft-versus-host disease (cGvHD), an immunological complication of allogeneic cell transplantation, is the principal cause of non-relapse mortality and morbidity. Even though advances have been made in understanding the pathophysiology of this disorder, many questions remain. We sought to evaluate gene expression of transforming growth factor β (TGF-β) pathway components, through quantitative RT-PCR and PCR array, in patients with cGvHD with different disease activity. We observed an upregulation of SMAD3, BMP2, CDKN1A, IL6, and TGF-β2 genes in the clinical tolerance group, which had never developed cGvHD, or which had been withdrawn from all immunosuppressive treatments (IST) for at least 1 year. In addition, SMAD5 gene upregulation was observed in cGvHD patients undergoing IST, and ordinal regression showed a correlation between SMAD5 expression and disease severity. Our data support the evidence of the important role of TGF-β effects in the pathological process of cGvHD.
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Affiliation(s)
| | | | - Fernanda Niemann
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | | | | | | | | | - Sara Olalla Saad
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | - Patricia Favaro
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil; Department of Biological Sciences, Federal University of São Paulo, Diadema, Brazil.
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Lia G, Giaccone L, Leone S, Bruno B. Biomarkers for Early Complications of Endothelial Origin After Allogeneic Hematopoietic Stem Cell Transplantation: Do They Have a Potential Clinical Role? Front Immunol 2021; 12:641427. [PMID: 34093530 PMCID: PMC8170404 DOI: 10.3389/fimmu.2021.641427] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/04/2021] [Indexed: 12/17/2022] Open
Abstract
Endothelial cell (EC) dysfunction causes a number of early and life-threatening post hematopoietic stem cell transplant (HCT) complications that result in a rapid clinical decline. The main early complications are graft-vs.-host disease (GVHD), transplant associated thrombotic microangiopathy (TA-TMA), and sinusoidal obstruction syndrome (SOS). Post-HCT endothelial dysfunction occurs as a result of chemotherapy, infections, and allogeneic reactivity. Despite major advances in transplant immunology and improvements in supportive care medicine, these complications represent a major obstacle for successful HCT. In recent years, different biomarkers have been investigated for early detection of post-transplant endothelial cell dysfunction, but few have been validated. In this review we will define GVHD, TA-TMA and SOS, summarize the current data available in HCT biomarker research and identify promising biomarkers for detection and diagnosis of early HCT complications.
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Affiliation(s)
- Giuseppe Lia
- Stem Cell Transplant Program, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Luisa Giaccone
- Stem Cell Transplant Program, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Sarah Leone
- Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
- Division of Hematology and Medical Oncology, New York University Grossman School of Medicine, Perlmutter Cancer Center, New York University Langone Health, New York, NY, United States
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Hildebrandt GC, Chao N. Endothelial cell function and endothelial-related disorders following haematopoietic cell transplantation. Br J Haematol 2020; 190:508-519. [PMID: 32319084 PMCID: PMC7496350 DOI: 10.1111/bjh.16621] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
Use of haematopoietic cell transplantation (HCT) in the treatment of haematologic and neoplastic diseases may lead to life-threatening complications that cause substantial morbidity and mortality if untreated. In addition to patient- and disease-related factors, toxicity associated with HCT puts patients at risk for complications that share a similar pathophysiology involving endothelial cells (ECs). Normally, the endothelium plays a role in maintaining homeostasis, including regulation of coagulation, vascular tone, permeability and inflammatory processes. When activated, ECs acquire cellular features that may lead to phenotypic changes that induce procoagulant, pro-inflammatory and pro-apoptotic mediators leading to EC dysfunction and damage. Elevated levels of coagulation factors, cytokines and adhesion molecules are indicative of endothelial dysfunction, and endothelial damage may lead to clinical signs and symptoms of pathological post-HCT conditions, including veno-occlusive disease/sinusoidal obstruction syndrome, graft-versus-host disease, transplant-associated thrombotic microangiopathy and idiopathic pneumonia syndrome/diffuse alveolar haemorrhage. The endothelium represents a rational target for preventing and treating HCT complications arising from EC dysfunction and damage. Additionally, markers of endothelial damage may be useful in improving diagnosis of HCT-related complications and monitoring treatment effect. Continued research to effectively manage EC activation, injury and dysfunction may be important in improving patient outcomes after HCT.
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Affiliation(s)
| | - Nelson Chao
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Politikos I, T Kim H, Karantanos T, Brown J, McDonough S, Li L, Cutler C, Antin JH, Ballen KK, Ritz J, Boussiotis VA. Angiogenic Factors Correlate with T Cell Immune Reconstitution and Clinical Outcomes after Double-Unit Umbilical Cord Blood Transplantation in Adults. Biol Blood Marrow Transplant 2017; 23:103-112. [PMID: 27777141 PMCID: PMC5489056 DOI: 10.1016/j.bbmt.2016.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 10/15/2016] [Indexed: 11/18/2022]
Abstract
Umbilical cord blood (UCB) is a valuable graft source for allogeneic hematopoietic stem cell transplantation (HSCT) in patients who lack adult donors. UCB transplantation (UCBT) in adults results in delayed immune reconstitution, leading to high infection-related morbidity and mortality. Angiogenic factors and markers of endothelial dysfunction have biologic and prognostic significance in conventional HSCT, but their role in UCBT has not been investigated. Furthermore, the interplay between angiogenesis and immune reconstitution has not been studied. Here we examined whether angiogenic cytokines, angiopoietin-1 (ANG-1) and vascular endothelial growth factor (VEGF), or markers of endothelial injury, thrombomodulin (TM) and angiopoietin-2 (ANG-2), associate with thymic regeneration as determined by T cell receptor excision circle (TREC) values and recovery of T cell subsets, as well as clinical outcomes in adult recipients of UCBT. We found that plasma levels of ANG-1 significantly correlated with the reconstitution of naive CD4+CD45RA+ and CD8+CD45RA+ T cell subsets, whereas plasma levels of VEGF displayed a positive correlation with CD4+CD45RO+ T cells and regulatory T cells and a weak correlation with TRECs. Assessment of TM and ANG-2 revealed a strong inverse correlation of both factors with naive T cells and TRECs. The angiogenic capacity of each patient's plasma, as determined by an in vitro angiogenesis assay, positively correlated with VEGF levels and with reconstitution of CD4+ T cell subsets. Higher VEGF levels were associated with worse progression-free survival and higher risk of relapse, whereas higher levels of TM were associated with chronic graft-versus-host disease and nonrelapse mortality. Thus, angiogenic factors may serve as valuable markers associated with T cell reconstitution and clinical outcomes after UCBT.
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Affiliation(s)
- Ioannis Politikos
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Haesook T Kim
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Theodoros Karantanos
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Julia Brown
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sean McDonough
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lequn Li
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Corey Cutler
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Karen K Ballen
- Bone Marrow Transplant Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Jerome Ritz
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vassiliki A Boussiotis
- Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Holtan SG, Arora M. Angiogenic factors and inflammation in steroid-refractory acute graft-vs-host disease. Transl Res 2016; 167:80-7. [PMID: 26117290 PMCID: PMC5747967 DOI: 10.1016/j.trsl.2015.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/25/2015] [Accepted: 06/01/2015] [Indexed: 01/29/2023]
Abstract
Steroid-refractory acute graft-vs-host disease (aGVHD) remains a frequent and often fatal complication of allogeneic hematopoietic cell transplantation. Recent evidence suggests that angiogenic factors-growth factors that contribute to blood vessel development-may be involved in tissue healing and restitution after inflammatory insults such as aGVHD. However, some angiogenic factors may also be involved in inflammation and worsen clinical outcomes. In this review, we summarize the data relevant to angiogenic factors that may contribute to healing after aGVHD (epidermal growth factor and vascular endothelial growth factor A) and angiogenic factors that may promote inflammation after aGVHD (placental growth factor and follistatin). It is currently unknown whether changes in these factors are a cause or a consequence of aGVHD. Mechanistic studies in the coming years will clarify their roles and identify new pathways for improving outcomes in steroid-refractory aGVHD.
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Affiliation(s)
- Shernan G Holtan
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minn.
| | - Mukta Arora
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minn
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Kim KW, Moon SJ, Park MJ, Kim BM, Kim EK, Lee SH, Lee EJ, Chung BH, Yang CW, Cho ML. Optimization of adipose tissue-derived mesenchymal stem cells by rapamycin in a murine model of acute graft-versus-host disease. Stem Cell Res Ther 2015; 6:202. [PMID: 26497134 PMCID: PMC4619057 DOI: 10.1186/s13287-015-0197-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/07/2015] [Accepted: 10/05/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction Mesenchymal stem cells (MSCs) can protect bone marrow transplantation (BMT) recipients from the lethal acute graft-versus-host disease (aGVHD) development. However, the mechanisms underlying the anti-inflammatory properties of MSCs in aGVHD remain to be elucidated. The immunoregulatory properties of MSCs are mediated by their production of anti-inflammatory molecules, including IL-10 and TGF-β. On the other hand, MSCs can also produce proinflammatory cytokines during their normal growth, such as IL-1β and IL-6. These opposite actions may limit their therapeutic application in aGVHD. Therefore, optimization of the functional properties of MSCs can increase their benefits. Methods The expressions of mRNA and protein were analyzed by real-time PCR and western blotting, respectively. Expression of MSC markers was assessed by flow cytometry. An animal model of aGVHD was established by transplanting C57BL/6 donor bone marrow cells and spleen cells into lethally irradiated BALB/c recipient mice. The recipient mice were divided into the control group and the therapy [adipose tissue-derived human MSCs (Ad-hMSCs) or rapamycin-treated Ad-hMSCs] groups. The survival, body weight and clinical score of aGVHD in transplanted mice were monitored. Results Rapamycin pre-treatment of Ad-hMSCs increased mRNA synthesis of IL-10, indoleamine 2,3-dioxygenase, and TGF-β compared with untreated Ad-hMSCs. Rapamycin-treated Ad-hMSCs suppressed clonal expansion of interleukin-17-producing CD4+ T (Th17) cells more effectively than untreated cells. mRNA expression of autophagy markers such as ATG5, LC3A and LC3B was significantly increased in the rapamycin-treated Ad-hMSCs compared with untreated Ad-hMSCs. Transmission electron microscopy revealed that Ad-hMSCs exposure to rapamycin resulted in the appearance of autophagic vacuoles. Interestingly, in vitro migration efficiency of rapamycin-treated Ad-hMSCs toward the CD4+ T cells was increased significantly compared with the untreated cells. And, these effects were associated with autophagy induction capacity of rapamycin. In vivo, the inhibiting properties of MSCs on the clinical severities of aGVHD were greater in the mice receiving rapamycin-treated Ad-hMSCs compared with untreated Ad-hMSCs. The beneficial effects of rapamycin treatment in Ad-hMSCs shown in vivo were associated with a reduction of Th17 cells and an increase in regulatory T cells. Conclusions Rapamycin can optimize the immunomodulatory potential of Ad-hMSCs, suggesting a promising strategy of MSC use in aGVHD treatment.
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Affiliation(s)
- Kyoung-Woon Kim
- Convergent Research Consortium for Immunologic disease, Transplant Research Center, The Catholic University of Korea, Seoul, South Korea.
| | - Su-Jin Moon
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Min-Jung Park
- The Rheumatism Research Center, The Catholic University of Korea, Seoul, South Korea.
| | - Bo-Mi Kim
- Convergent Research Consortium for Immunologic disease, Transplant Research Center, The Catholic University of Korea, Seoul, South Korea.
| | - Eun-Kyung Kim
- The Rheumatism Research Center, The Catholic University of Korea, Seoul, South Korea.
| | - Sung-Hee Lee
- The Rheumatism Research Center, The Catholic University of Korea, Seoul, South Korea.
| | - Eun-Jung Lee
- The Rheumatism Research Center, The Catholic University of Korea, Seoul, South Korea.
| | - Byung-Ha Chung
- Convergent Research Consortium for Immunologic disease, Transplant Research Center, The Catholic University of Korea, Seoul, South Korea. .,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Chul-Woo Yang
- Convergent Research Consortium for Immunologic disease, Transplant Research Center, The Catholic University of Korea, Seoul, South Korea. .,Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,Department of Internal Medicine, Seoul St. Mary's Hospital, 505 Banpo-Dong, Seocho-Ku, 137-040, , Seoul, Korea.
| | - Mi-La Cho
- Convergent Research Consortium for Immunologic disease, Transplant Research Center, The Catholic University of Korea, Seoul, South Korea. .,The Rheumatism Research Center, The Catholic University of Korea, Seoul, South Korea.
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Nie DM, Wu QL, Zhu XX, Zhang R, Zheng P, Fang J, You Y, Zhong ZD, Xia LH, Hong M. Angiogenic factors are associated with development of acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. ACTA ACUST UNITED AC 2015; 35:694-699. [DOI: 10.1007/s11596-015-1492-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/18/2015] [Indexed: 10/22/2022]
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10
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Holtan SG, Verneris MR, Schultz KR, Newell LF, Meyers G, He F, DeFor TE, Vercellotti GM, Slungaard A, MacMillan ML, Cooley SA, Blazar BR, Panoskaltsis-Mortari A, Weisdorf DJ. Circulating angiogenic factors associated with response and survival in patients with acute graft-versus-host disease: results from Blood and Marrow Transplant Clinical Trials Network 0302 and 0802. Biol Blood Marrow Transplant 2015; 21:1029-36. [PMID: 25759146 PMCID: PMC4426052 DOI: 10.1016/j.bbmt.2015.02.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/17/2015] [Indexed: 12/26/2022]
Abstract
Circulating angiogenic factors (AF) reflect tissue healing capacity, although some AF can also contribute to inflammation and are indicative of endothelial dysfunction. The AF milieu in acute graft-versus-host disease (aGVHD) has not been broadly characterized. We hypothesized that patients with abundant AF involved in repair/regeneration versus those mediating damage/inflammation would have improved outcomes. Circulating AF known predominantly for repair/regeneration (epidermal growth factor [EGF], fibroblast growth factor-1 and -2, heparin binding-EGF-like growth factor, and vascular endothelial growth factor-A [VEGF-A], -C, and -D) and for damage/inflammation (angiopoietin-2, endothelin-1, soluble endoglin [sEng], follistatin [FS], leptin, and placental growth factor [PlGF]) were measured in a discovery set of hematopoietic cell recipients with grade III and IV aGVHD and compared with controls, then validated in 2 aGVHD cohorts enrolled in Blood and Marrow Transplant Clinical Trials Network (BMT CTN) trials 0302 (n = 105, serum) and 0802 (n = 158, plasma) versus controls without aGVHD (n = 53, serum). Levels of EGF and VEGF-A were lower than in controls at the onset of aGVHD in both trials and higher with complete response to first-line aGVHD therapy in CTN 0802. FS and PlGF were elevated in aGVHD measured in either serum or plasma. At day 28 after initial aGVHD therapy, elevated FS was an independent negative prognostic factor for survival in both cohorts (hazard ratio, 9.3 in CTN 0302; 2.8 in CTN 0802). These data suggest that circulating AF are associated with clinical outcomes after aGVHD and, thus, may contribute to both pathogenesis and recovery.
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Affiliation(s)
- Shernan G Holtan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
| | - Michael R Verneris
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Kirk R Schultz
- Division of Pediatric Hematology/Oncology/BMT, BC Children's Hospital, Vancouver, University of British Columbia; Blood and Marrow Transplant Clinical Trials Network, Rockville, Maryland
| | - Laura F Newell
- Blood and Marrow Transplant Program, Oregon Health & Science University, Portland, Oregon
| | - Gabrielle Meyers
- Blood and Marrow Transplant Program, Oregon Health & Science University, Portland, Oregon
| | - Fiona He
- School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Todd E DeFor
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Gregory M Vercellotti
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Arne Slungaard
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Sarah A Cooley
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Bruce R Blazar
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | | | - Daniel J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Blood and Marrow Transplant Clinical Trials Network, Rockville, Maryland
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11
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Chen W, Zhu H, Yu L, Lu Z, Yao Z, Xiao Y. TNF-α -308 G>A polymorphism and risk of bone marrow failure syndrome: A meta-analysis. Gene 2015; 565:1-8. [PMID: 25895473 DOI: 10.1016/j.gene.2015.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/17/2015] [Accepted: 04/09/2015] [Indexed: 11/19/2022]
Abstract
The influence of the TNF-α -308 G>A polymorphism on bone marrow failure syndrome susceptibility is unclear. We have conducted a meta-analysis of all relevant published studies. We searched PubMed, Chinese Biomedical Literature and China National Knowledge Infrastructure databases up to February 2015. Odds ratios (ORs) with 95% confidence intervals (CIs) were applied to assess the strength of associations. Eleven case-control studies with a total sample size of 909 cases and 1803 controls were eligible to assess the association between the TNF-α -308 G>A polymorphism and susceptibility to bone marrow failure syndrome. Overall, the TNF-α -308 G>A polymorphism was significantly associated with an increased risk of bone marrow failure syndrome in any genetic model. In stratified analysis by disease type, there was a significant association between the TNF-α -308 G>A polymorphism and increased risk of aplastic anemia but no significant association with myelodysplastic syndrome (AA vs. GG: OR=2.23, 95% CI=1.23-4.05, P=0.006; recessive model: OR=3.52, 95% CI=1.30-9.53, P=0.010). In subgroup analysis by ethnicity, there were significant associations between the TNF-α -308 G>A polymorphism and increased risk of bone marrow failure syndrome for Caucasians in two models, but not in Asian populations (AA vs. GG: OR=2.66, 95% CI=1.36-5.21, P=0.003; recessive model: OR=2.68, 95% CI=1.37-5.24, P=0.002). In conclusion, our meta-analysis suggests that the TNF-α -308 G>A polymorphism may contribute to the risk of bone marrow failure syndrome, particularly among Caucasian and aplastic anemia patients. Further investigations are needed to clarify the role of the TNF-α -308 G>A polymorphism in bone marrow failure syndrome.
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Affiliation(s)
- Wancheng Chen
- Department of Hematology, First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Hematology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China
| | - Haili Zhu
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Lili Yu
- Cancer Research Institute, Southern Medical University, Guangzhou 510515, China
| | - Ziyuan Lu
- Department of Hematology, First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Zhuoxin Yao
- Department of Hematology, First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Hematology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China
| | - Yang Xiao
- Department of Hematology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China.
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Moiseev IS, Lapin SV, Surkova EA, Lerner MY, Vavilov VN, Afanasyev BV. Level of Vascular Endothelial Growth Factor Predicts Both Relapse and Nonrelapse Mortality after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2013; 19:1677-82. [DOI: 10.1016/j.bbmt.2013.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 08/30/2013] [Indexed: 01/06/2023]
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13
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Ayuk F, Bussmann L, Zabelina T, Veit R, Alchalby H, Wolschke C, Lellek H, Bacher U, Zander AR, Kröger N. Serum albumin level predicts survival of patients with gastrointestinal acute graft-versus-host disease after allogeneic stem cell transplantation. Ann Hematol 2013; 93:855-61. [PMID: 24248672 DOI: 10.1007/s00277-013-1957-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Abstract
In a retrospective single-centre study, we analysed the prognostic impact of factors identifiable at initial diagnosis of acute GVHD (aGVHD). We retrospectively analysed 495 adult patients of whom 308 (62 %) developed acute GVHD (I-IV) and were included in further analysis. Gut aGVHD was diagnosed in 163/308 cases (53 %). Conditioning was myeloablative conditioning (MAC) in 123 (39.9 %) and reduced intensity (RIC) in 185 (60.1 %) patients. Median serum albumin level at diagnosis of aGVHD was 34 g/l, which was used as cut-off for low vs. normal albumin levels. In patients with gut aGVHD, low albumin level at the time of diagnosis of aGVHD was associated with poorer overall survival (OS) which was 52 vs. 67 % at 1 year and 40 vs. 61 % at 3 years, p = 0.015. In patients with only skin aGVHD, 1- and 3-year OS of patients with low vs. normal albumin levels were 72 vs. 72 % and 59 vs. 57 %, respectively, p = 0.69. In multivariate analysis of patients with gut aGVHD, low serum albumin level ≤34 g/l (relative risk (RR) 2.13, p = 0.003), gut aGVHD grades 3-4 (RR 2.70, p = 0.001), RIC (RR 1.84, p = 0.024), matched unrelated donor (RR 1.86, p = 0.18) and mismatched unrelated donor (RR 2.76, p = 0.03) retained negative impact on OS. Subgroup analysis revealed that impact of albumin was restricted to patients with gut aGVHD after RIC. Low serum albumin levels are associated with poorer OS in patients with gut but not skin aGVHD after RIC but not MAC allogeneic stem cell transplantation.
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Affiliation(s)
- Francis Ayuk
- Clinic for stem cell transplantation, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20245, Hamburg, Germany,
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14
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Knight JM, Lyness JM, Sahler OJZ, Liesveld JL, Moynihan JA. Psychosocial factors and hematopoietic stem cell transplantation: potential biobehavioral pathways. Psychoneuroendocrinology 2013; 38:2383-93. [PMID: 23845514 PMCID: PMC3812389 DOI: 10.1016/j.psyneuen.2013.06.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 01/23/2023]
Abstract
While psychosocial factors are known to affect cancer progression via biobehavioral pathways in many patient populations, these relationships remain largely unexplored in hematopoietic stem cell transplant (HCT) patients. The purpose of this paper is to critically review the literature regarding psychosocial and endocrine/immune aspects of HCT, with an emphasis on exploring pathways that may mediate the associations between psychosocial factors and disease outcomes. These include the roles of catecholamines, glucocorticoids, inflammation, vascular endothelial growth factor (VEGF), immune reconstitution and infectious susceptibility, as well as the new opportunities available in genomics research. We also discuss the implications for potential immunomodulating psychosocial interventions. Elucidating the biological pathways that account for the associations between psychosocial factors and clinical course could ultimately lead to improved outcomes for this psychologically and immunologically vulnerable population.
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Affiliation(s)
- Jennifer M. Knight
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin
| | - Jeffrey M. Lyness
- Rochester Center for Mind-Body Research, Department of Psychiatry, University of Rochester Medical Center
| | - Olle Jane Z. Sahler
- Division of Hematology/Oncology, Department of Pediatrics, University of Rochester Medical Center,Medical Humanities
| | - Jane L. Liesveld
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Jan A. Moynihan
- Rochester Center for Mind-Body Research, Department of Psychiatry, University of Rochester Medical Center
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15
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Parra A, Ramírez-Peredo J, Reyes E, Hidalgo R, Macías-Gallardo J, Lutz-Presno J, Ruiz-Argüelles A, Garza E, Infante E, Gutiérrez-Aguirre CH, Salazar-Riojas R, Villarreal JZ, Gómez-Almaguer D, Ruiz-Argüelles GJ. Moderate hyperprolactinemia is associated with survival in patients with acute graft-versus-host disease after allogeneic stem cell transplantation. Hematology 2013; 17:85-92. [DOI: 10.1179/102453312x13221316477930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
| | | | - Enrique Reyes
- Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Rocío Hidalgo
- Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Julio Macías-Gallardo
- Centro de Hematología y Medicina Interna de Puebla, Clínica Ruiz de Puebla, Puebla, Mexico
| | - Julia Lutz-Presno
- Centro de Hematología y Medicina Interna de Puebla, Clínica Ruiz de Puebla, Puebla, Mexico
| | | | - Eduardo Garza
- Laboratorios Clínicos de Puebla, Clínica Ruiz de Puebla, Puebla, Mexico
| | | | | | - Rosario Salazar-Riojas
- Hematology Department Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jesús Z. Villarreal
- Hematology Department Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Hematology Department Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Guillermo J. Ruiz-Argüelles
- Centro de Hematología y Medicina Interna de Puebla, Clínica Ruiz de Puebla, Puebla, Mexico
- Laboratorios Clínicos de Puebla, Clínica Ruiz de Puebla, Puebla, Mexico
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16
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Berger M, Signorino E, Muraro M, Quarello P, Biasin E, Nesi F, Vassallo E, Fagioli F. Monitoring of TNFR1, IL-2Rα, HGF, CCL8, IL-8 and IL-12p70 following HSCT and their role as GVHD biomarkers in paediatric patients. Bone Marrow Transplant 2013; 48:1230-6. [PMID: 23584443 DOI: 10.1038/bmt.2013.41] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 11/12/2022]
Abstract
No predictive factors are currently available to establish patient-specific GVHD risk. A panel of six serum cytokines (TNF receptor 1, IL-2 receptor alfa (IL-2Rα), hepatocyte growth factor (HGF), monocyte chemo-attractant protein-2, IL-8, IL-12p70) were monitored at established time points (days -1, +1, +7, +14, +21, +28 and +60) in 170 paediatric hematopoietic SCT (HSCT) recipients. We found that higher concentrations of IL-2Rα on days +14 and +21 together with HGF on days +14 and +21 were significantly associated at a higher probability of both grade II-IV GVHD (on day +14 it was: 60% vs 28%, P=0.007) and grade III-IV (on day +14 it was: 40% vs 15%, P=0.001). The higher IL-8 serum concentration on day +28 was associated with a lower probability of chronic GVHD being 4% vs 29% (P=0.01) for patients with higher vs lower IL-8 serum concentration. These findings were confirmed when the analysis was restricted to the the matched unrelated donor group. In conclusion, even if the serum cytokine levels were related to several variables associated with HSCT, we identified two cytokines as predictors of GVHD II-IV and III-IV, translating into a higher TRM risk (17% vs 3%, P=0.004).
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Affiliation(s)
- M Berger
- Paediatric Onco-Hematology and Stem Cell Transplant Unit, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, Italy.
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17
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Wiegering V, Winkler B, Haubitz I, Wölfl M, Schlegel PG, Eyrich M. Lower TGFß serum levels and higher frequency of IFNγ-producing T cells during early immune reconstitution in surviving children after allogeneic stem cell transplantation. Pediatr Blood Cancer 2013; 60:121-8. [PMID: 22623061 DOI: 10.1002/pbc.24208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 05/02/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (SCT) is increasingly used as a salvage therapy for patients with high-risk malignancies as well as life-threatening non-malignant diseases. However, only limited data about the association between outcome and functional parameters of recovering lymphocytes are available so far. PROCEDURES In this prospective study of 19 pediatric SCT recipients, we serially evaluated immune parameters quantitatively and qualitatively before and throughout allogeneic SCT. These data were analyzed with respect to survival. RESULTS Age, gender, GvHD, and type of graft were not different between surviving and non-surviving patients. Notably, in our cohort there was no case of transplant-related or infectious mortality. However, with the exception of two patients with advanced MDS, all patients not in complete remission (CR) relapsed in addition to three patients in higher CR (n = 7). All seven patients relapsing after allogeneic SCT later succumbed to their disease recurrence. Uni- and multivariate analysis showed that relapsing patients had higher TGFß serum levels as well as lower percentages of IFNγ-producing T cells before and early after transplantation. Furthermore, relapsing patients had a further decline in their thymic function between day 60 and 120 whereas non-relapsing patients already showed increasing TREC values during this time interval. CONCLUSIONS Collectively, patients who later relapse show a different pattern of immune reconstitution before and at early time points post-transplantation.
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Affiliation(s)
- Verena Wiegering
- Pediatric Stem Cell Transplant Unit, University Children's Hospital, Germany
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18
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GVHD after allogeneic haematopoietic SCT for AML: angiogenesis, vascular endothelial growth factor and VEGF receptor expression in the BM. Bone Marrow Transplant 2012; 48:715-21. [PMID: 23085826 DOI: 10.1038/bmt.2012.200] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is increasing evidence suggesting that both angiogenesis and endothelial injury are involved in GVHD. To study the dynamics of angiogenesis, we examined 26 patients with AML who had undergone allogeneic haematopoietic SCT. All were in CR and had either acute GVHD (aGVHD) or chronic GVHD (cGVHD). We performed immunohistochemical studies of BM microvessel density (MVD) using Abs against vascular-endothelial (VE)-cadherin, CD34 and CD105, and expression of vascular endothelial growth factor (VEGF) and its receptors VEGFR-1 and VEGFR-2. At the time of diagnosis, the MVD in AML patients was higher than that in the normal controls, and the MVD decreased after induction chemotherapy. Patients with aGVHD had a significantly higher MVD than patients without aGVHD. Conversely, patients with cGVHD did not have a significantly different MVD. In previous aGVHD, we also found more VEGF+ megakaryocytes. XY FISH in sex-mismatched patients showed that the BM blood vessels consisted mainly of recipient endothelial cells. Taken together, these results suggest that new vessel formation and the VEGF/VEGFR system are involved in aGVHD.
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19
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Holtan SG, Steen PD, Foster NR, Erlichman C, Medeiros F, Ames MM, Safgren SL, Graham DL, Behrens RJ, Goetz MP. Gemcitabine and irinotecan as first-line therapy for carcinoma of unknown primary: results of a multicenter phase II trial. PLoS One 2012; 7:e39285. [PMID: 22815703 PMCID: PMC3398897 DOI: 10.1371/journal.pone.0039285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/07/2012] [Indexed: 11/18/2022] Open
Abstract
Metastatic carcinoma of unknown primary (CUP) has a very poor prognosis, and no standard first-line therapy currently exists. Here, we report the results of a phase II study utilizing a combination of gemcitabine and irinotecan as first-line therapy. Treatment was with gemcitabine 1000 mg/m2 and irinotecan 75 mg/m2 weekly times four on a six week cycle (Cohort I). Due to excessive toxicity, the dose and schedule were modified as follows: gemcitabine 750 mg/m2 and irinotecan 75 mg/m2 given weekly times three on a four week cycle (Cohort II). The primary endpoint was the confirmed response rate (CR + PR). Secondary endpoints consisted of adverse events based upon the presence or absence of the UDP glucuronosyltransferase 1 family, polypeptide A1*28 (UGT1A1*28) polymorphism, time to progression, and overall survival. Thirty-one patients were enrolled with a median age of 63 (range: 38–94), and 26 patients were evaluable for efficacy. Significant toxicity was observed in Cohort 1, characterized by 50% (7/14) patients experiencing a grade 4+ adverse event, but not in cohort II. The confirmed response rate including patients from both cohorts was 12% (95% CI: 2–30%), which did not meet the criteria for continued enrollment. Overall median survival was 7.2 months (95% CI: 4.0 to 11.6) for the entire cohort but notably longer in cohort II than in cohort I (9.3 months (95% CI: 4.1 to 12.1) versus 4.0 months (95% CI: 2.2 to 15.6)). Gemcitabine and irinotecan is not an active combination when used as first line therapy in patients with metastatic carcinoma of unknown primary. Efforts into developing novel diagnostic and therapeutic approaches remain important for improving the outlook for this heterogeneous group of patients.
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Affiliation(s)
- Shernan G. Holtan
- Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Preston D. Steen
- Sanford Roger Maris Cancer Center, Fargo, North Dakota, United States of America
| | - Nathan R. Foster
- Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Charles Erlichman
- Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Fabiola Medeiros
- Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Matthew M. Ames
- Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | | | - David L. Graham
- Carle Cancer Center CCOP, Urbana, Illinois, United States of America
| | - Robert J. Behrens
- Iowa Oncology Research Association CCOP, Des Moines, Iowa, United States of America
| | - Matthew P. Goetz
- Mayo Clinic Rochester, Rochester, Minnesota, United States of America
- * E-mail:
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20
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Porkholm M, Bono P, Saarinen-Pihkala UM, Kivivuori SM. Higher angiopoietin-2 and VEGF levels predict shorter EFS and increased non-relapse mortality after pediatric hematopoietic SCT. Bone Marrow Transplant 2012; 48:50-5. [DOI: 10.1038/bmt.2012.101] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Arrieta-Bolaños E, Alejandro Madrigal J, Shaw BE. Transforming growth factor-β1 polymorphisms and the outcome of hematopoietic stem cell transplantation. Int J Immunogenet 2012; 39:192-202. [DOI: 10.1111/j.1744-313x.2012.01089.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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22
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Kim AR, Lim JY, Jeong DC, Park G, Lee BC, Min CK. Blockade of Vascular Endothelial Growth Factor (VEGF) Aggravates the Severity of Acute Graft-versus-host Disease (GVHD) after Experimental Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT). Immune Netw 2011; 11:368-75. [PMID: 22346777 PMCID: PMC3275706 DOI: 10.4110/in.2011.11.6.368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 10/28/2011] [Accepted: 11/03/2011] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Recent clinical observation reported that there was a significant correlation between change in circulating vascular endothelial growth factor (VEGF) levels and the occurrence of severe acute graft-versus-host disease (GVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT), but the action mechanisms of VEGF in GVHD have not been demonstrated. METHODS This study investigated whether or not blockade of VEGF has an effect on acute GVHD in a lethally irradiated murine allo-HSCT model of B6 (H-2(b))→B6D2F1 (H-2(b/d)). Syngeneic or allogeneic recipient mice were injected subcutaneously with anti-VEGF peptides, dRK6 (50 µg/dose) or control diluent every other day for 2 weeks (total 7 doses). RESULTS Administration of the dRK6 peptide after allo-HSCT significantly reduced survival with greaterclinical GVHD scores and body weight loss. Allogeneic recipients injected with the dRK6 peptide exhibited significantly increased circulating levels of VEGF and expansion of donor CD3(+) T cells on day +7 compared to control treated animals. The donor CD4(+) and CD8(+) T-cell subsets have differential expansion caused by the dRK6 injection. The circulating VEGF levels were reduced on day +14 regardless of blockade of VEGF. CONCLUSION Together these findings demonstrate that the allo-reactive responses after allo-HSCT are exaggerated by the blockade of VEGF. VEGF seems to be consumed during the progression of acute GVHD in this murine allo-HSCT model.
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Affiliation(s)
- Ai-Ran Kim
- Department of Pediatrics, The Catholic University of Korea, Seoul 137-701, Korea
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23
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Rezvani AR, Storer BE, Storb RF, Mielcarek M, Maloney DG, Sandmaier BM, Martin PJ, McDonald GB. Decreased serum albumin as a biomarker for severe acute graft-versus-host disease after reduced-intensity allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2011; 17:1594-601. [PMID: 21806949 PMCID: PMC3203323 DOI: 10.1016/j.bbmt.2011.07.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 07/25/2011] [Indexed: 01/26/2023]
Abstract
Biomarkers capable of predicting the onset and severity of acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic cell transplantation (HCT) would enable preemptive and risk-stratified therapy. Severe aGVHD leads to gastrointestinal protein loss, resulting in hypoalbuminemia. We hypothesized that decreases in serum albumin at onset of aGVHD would predict the risk of progression to severe aGVHD. We identified 401 patients who developed aGVHD grades II-IV after reduced-intensity allogeneic HCT and reviewed all available serum albumin values from 30 days before HCT to 45 days after initiation of treatment for aGVHD. A ≥0.5 g/dL decrease in serum albumin concentration from pretransplantation baseline to the onset of treatment for aGVHD predicted the subsequent development of grade III/IV aGVHD (versus grade II aGVHD) with a sensitivity of 69% and a specificity of 73%. Overall mortality at 6 months after initiation of aGVHD treatment was 36% versus 17% for patients with and without ≥0.5 g/dL decreases in serum albumin, respectively (P = .0009). We conclude that change in serum albumin concentration from baseline to initiation of aGVHD treatment is an inexpensive, readily available, and predictive biomarker of GVHD severity and mortality after reduced-intensity allogeneic HCT.
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Affiliation(s)
- Andrew R Rezvani
- Clinical Research Division, Fred Hutchinson Cancer Research Center and University of Washington Medical Center, 1100Fairview Ave. N, Seattle, WA 98109, USA.
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24
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HU STEPHANIEW, COTLIAR JONATHAN. Acute graft-versus-host disease following hematopoietic stem-cell transplantation. Dermatol Ther 2011; 24:411-23. [DOI: 10.1111/j.1529-8019.2011.01436.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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25
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Ye Q, Wang Z, Li Y, Wang S, Zhou H, Zhu H, Lei P, Liu L, Shen G. The effect of anti-TfR mouse/human chimeric antibody on anti-transplant rejection. Transpl Int 2010; 24:167-74. [DOI: 10.1111/j.1432-2277.2010.01155.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Li Q, Zhai Z, Xu X, Shen Y, Zhang A, Sun Z, Liu H, Geng L, Wang Y. Decrease of CD4(+)CD25(+) regulatory T cells and TGF-beta at early immune reconstitution is associated to the onset and severity of graft-versus-host disease following allogeneic haematogenesis stem cell transplantation. Leuk Res 2010; 34:1158-68. [PMID: 20409584 DOI: 10.1016/j.leukres.2010.03.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 03/06/2010] [Accepted: 03/09/2010] [Indexed: 11/25/2022]
Abstract
Graft-versus-host disease (GVHD) is a frequent and life threatening complication of allogeneic haematogenesis stem cell transplantation (aHSCT). The correlation of CD4(+)CD25(+) regulatory T cells (Tregs) in the patients after aHSCT to the occurrence and severity of acute and chronic GVHD (aGVHD and cGVHD) is not fully investigated. Here, we examined the levels of CD4(+)CD25(+) Tregs by assessment of CD4(+)CD25(high) and CD4(+)CD25(+)CD127(low) in peripheral blood, and the levels of serum TGF-beta and TNF-alpha in 56 patients at early immune reconstitution following aHSCT. Our data showed a significant reduction in the frequency of Tregs in patients with grades II-IV aGVHD and extensive cGVHD compared to healthy controls. Moreover, a decreased level of CD4(+)CD25(+) Tregs was correlated to increased severity of GVHD. The levels of CD4(+)CD25(+) Tregs in non-GVHD groups were however significantly higher than that in healthy controls. A significant decrease in the levels of TGF-beta and a significant increase the levels of TNF-alpha was also seen with increased severity of GVHD. This study suggested that measurement of CD4(+)CD25(+) Tregs along with serum TGF-beta and TNF-alpha at early immune reconstruction after aHSCT may indicate the onset and severity of both aGVHD and cGVHD.
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Affiliation(s)
- Qing Li
- The Central Laboratory of Medical Research Center in the Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei City, China
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27
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Rio B, Petropoulou AD, Mirshahi P, Soria J, Rendu F, Samama MM, Marie JP, Elalamy I. Endothelial cell markers' kinetics following umbilical cord blood transplantation. Leuk Lymphoma 2009; 49:2209-12. [DOI: 10.1080/10428190802322901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Luft T, Conzelmann M, Benner A, Rieger M, Hess M, Strohhaecker U, Görner M, Hegenbart U, Ho AD, Dreger P. Serum cytokeratin-18 fragments as quantitative markers of epithelial apoptosis in liver and intestinal graft-versus-host disease. Blood 2007; 110:4535-42. [PMID: 17702900 DOI: 10.1182/blood-2006-10-049817] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Graft-versus-host disease (GVHD) is the main complication of allogeneic stem cell transplantation. However, diagnosis of GVHD and evaluation of response to immunosuppressive treatment is sometimes difficult. Since apoptosis is the histopathologic hallmark in GVHD, we investigated whether active GVHD-induced target organ destruction is mirrored by serum levels of the caspase-cleaved neo-epitope of cytokeratin-18 fragments (CK18Fs). Serum CK18F kinetics was monitored by M30 antibody-based enzyme-linked immunosorbent assay (ELISA) in 50 patients who fulfilled histopathologic and/or clinical criteria diagnostic for GVHD. Both intestinal and hepatic GVHD were consistently associated with significant elevations of CK18F levels over baseline. Responses of GVHD to immunosuppressive therapy were paralleled by CK18F decreases, whereas resistant GVHD was characterized by persistent CK18F rises. Clinical conditions that might represent relevant differential diagnoses, such as toxic mucositis, noncomplicated, infection-related diarrhea, and veno-occlusive disease were not associated with CK18F elevations. In conclusion, CK18F monitoring provides a serum marker for quantitative assessment of GVHD-associated apoptotic activity in intestinal and hepatic GVHD. Although apoptosis is not GVHD-specific, CK18Fs may help to distinguish active GVHD from GVHD-unrelated conditions with similar symptoms, and to monitor response to immunosuppressive treatment. Prospective studies are warranted to evaluate how CK18Fs may assist in the diagnosis, grading, and treatment guidance of GVHD.
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Affiliation(s)
- Thomas Luft
- Department Medicine V, University of Heidelberg, Heidelberg, Germany.
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29
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Lin SJ, Cheng PJ, Yan DC, Lee PT, Hsaio HS. Effect of interleukin-15 on alloreactivity in umbilical cord blood. Transpl Immunol 2006; 16:112-6. [PMID: 16860714 DOI: 10.1016/j.trim.2006.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 04/14/2006] [Accepted: 04/25/2006] [Indexed: 11/28/2022]
Abstract
Interleukin(IL)-15 is a promising immunotherapeutic agent for immune reconstitution following stem cell transplantation. To investigate whether IL-15 would aggravate graft-versus-host disease (GVHD) in the setting of unrelated umbilical cord blood (CB) transplantation, we examined the effect of IL-15 on activation marker expression, proliferation and cytokine production of CB in a one-way mixed lymphocyte culture (MLC) assay. We found that IL-15 differentially enhanced CD69 and CD25 expression on CB T cells following allo-stimulation. The maximum degree of allo-specific CB proliferation was achieved on Day 6. IL-15 down-regulated the CB alloreactive proliferative response on Days 4, 6, and 8, with preferentially enhanced autologous proliferation. Exogenous IL-15 further enhanced CB TNF-alpha and IL-10 production in both autologous and allogeneic MLC 6 days after allopriming. Thus, IL-15 was effective in enhancing activation marker expression and cytokine production during CB alloreactivity, but failed to enhance allospecific proliferation. Further studies would be needed to study the role of IL-15 on GVHD in the setting of CB transplantation.
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Affiliation(s)
- Syh-Jae Lin
- Division of Allergy and Immunology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chang Gung Children's Hospital, 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
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30
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Min CK, Kim SY, Lee MJ, Eom KS, Kim YJ, Kim HJ, Lee S, Cho SG, Kim DW, Lee JW, Min WS, Kim CC, Cho CS. Vascular endothelial growth factor (VEGF) is associated with reduced severity of acute graft-versus-host disease and nonrelapse mortality after allogeneic stem cell transplantation. Bone Marrow Transplant 2006; 38:149-56. [PMID: 16751784 DOI: 10.1038/sj.bmt.1705410] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study investigated whether or not there is a correlation between the changes in the serum levels of vascular endothelial growth factor (VEGF) and the outcome of allogeneic stem cell transplantation (allo-SCT). Eighty-five patients undergoing allo-SCT were prospectively studied. The serum VEGF levels were measured on days 0, +7 and +14 after transplantation. The VEGF levels decreased significantly on day +7 and recovered on day +14. The highest levels from day +7 through day +14 were categorized by cluster analysis, which were then correlated with the nonrelapse mortality (NRM). There was a significant correlation between a low VEGF level and the occurrence of severe acute graft-versus-host disease (GVHD) including grade III-IV (P=0.029). The 1-year probability of NRM in patients with a low VEGF level was 22.5% compared with 3.5% for those with a high VEGF level (P=0.024). Multivariate analysis revealed clinically defined infections (P=0.011), advanced disease (P=0.014) and a low VEGF cluster (P=0.05) to be significantly associated with the occurrence of NRM in the cohort. In conclusion, low VEGF levels after allo-SCT are associated with NRM with an exacerbated severity of acute GVHD. VEGF monitoring after a transplant might identify those patients at risk of severe transplant-related mortality.
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Affiliation(s)
- C-K Min
- Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, Seoul, Korea.
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Parra A, Ramírez-Peredo J, Hidalgo R, Morales-Toquero A, Velásquez-Ramírez G, Ruiz-Argüelles A, Ruiz-Argüelles GJ. Altered Functional Status of the Hypothalamic Dopaminergic Tone in Patients with Chronic Graft-versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation: A Pilot Study. Biol Blood Marrow Transplant 2006; 12:566-72. [PMID: 16635792 DOI: 10.1016/j.bbmt.2005.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 12/16/2005] [Indexed: 11/22/2022]
Abstract
We compared the functional status of the hypothalamic dopaminergic tone in patients given an allogeneic hematopoietic stem cell transplantation (allo-HSCT) with chronic graft-versus-host disease (GVHD) with that observed in patients with allo-HSCT without chronic GVHD and in healthy controls. The effect of acute dopaminergic blockade with intravenous metoclopramide on serum prolactin (PRL) concentrations was evaluated. Twenty volunteers, 20 to 52 years of age, seronegative for both hepatitis C virus and the human immunodeficiency virus, were studied: (1) 10 clinically healthy men (group 1), and (2) 9 patients with leukemia, and 1 patient with refractory aplastic anemia who underwent allo-HSCT, 5 of whom (3 men and 2 women) developed chronic GVHD (group 2), and 5 (3 men and 2 women) who did not develop chronic GVHD (group 3). Serum PRL concentrations were measured both fasting and after intravenous administration of metoclopramide (10-mg bolus). The area under the PRL curve was calculated. Patients in group 2 were older than those in groups 1 and 3 (P<.018), but their body mass index was similar. Fasting serum PRL concentrations were similar among the 3 groups; however, group 2 had higher PRL concentrations throughout the test (P<.001) and a greater area under the PRL curve than groups 1 and 3 (P<.001), without differences between the last 2 groups. The differences remained significant after adjustment for age (P<.01). Our results in a small group of patients with chronic GVHD after allo-HSCT suggest the existence of an increased functional level of their hypothalamic dopamine tone, which would favor a tendency toward a diminished endogenous production, release of pituitary PRL, or both. This could represent an adaptive mechanism aiming to maintain circulating PRL concentrations within a physiological range.
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Affiliation(s)
- Adalberto Parra
- Department of Endocrinology, Instituto Nacional de Perinatología, Mexico City, Mexico
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