1
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Trunk AD, Guo M, Budvytyte L, Islam NS, Khera N, Hamilton BK, Amonoo HL. Hematopoietic Stem-Cell Transplantation: Exploring the Latest Advances and Gaps in Disparities, Psychosocial and Symptom Management Interventions, and Chronic Graft-Versus-Host Disease Care. Am Soc Clin Oncol Educ Book 2024; 44:e432186. [PMID: 38754066 DOI: 10.1200/edbk_432186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Although allogeneic hematopoietic cell transplantation (HCT) offers a potential for cure for many patients with advanced hematologic malignancies and bone marrow failure or immunodeficiency syndromes, it is an intensive treatment and accompanied by short- and long-term physical and psychological symptoms requiring specialized care. With substantial advances in therapeutic approaches for HCT and supportive care, HCT survivors experience less morbidity and mortality. However, disparities in both HCT access and outcomes persist, and HCT survivors and their caregivers often lack access to much-needed psychosocial care. Additionally, more medical and psychosocial resources are needed to holistically care for HCT survivors with chronic graft-versus-host disease (GVHD). Hence, this chapter focuses on three areas pertaining to advances and gaps in HCT care: disparities in access to and outcomes of HCT, psychosocial and physical symptom management with supportive care interventions, and GVHD prevention and management.
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Affiliation(s)
- Andrew D Trunk
- Blood and Marrow Transplant Program, Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Michelle Guo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | | | - Betty K Hamilton
- Blood and Marrow Transplant Program, Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Hermioni L Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
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2
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Jeurkar C, Leiby B, Rashid S, Gergis U, Grossso D, Carabasi M, Filicko-O'Hara J, O'Hara W, Klumpp T, Porcu P, Flomenberg N, Wagner JL. A prospective study of posttransplant cyclophosphamide for unrelated donor peripheral blood stem cell transplant with special attention to graft content and the impact of a higher γδ T cell dose. Eur J Haematol 2024. [PMID: 38711359 DOI: 10.1111/ejh.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024]
Abstract
Posttransplant cyclophosphamide (PtCy) has been shown to decrease post-hematopoietic stem cell transplant acute and chronic graft-versus-host disease (GVHD). In this study, PtCy was used in 44 patients along with mycophenolate and tacrolimus with HLA matched (29) and mismatched (15) unrelated donors to determine the impact of graft content on outcome; thus, all patients had flow cytometric analysis of their graft content including the number of B cells, NK cells, and various T cell subsets. Higher γδ T cell dose was associated with the development of acute GVHD (p = .0038). For PtCy, further studies of the cell product along with further graft manipulation, such as selective γδ T cell depletion, could potentially improve outcomes.
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Affiliation(s)
- Chetan Jeurkar
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Benjamin Leiby
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Shaik Rashid
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Usama Gergis
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dolores Grossso
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Matthew Carabasi
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joanne Filicko-O'Hara
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William O'Hara
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thomas Klumpp
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pierluigi Porcu
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Neal Flomenberg
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John L Wagner
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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3
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Arcuri LJ, Ribeiro AAF, Hamerschlak N, Kerbauy MN. Posttransplant cyclophosphamide beyond haploidentical transplantation. Ann Hematol 2024; 103:1483-1491. [PMID: 37261557 DOI: 10.1007/s00277-023-05300-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
Posttransplant cyclophosphamide (PTCy) has practically revolutionized haploidentical (Haplo) hematopoietic cell transplantation (HCT). Comparisons between Haplo with PTCy and unrelated donor (URD) with conventional graft-versus-host disease (GVHD) prophylaxis have shown comparable overall survival with lower incidences of GVHD with Haplo/PTCy and led to the following question: is it PTCy so good that can be successfully incorporated into matched related donor (MRD) and URD HCT? In this review, we discuss other ways of doing PTCy, PTCy in peripheral blood haploidentical transplants, PTCy in the context of matched related and matched unrelated donors, PTCy with mismatched unrelated donors, and PTCy following checkpoint inhibitor treatment. PTCy is emerging as a new standard GVHD prophylaxis in haploidentical, HLA-matched, and -mismatched HCT.
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Affiliation(s)
- Leonardo Javier Arcuri
- Academic Research Organization, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, São Paulo, SP, 05652-900, Brazil.
- Bone Marrow Transplantation Unit, Insituto Nacional de Cancer, Rio de Janeiro, Brazil.
| | | | - Nelson Hamerschlak
- Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
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4
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Paviglianiti A, Ngoya M, Peña M, Boumendil A, Gülbas Z, Ciceri F, Bonifazi F, Russo D, Fegueux N, Stolzel F, Bulabois CE, Socié G, Forcade E, Solano C, Finel H, Robinson S, Glass B, Montoto S. Graft-versus-host-disease prophylaxis with ATG or PTCY in patients with lymphoproliferative disorders undergoing reduced intensity conditioning regimen HCT from one antigen mismatched unrelated donor. Bone Marrow Transplant 2024; 59:597-603. [PMID: 38331980 DOI: 10.1038/s41409-024-02225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
Post-transplant cyclophosphamide (PTCY) has been introduced as graft-versus-host disease (GvHD) prophylaxis in mismatched and matched unrelated hematopoietic cell transplant (HCT). However, data comparing outcomes of PTCY or ATG in patients undergoing a 1 antigen mismatched HCT for lymphoproliferative disease are limited. We compared PTCY versus ATG in adult patients with lymphoproliferative disease undergoing a first 9/10 MMUD HCT with a reduced intensity conditioning regimen from 2010 to 2021. Patients receiving PTCY were matched to patients receiving ATG according to: age, disease status at transplant, female to male matching, stem cell source and CMV serology. Grade II-IV acute GvHD at 100 day was 26% and 41% for the ATG and PTCY group, respectively (p = 0.08). Grade III-IV acute GvHD was not significantly different between the two groups. No differences were observed in relapse incidence, non-relapse mortality, progression-free survival, overall survival and GvHD-relapse-free survival at 1 year. The cumulative incidence of 1-year extensive chronic GvHD was 18% in the ATG and 5% in the PTCY group, respectively (p = 0.06). In patients with lymphoproliferative diseases undergoing 9/10 MMUD HCT, PTCY might be a safe option providing similar results to ATG prophylaxis. Due to the limited number of patients, prospective randomized trials are needed.
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Affiliation(s)
- Annalisa Paviglianiti
- Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Maud Ngoya
- Lymphoma Working Party, EBMT, Paris, France
| | - Marta Peña
- Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | | | - Zafer Gülbas
- Bone Marrow Transplantation Department, Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Domenico Russo
- Unit of Blood Diseases and Bone Marrow Transplantation, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Nathalie Fegueux
- Department of Hematology and Oncology, CHU Lapeyronie, Montpellier, France
| | - Friedrich Stolzel
- University Hospital, Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Claude Eric Bulabois
- CHU Grenoble Alpes - Université Grenoble Alpes, Service d'Hématologie, Grenoble, France
| | - Gerard Socié
- Hopital Saint Louis, Department of Hematology - BMT, Paris, France
| | | | - Carlo Solano
- Hospital Clínico de Valencia, Servicio de Hematología, University of Valencia, Valencia, Spain
| | | | | | | | - Silvia Montoto
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Haemato-oncology St.Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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5
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Hammami MB, Verceles JA, Goldfinger M, Shah N, Sica RA, Mantzaris I, Kornblum N, Konopleva M, Shastri A, Shapiro LC, Feldman EJ, Gritsman K, Verma A, Cooper DL. Improving Unrelated Donor Equity: Assessing Mismatched Donor Opportunities with Real-World Data in a Minority-Predominant Cohort. Transplant Cell Ther 2024; 30:544.e1-544.e8. [PMID: 38417677 DOI: 10.1016/j.jtct.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
Recent advances in graft-versus-host disease (GVHD) prophylaxis including post-transplant cyclophosphamide (PTCy) and abatacept have significantly improved outcomes following HLA-mismatched allogenic hematopoietic stem cell transplantation (allo-HSCT) and have tremendous potential for reducing racial disparities in donor availability. A recent small study employing bone marrow as the source of stem cells showed similar outcomes after 5/8 versus 7/8 matches and is currently being tested in a larger study using peripheral blood stem cells. In this study, we examine real-world alternative donor HSCT options for a minority-predominant cohort in the Bronx, NY, focusing on the availability of lesser-matched (5/8 to 7/8) donors. Records of patients who underwent HLA typing at Montefiore Medical Center (2019 to 2022) were reviewed. The National Marrow Donor Program registry was queried to evaluate the availability of donors with at least 99% likelihood of HLA match at various levels (5/8, 6/8, 7/8, 8/8). Two hundred forty-one patients were included, 70% were non-White. Although the availability of ≥7/8 donors was less common in non-White patients, 100% of patients from each group had at least one or more 5/8 and 6/8 HLA-matched donors and more than 80% of these patients had >100 potential 5/8 and 6/8 HLA-matched donors. There was no statistical difference by race or ethnicity in the mean number of donors at 5/8 and 6/8 HLA-match levels. We demonstrate through real-world data that patients from diverse ethnic and racial backgrounds have access to 5/8 and 6/8 HLA-matched donors for allo-HSCT, potentially eliminating disparities in donor availability and allowing prioritization of other donor selection characteristics such as donor age, sex, ABO, and B leader matching. Further work is needed to study whether the use of mismatched donors offers a more potent graft-versus malignancy effect and optimal GVHD prophylaxis.
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Affiliation(s)
- M Bakri Hammami
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Jhannine Alyssa Verceles
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Mendel Goldfinger
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Nishi Shah
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - R Alejandro Sica
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Ioannis Mantzaris
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Noah Kornblum
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Marina Konopleva
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Aditi Shastri
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Lauren C Shapiro
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Eric J Feldman
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Kira Gritsman
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Amit Verma
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Dennis L Cooper
- Department of Hematology-Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
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6
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Piemontese S, Lupo Stanghellini MT, Sora F, Sica S, Peccatori J, Marcatti M, Metafuni E, Giammarco S, Greco R, Bruno A, Ciceri F, Bacigalupo A, Chiusolo P. Post-transplant cyclophosphamide with Sirolimus or Cyclosporine for GvHD prophylaxis in matched related and unrelated transplantation: a two-center analysis on 213 consecutive patients. Bone Marrow Transplant 2024; 59:692-694. [PMID: 38355909 DOI: 10.1038/s41409-024-02221-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Simona Piemontese
- Hematology and Bone Marrow transplant Unit, San Raffaele Scientific Institute IRCCS, Milano, Italy.
| | | | - Federica Sora
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jacopo Peccatori
- Hematology and Bone Marrow transplant Unit, San Raffaele Scientific Institute IRCCS, Milano, Italy
| | - Magda Marcatti
- Hematology and Bone Marrow transplant Unit, San Raffaele Scientific Institute IRCCS, Milano, Italy
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sabrina Giammarco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Raffaella Greco
- Hematology and Bone Marrow transplant Unit, San Raffaele Scientific Institute IRCCS, Milano, Italy
| | - Alessandro Bruno
- Hematology and Bone Marrow transplant Unit, San Raffaele Scientific Institute IRCCS, Milano, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow transplant Unit, San Raffaele Scientific Institute IRCCS, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Andrea Bacigalupo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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Bono R, Sapienza G, Tringali S, Rotolo C, Patti C, Mulè A, Calafiore V, Santoro A, Castagna L. Allogeneic Stem Cell Transplantation in Refractory Acute Myeloid Leukaemia. Cells 2024; 13:755. [PMID: 38727291 PMCID: PMC11083056 DOI: 10.3390/cells13090755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Refractory acute myeloid leukaemia is very difficult to treat and represents an unmet clinical need. In recent years, new drugs and combinations of drugs have been tested in this category, with encouraging results. However, all treated patients relapsed and died from the disease. The only curative option is allogeneic transplantation through a graft from a healthy donor immune system. Using myeloablative conditioning regimens, the median overall survival regimens is 19%. Several so-called sequential induction chemotherapies followed by allogeneic transplantation conditioned by reduced intensity regimens have been developed, improving the overall survival to 25-57%. In the allogeneic transplantation field, continuous improvements in practices, particularly regarding graft versus host disease prevention, infection prevention, and treatment, have allowed us to observe improvements in survival rates. This is true mainly for patients in complete remission before transplantation and less so for refractory patients. However, full myeloablative regimens are toxic and carry a high risk of treatment-related mortality. In this review, we describe the results obtained with the different modalities used in more recent retrospective and prospective studies. Based on these findings, we speculate how allogeneic stem cell transplantation could be modified to maximise its therapeutic effect on refractory acute myeloid leukaemia.
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Affiliation(s)
- Roberto Bono
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
| | - Giuseppe Sapienza
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
| | - Stefania Tringali
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
| | - Cristina Rotolo
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
| | - Caterina Patti
- Onco-Hematology Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (C.P.); (A.M.); (V.C.)
| | - Antonino Mulè
- Onco-Hematology Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (C.P.); (A.M.); (V.C.)
| | - Valeria Calafiore
- Onco-Hematology Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (C.P.); (A.M.); (V.C.)
| | - Alessandra Santoro
- Onco-Hematology and Cell Manipulation Laboratory Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy;
| | - Luca Castagna
- BMT Unit, AOR Villa Sofia-Vincenzo Cervello, 90146 Palermo, Italy; (R.B.); (G.S.); (S.T.); (C.R.)
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8
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Copsel SN, Garrido VT, Barreras H, Bader CS, Pfeiffer B, Mateo-Victoriano B, Wolf D, Gallardo M, Paczesny S, Komanduri KV, Benjamin CL, Villarino AV, Saluja AK, Levy RB. Minnelide suppresses GVHD and enhances survival while maintaining GVT responses. JCI Insight 2024; 9:e165936. [PMID: 38602775 DOI: 10.1172/jci.insight.165936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (aHSCT) can cure patients with otherwise fatal leukemias and lymphomas. However, the benefits of aHSCT are limited by graft-versus-host disease (GVHD). Minnelide, a water-soluble analog of triptolide, has demonstrated potent antiinflammatory and antitumor activity in several preclinical models and has proven both safe and efficacious in clinical trials for advanced gastrointestinal malignancies. Here, we tested the effectiveness of Minnelide in preventing acute GVHD as compared with posttransplant cyclophosphamide (PTCy). Strikingly, we found Minnelide improved survival, weight loss, and clinical scores in an MHC-mismatched model of aHSCT. These benefits were also apparent in minor MHC-matched aHSCT and xenogeneic HSCT models. Minnelide was comparable to PTCy in terms of survival, GVHD clinical score, and colonic length. Notably, in addition to decreased donor T cell infiltration early after aHSCT, several regulatory cell populations, including Tregs, ILC2s, and myeloid-derived stem cells in the colon were increased, which together may account for Minnelide's GVHD suppression after aHSCT. Importantly, Minnelide's GVHD prevention was accompanied by preservation of graft-versus-tumor activity. As Minnelide possesses anti-acute myeloid leukemia (anti-AML) activity and is being applied in clinical trials, together with the present findings, we conclude that this compound might provide a new approach for patients with AML undergoing aHSCT.
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Affiliation(s)
| | | | | | | | - Brent Pfeiffer
- Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | | | | | | | - Sophie Paczesny
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Krishna V Komanduri
- Department of Microbiology and Immunology
- Sylvester Comprehensive Cancer Center
- Department of Medicine, and
| | - Cara L Benjamin
- Sylvester Comprehensive Cancer Center
- Department of Medicine, and
| | | | - Ashok K Saluja
- Department of Surgery, and
- Sylvester Comprehensive Cancer Center
| | - Robert B Levy
- Department of Microbiology and Immunology
- Sylvester Comprehensive Cancer Center
- Department of Ophthalmology, University of Miami, Miller School of Medicine, Miami, Florida, USA
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9
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Wang L, Xu G, Wang L, Jiang J, Gao W, Wan M, Blaise D, Hu J. Post-transplant cyclophosphamide at 80 mg/kg with low dose post-engraftment anti-thymocyte globulin in haploidentical transplantation with myeloablative conditioning. Bone Marrow Transplant 2024:10.1038/s41409-024-02277-4. [PMID: 38600162 DOI: 10.1038/s41409-024-02277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Abstract
While post-transplant cyclophosphamide (PTCy) is commonly used as graft-versus-host disease (GvHD) prophylaxis in haploidentical stem cell transplantation (haplo-HSCT), its dose remains a matter of debate due to side effect concerns. Standard dose of 100 mg/kg associated with tacrolimus and post-engraftment anti-thymocyte globulin (ATG) was used as the reference GvHD prophylaxis in our center and had demonstrated encouraging results. Though PTCy 80 mg/kg was shown to be feasible in patients in reduced-intensity conditioning, whether it exerts equivalent GvHD prophylactic efficacy in myeloablative conditioning (MAC) setting has not been confirmed. Here, we retrospectively analyzed the efficacy and safety of PTCy 80 mg/kg combined with tacrolimus and post-engraftment ATG as GvHD prophylaxis in patients aged more than 55 years or with cardiac antecedents or HCT-CI score >2 undergoing haplo-HSCT with MAC. The cumulative incidence of grade III-IV aGvHD at day 100 and moderate-to-severe cGvHD at 1 year was 4.8% ± 3.4% and 19.9% ± 7.0%, respectively. When compared with patients receiving the reference regimen, patients from the PTCy 80 mg/kg group had similar incidence of GvHDs and survival as their younger counterparts. Thus, PTCy 80 mg/kg seems to be feasible for patients treated with MAC conditioning regimens in haplo-HSCT, inviting further investigation notably in frail patients.
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Affiliation(s)
- Lining Wang
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, National Research Center for Translational Medicine, Blood and Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guilin Xu
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, National Research Center for Translational Medicine, Blood and Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ling Wang
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, National Research Center for Translational Medicine, Blood and Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jieling Jiang
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, National Research Center for Translational Medicine, Blood and Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Gao
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, National Research Center for Translational Medicine, Blood and Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Wan
- Shanghai Clinical Research Center (SCRC), Fenglin International Centre, Shanghai, China
| | - Didier Blaise
- Department of Hematology, Program of Transplantation and Cell Therapy, Program of Leukemia, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, Aix Marseille University, Marseille, France.
| | - Jiong Hu
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, National Research Center for Translational Medicine, Blood and Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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10
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Khera N, Edwards ML, Song Y, Sun R, Manghani R, Shin H, Simantov R, Signorovitch J, Sivaraman S, Gergis U. Projected Impact of Omidubicel-onlv on Racial/Ethnic Disparities in Allogeneic Hematopoietic Cell Transplantation (Allo-HCT) Outcomes in Hematologic Malignancies. Adv Ther 2024; 41:1637-1651. [PMID: 38427220 PMCID: PMC10960759 DOI: 10.1007/s12325-023-02771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/14/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION In a phase III clinical trial (NCT02730299), omidubicel-onlv, a nicotinamide-modified allogeneic hematopoietic progenitor cell therapy, showed rapid hematopoietic and immune recovery compared with standard umbilical cord blood (UCB) transplant across all racial/ethnic groups. METHODS A decision-tree model was used to project the effect of omidubicel-onlv availability on addressing health disparities in allogeneic hematopoietic cell transplantation (allo-HCT) access and outcomes for patients with hematologic malignancies. The model used a hypothetical population of 10,000 allo-HCT-eligible US adults, for whom matched related donors were not available. Patients received matched or mismatched unrelated donor, haploidentical, UCB transplant, or no transplant. Scenarios with omidubicel-onlv use of 0% (status quo), 10%, 15%, 20%, and 30% were modeled on the basis of proportional reductions in other allo-HCT sources or no transplant by racial/ethnic group. RESULTS Increased omidubicel-onlv use was associated with a higher proportion of patients undergoing allo-HCT, decreased time to allo-HCT, decreased 1-year non-relapse mortality, and increased 1-year overall survival, particularly among racial minorities. In the scenario modeling 20% omidubicel-onlv use, the proportion of Black patients receiving allo-HCT increased by 129%; increases were also observed in Asian (64%), Hispanic (45%), and other (42%) patient groups. Modeled time to allo-HCT improved among transplanted patients (23%) from 11.4 weeks to 8.8 weeks. One-year OS in the overall population increased by 3%, with improvements ranging from 3% for White patients to 5% for Black patients. CONCLUSION This study demonstrates that broad access to omidubicel-onlv could increase access to allo-HCT and improve outcomes for patients, with the greatest benefits seen among racial/ethnic minority groups.
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Affiliation(s)
- Nandita Khera
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Yan Song
- Analysis Group Inc., Boston, MA, USA
| | | | | | | | | | | | | | - Usama Gergis
- Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St, Ste 308, Philadelphia, PA, 19107, USA.
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11
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Lin RJ, Dahi PB, Korc-Grodzicki B, Shahrokni A, Jakubowski AA, Giralt SA. Transplantation and Cellular Therapy for Older Adults-The MSK Approach. Curr Hematol Malig Rep 2024; 19:82-91. [PMID: 38332462 DOI: 10.1007/s11899-024-00725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE OF REVIEW Hematologic malignances more commonly affect older individuals and often present with advanced, higher risk disease than younger patients. Allogeneic and autologous hematopoietic cell transplantation is well-established treatment modalities with curative potential following either frontline treatments for these diseases or salvage therapy in the relapsed or refractory setting. More recently, novel cellular immunotherapy such as chimeric antigen receptor T-cell therapy has been shown to lead to high response rate and durable remission in many patients with advanced blood cancers. RECENT FINDINGS Given unique characteristics of older patients, how best to deliver these higher-intensity and time sensitive treatment modalities for them remains challenging. Moreover, their short-term and potential long-term impact on their functional status, cognitive status, and quality of life may be significant considerations for many older patients. All these issues contributed to the lack of access and significant underutilization of these potential curative treatment strategies. In this review, we present up to date evidence to support potential benefits of transplantation and cellular therapy for older adults, their steady improving outcomes, and most importantly, highlight the use of geriatric assessment to help select appropriate older patients and optimize them prior to and following transplantation and cellular therapy. We specifically describe our approach at Memorial Sloan Kettering Cancer Center and encouraging early results from its implementation.
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Affiliation(s)
- Richard J Lin
- Adult Blood and Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- David H. Koch Center for Cancer Care, Memorial Sloan Kettering Cancer Center, 530 E 74th Street, Room 21-142, New York, NY, 10022, USA.
| | - Parastoo B Dahi
- Adult Blood and Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Beatriz Korc-Grodzicki
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Armin Shahrokni
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ann A Jakubowski
- Adult Blood and Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sergio A Giralt
- Adult Blood and Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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12
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Ma N, Wu WB, Zhao XY, Xu LP, Zhang XH, Wang Y, Mo XD, Zhang YY, Zhao XS, Sun YQ, Cheng YF, Liu KY, Chang YJ, Huang XJ. Targeting T FH cells is a novel approach for donor-specific antibody desensitization of allograft candidates: an in vitro and in vivo study. Haematologica 2024; 109:1233-1246. [PMID: 37822236 PMCID: PMC10985458 DOI: 10.3324/haematol.2023.283698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
The presence of donor-specific antibodies (DSA) are associated with graft failure either following human leukocyte antigen (HLA)-mismatched allogeneic stem cell transplantation or after organ transplantation. Although targeting B cells and plasma cells have been used for desensitization, there have been reports of failure. T-follicular helper (Tfh) cells assist B cells in differentiating into antibody-secreting plasma cells. We used haploidentical allograft as a platform to investigate the possibility of targeting Tfh cells to desensitize DSA. The quantities of circulating Tfh (cTfh) cell subsets in allograft candidates were abnormal, and these cells, including the cTfh2 and cTfhem cell subsets, were positively related to the production of anti-HLA antibodies. Ex vivo experiments showed that the cTfh cells of anti-HLA antibody-positive allograft candidates could induce B cells to differentiate into DSA-producing plasmablasts. The immune synapse could be involved in the assistance of cTfh cells to B cells in antibody production. In vitro experiments and in vivo clinical pilot studies indicated that targeting cTfh cells with sirolimus can inhibit their auxiliary function in assisting B cells. Ex vivo and in vivo studies demonstrated the effect of sirolimus and rituximab on DSA desensitization compared with either sirolimus or rituximab alone (60%, 43.75%, and 30%, respectively). Our findings provide new insight into the role of Tfh cells in the pathogenesis of DSA production in HLA-mismatched transplant candidates. Our data also indicate that targeting Tfh cells is a novel strategy for DSA desensitization and combination of sirolimus and rituximab might be a potential therapy. The prospective cohort of this study is registered at http://www.chictr.org.cn as #ChiCTR-OPC-15006672.
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Affiliation(s)
- Ning Ma
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Wei-Bing Wu
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Xiang-Yu Zhao
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Lan-Ping Xu
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Xiao-Hui Zhang
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Yu Wang
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Xiao-Dong Mo
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Yuan-Yuan Zhang
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Xiao-Su Zhao
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Yu-Qian Sun
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Yi-Fei Cheng
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Kai-Yan Liu
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044
| | - Ying-Jun Chang
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044.
| | - Xiao-Jun Huang
- Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Xicheng District, Beijing 100044, China; Peking-Tsinghua Center for Life Sciences, Beijing 100871, China; Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, 2019RU029, Beijing.
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13
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Sugita J, Kuroha T, Ishikawa J, Eto T, Fukushima K, Yokota I, Akashi K, Taniguchi S, Harada M, Teshima T. Posttransplant cyclophosphamide in unrelated and related peripheral blood stem cell transplantation from HLA-matched and 1 allele mismatched donor. Bone Marrow Transplant 2024; 59:344-349. [PMID: 38114645 DOI: 10.1038/s41409-023-02162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Abstract
Posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis has been increasingly used in HLA-haploidentical transplantation and recent studies also demonstrated the efficacy of PTCy in HLA-matched transplantation. We conducted a prospective multicenter phase II study to evaluate the safety and efficacy of PTCy with tacrolimus and mycophenolate mofetil in 43 patients who underwent HLA-matched (n = 21), 1 allele mismatched (n = 20), or 2 allele mismatched (n = 2) peripheral blood stem cell transplantation (PBSCT) following myeloablative (n = 28) or reduced-intensity (n = 15) conditioning. The incidence of grade III-IV acute GVHD at 100 days was 2.3%. The incidences of grades II-IV acute GVHD, all grade chronic GVHD, and moderate to severe chronic GVHD at 2 years were 16.3%, 14.0%, and 4.7%, respectively. Overall survival, disease-free survival, and non-relapse mortality at 2 years were 75.3%, 74.0%, and 7.0%, respectively. GVHD-free, relapse-free survival at 2 years was 67.0%. The rate of off-immunosuppressants in patients who survived without relapse at 2 years was 85.4%. These results indicate that PTCy is a valid option for GVHD prophylaxis in both HLA-matched and HLA 1-2 allele mismatched PBSCT.
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Affiliation(s)
- Junichi Sugita
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Takashi Kuroha
- Department of Hematology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Kentaro Fukushima
- Department of Hematology and Oncology, Osaka University Hospital, Suita, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koichi Akashi
- Department of Hematology/Oncology, Kyushu University Hospital, Fukuoka, Japan
| | | | - Mine Harada
- Karatsu Higashimatsuura Medical Center, Karatsu, Japan
| | - Takanori Teshima
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
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14
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Chhabra S, Jerkins JH, Monahan K, Szabo A, Shah NN, Abedin S, Runaas L, Fenske TS, Pasquini MC, Shaw BE, Drobyski WR, Saber W, D'Souza A, Dhakal B, Mohan M, Longo W, Hamadani M. Severity and organ distribution of chronic graft-versus-host disease with posttransplant cyclophosphamide-based versus methotrexate/calcineurin inhibitor-based allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2024; 59:373-379. [PMID: 38177221 DOI: 10.1038/s41409-023-02178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
The reduced risk of chronic graft-versus-host-disease (GVHD) with posttransplant cyclophosphamide (ptCy) in the setting of haploidentical related donor and more recently, with HLA-matched related and matched and mismatched unrelated donor allogeneic transplantation has been established. There is, however, paucity of data to show if ptCy impacts chronic GVHD pathogenesis, its phenotype and evolution after HCT regardless of the donor status. We examined the differences in chronic GVHD incidence and presentation in 314 consecutive patients after receiving their first allogeneic transplantation (HCT) using ptCy-based GVHD prophylaxis (ptCy-HCT; n = 120; including 95 with haploidentical related donor) versus conventional calcineurin inhibitor-based prophylaxis (CNI-MUD; n = 194) between 2012 and 2019. The 1-year cumulative incidence of all-grade chronic GVHD and moderate/severe chronic GVHD was 24% and 12%, respectively, after ptCy-HCT and 40% and 23% in the CNI-MUD recipients (p = 0.0003 and 0.007). Multivariable analysis confirmed that use of CNI-based GVHD prophylaxis and peripheral blood stem cell graft as the risk factors for chronic GVHD. The cumulative incidence of visceral (involving ≥1 of the following organs: liver, lungs, gastrointestinal tract, serous membranes) chronic GVHD was significantly higher with CNI-MUD vs. ptCy-HCT (27% vs. 15% at 1 year, p = 0.009). The incidence of moderate/severe visceral chronic GVHD was 20% in CNI-MUD group vs. 7.7% in the ptCy-HCT group at 1 year (p = 0.002). In addition, significantly fewer ptCy-HCT recipients developed severe chronic GVHD in ≥3 organs (0.8%) vs. 8.8% in the CNI-MUD group at 1-year posttransplant (p = 0.004). There was no significant different in relapse, non-relapse mortality, and relapse-free and overall survival between the two groups. Further investigation is needed to confirm that reduced risk and severity of chronic GVHD, less visceral organ distribution with ptCy-HCT leads to improved quality of life.
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Affiliation(s)
- Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
- Previously at Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James H Jerkins
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Previously at Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathleen Monahan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nirav N Shah
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sameem Abedin
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lyndsey Runaas
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy S Fenske
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcelo C Pasquini
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bronwen E Shaw
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William R Drobyski
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wael Saber
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Walter Longo
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
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15
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Kantor NB, Tovar A, Wang T, Galor A. How does ocular graft-versus-host disease fit under the dry eye umbrella? A review. Clin Exp Ophthalmol 2024; 52:167-185. [PMID: 38204146 PMCID: PMC10939887 DOI: 10.1111/ceo.14347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
Graft-versus-host disease (GVHD) is a systemic disease that can affect multiple organs as a consequence of an allogeneic haematopoietic stem cell transplant. One organ system that is often affected in GVHD is the eyes. Ocular GVHD (oGVHD) may involve various structures within the eye including the lacrimal glands, eyelids, conjunctiva, cornea, and nasolacrimal ducts, and is a source of morbidity in patients with GVHD. Common presenting features of GVHD overlap with dry eye disease (DED), including decreased tear production, epithelial disruption, and Meibomian gland dysfunction (MGD). In this review, we aim to compare oGVHD and DED to better understand the similarities and differences between the conditions, with a focus on pathophysiology, risk factors, clinical features, and treatments.
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Affiliation(s)
- Nicole B. Kantor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
| | | | - Trent Wang
- Division of Transplantation and Cellular Therapy, Sylvester Comprehensive Cancer Center, Adult Stem Cell Transplant Program, University of Miami Hospital and Clinics, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
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16
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Fingerson S, Maiers M, Bolon YT, Devine SM, Spellman SR. Expanding donor options: haploidentical transplant recipients are also highly likely to have a 7/8-matched unrelated donor. Blood Adv 2024; 8:758-765. [PMID: 38127270 PMCID: PMC10847856 DOI: 10.1182/bloodadvances.2023011814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
ABSTRACT The use of haploidentical related donor (HRD) hematopoietic cell transplants (HCTs) in the United States grew by more than fourfold in the last decade, driven mainly by use of posttransplant cyclophosphamide (PTCy)-based graft-versus-host-disease prophylaxis. However, not all patients have a suitable HRD available. In this study, we explored the existence of unrelated donors (URDs) on the National Marrow Donor Program (NMDP) registry at the 8/8- or 7/8-match level for patients receiving HRD HCT in the United States and reporting to the Center for International Blood and Marrow Transplant Research between 2013 and 2020. The data consist of 9696 HRD HCT recipients. The NMDP search prognosis score and a search simulation were used to estimate counts of URD matches on the registry. NMDP search prognosis varied by patient ancestry, with 27.5% non-Hispanic White having a good score compared with 4.6% of African American HRD HCT recipients. Overall, 34% of recipients had ≥1 8/8-matched URDs and 84% had ≥1 7/8 URDs. Recipients of older HRDs (≥35 years) had a likelihood of between 20%- 65% of having ≥5 existing 7/8-matched URDs who were aged ≤35 years. Donor-selection practices varied among the 10 highest-volume HRD centers: 6 had >20% chance of an existing 8/8-matched URD for their HRD recipients, whereas 4 centers had low likelihood of identifying an 8/8-matched URD. In conclusion, although most US patients undergoing HRD HCT do not have an existing 8/8 URD, the majority have an existing 7/8-matched URD. Studies comparing outcomes in patients receiving either HRD or 7/8-matched URD HCT and PTCy-based graft-versus-host disease prophylaxis may be warranted.
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Affiliation(s)
- Stephanie Fingerson
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, MN
| | - Martin Maiers
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, MN
| | - Yung-Tsi Bolon
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, MN
| | - Steven M. Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, MN
| | - Stephen R. Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, MN
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17
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Montoro J, Boumendil A, Finel H, Bramanti S, Castagna L, Blaise D, Dominietto A, Kulagin A, Yakoub-Agha I, Tbakhi A, Solano C, Giebel S, Gulbas Z, López Corral L, Pérez-Simón JA, Díez Martín JL, Sanz J, Farina L, Koc Y, Socié G, Arat M, Jurado M, Bermudez A, Labussière-Wallet H, Villalba M, Ciceri F, Martinez C, Nagler A, Sureda A, Glass B. Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis in HLA-Matched and Haploidentical Donor Transplantation for Patients with Hodgkin Lymphoma: A Comparative Study of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:210.e1-210.e14. [PMID: 38043802 DOI: 10.1016/j.jtct.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
Post-transplantation cyclophosphamide (PTCy) has emerged as a promising approach for preventing graft-versus-host disease (GVHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, there is a lack of studies examining the impact of this GVHD prophylaxis when different donor types are used in patients with Hodgkin lymphoma (HL). This study compared the outcomes of patients with HL undergoing HSCT from HLA-matched donors, including matched sibling donors (MSDs) and matched unrelated donors (MUDs), and haploidentical donors, using PTCy as the GVHD prophylaxis approach in all cohorts. We retrospectively compared outcomes of allo-HSCT from 166 HLA-matched donors (96 sibling and 70 unrelated donors) and 694 haploidentical donors using PTCy-based GVHD prophylaxis in patients with HL registered in the European Society for Blood and Marrow Transplantation database from 2010 to 2020. Compared to HLA-matched HSCT, haploidentical donor HSCT was associated with a significantly lower rate of platelet engraftment (86% versus 94%; P < .001) and a higher rate of grade II-IV acute GVHD (34% versus 24%; P = .01). The 2-year cumulative incidence of nonrelapse mortality (NRM) was significantly lower in the HLA-matched cohort compared to the haploidentical cohort (10% versus 18%; P = .02), resulting in a higher overall survival (OS) rate (82% versus 70%; P = .002). There were no significant differences between the 2 cohorts in terms of relapse, progression-free survival, or GVHD-free relapse-free survival. In multivariable analysis, haploidentical HSCT was associated with an increased risk of grade II-IV acute GVHD and NRM and worse OS compared to HLA-matched HSCT. Our findings suggest that in the context of PTCy-based GVHD prophylaxis, transplantation from HLA-matched donors appears to be a more favorable option compared to haploidentical HSCT.
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Affiliation(s)
- Juan Montoro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Universidad Católica de Valencia, Spain.
| | - Ariane Boumendil
- European Society for Blood and Marrow Transplantation Lymphoma Working Party, Paris, France
| | - Hervé Finel
- European Society for Blood and Marrow Transplantation Lymphoma Working Party, Paris, France
| | - Stefania Bramanti
- Department of Oncology/Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Castagna
- Department of Oncology/Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire, Marseille, France
| | - Alida Dominietto
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Aleksandr Kulagin
- RM Gorbacheva Research Institute, Pavlov University, Saint Petersburg, Russia
| | | | | | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario-INCLIVA, Valencia, Spain
| | - Sebastian Giebel
- The Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Zafer Gulbas
- Anadolu Health Center Avliated John Hopkins, Kocaeli, Gebze, Turkey
| | | | - José A Pérez-Simón
- Servicio de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), CSIC, Universidad de Sevilla, Spain
| | | | - Jaime Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lucia Farina
- University of Milan. Hematology Division, Fondazione IRCCS Istituto. Nazionale dei Tumori di Milano, Milan, Italy
| | - Yener Koc
- Medical Park Hospitals, Beylikduzu, Istanbul, Turkey
| | - Gerard Socié
- Department of Hematology - BMT, Hematology Transplantation, Paris, France
| | - Mutlu Arat
- Demiroglu Bilim University Istanbul Florence Nightingale Hospital, Hematopoietic SCT Unit, Istanbul, Turkey
| | | | | | | | - Marta Villalba
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Milano, Italy
| | - Carmen Martinez
- Hematopoietic Stem Cell Transplantation Unit, Hospital Clínic de Barcelona, Institute of Cancer and Blood Diseases, Barcelona, Spain
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Anna Sureda
- Hematology Department. Institut Català d'Oncologia, Hospital Duran i Reynals. Institut d'Investigació Biomèdica de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Bertram Glass
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Klinik St. Georg, Hamburg, Germany
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18
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Cornillon J, Crocchiolo R, Dubois V, Guidicelli G, Jorge-Cordeiro D, Meunier MC, Michiels S, Timmermans A, Villemonteix J, Yakoub-Agha I, Ahmad I. [Unrelated donor selection for allogeneic hematopoietic stem cell transplantation: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2024; 111:S1-S13. [PMID: 37690877 DOI: 10.1016/j.bulcan.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
The selection of a donor is an essential element in allogeneic hematopoietic stem cell transplantation. In the absence of an HLA-matched related donor, the selection of an unrelated donor is considered, and is currently the most common type of allogenic donor used in practice. Many criteria are considered for the selection when multiple donors are available, particularly in case of partial match. The aim of this workshop is to assist in the selection of an unrelated donor, in keeping with recent data from the literature.
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Affiliation(s)
- Jérôme Cornillon
- Centre hospitalo-universitaire de Saint-Étienne 42, département d'hématologie et de thérapie cellulaire, Saint-Étienne, France.
| | | | | | | | - Debora Jorge-Cordeiro
- Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Saint-Louis, laboratoire d'immunologie, Paris, France
| | - Marie-Christine Meunier
- Hôpital Maisonneuve-Rosemont, Optilab-CHUM, laboratoire de diagnostic moléculaire et cytogénétique, Montréal, Québec, Canada
| | - Sandra Michiels
- Hôpital universitaire de Bruxelles, institut Jules-Bordet, unité de transplantation-hématologie, Bruxelles, Belgique
| | - Aurélie Timmermans
- Hôpital universitaire de Bruxelles, institut Jules-Bordet, unité de transplantation-hématologie, Bruxelles, Belgique
| | - Juliette Villemonteix
- Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Saint-Louis, laboratoire d'immunologie, Paris, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Inserm U1286, Infinite, université de Lille, 59000 Lille, France
| | - Imran Ahmad
- Université de Montréal, hôpital Maisonneuve-Rosemont, institut universitaire d'hématologie-oncologie & de thérapie cellulaire, Montréal, Québec, Canada
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19
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Little JS, Duléry R, Shapiro RM, Aleissa MM, Prockop SE, Koreth J, Ritz J, Antin JH, Cutler C, Nikiforow S, Romee R, Issa NC, Ho VT, Baden LR, Soiffer RJ, Gooptu M. Opportunistic Infections in Patients Receiving Post-Transplantation Cyclophosphamide: Impact of Haploidentical versus Unrelated Donor Allograft. Transplant Cell Ther 2024; 30:233.e1-233.e14. [PMID: 37984797 DOI: 10.1016/j.jtct.2023.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
Post-transplantation cyclophosphamide (PTCy) is an effective strategy for graft-versus-host disease (GVHD) prophylaxis and is the standard of care for haploidentical hematopoietic cell transplantation (HCT). It is increasingly used for matched and mismatched unrelated donor (MUD/MMUD) HCT, but infections remain a concern. The objective of this study was to evaluate the characteristics and risk factors for infections in haploidentical and unrelated donor HCT recipients treated with PTCy-based GVHD prophylaxis. This single-center retrospective study examined 354 consecutive adults undergoing HCT with PTCy-based GVHD prophylaxis (161 MUD/MMUD; 193 haploidentical) between 2015 and 2022. Opportunistic infections (OIs), including cytomegalovirus (CMV), adenovirus (AdV), Epstein-Barr virus (EBV), and invasive fungal disease (IFD), were assessed from day 0 through day +365. The 1-year cumulative incidence functions of OIs and nonrelapse mortality (NRM) were calculated using dates of relapse and repeat HCT as competing risks. Secondary analysis evaluated risk factors for OIs and NRM using univariate and multivariable Cox regression models. Haploidentical HCT recipients had an increased risk of OIs compared to unrelated donor allograft recipients (39% for haploidentical versus 25% for MUD/MMUD; hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.16 to 2.49; P = .006). On multivariable analysis, haploidentical donor (HR, 1.50; 95% CI, 1.01 to 2.23; P = .046), prior HCT (HR, 1.99; 95% CI, 1.29 to 3.09; P = .002), and diagnosis of aGVHD (HR, 1.47; 95% CI, 1.02 to 2.14; P = .041) were associated with increased risk of OIs. NRM within the first year was not significantly different between the 2 cohorts (HR, 1.11; 95% CI, .64 to 1.93; P = .70). Overall, haploidentical donor was a significant risk factor for OIs in patients receiving PTCy, although 1-year NRM was not different between haploidentical HCT and MUD/MMUD HCT recipients. CMV and AdV infections were significantly increased among haploidentical HCT recipients, whereas the incidences of EBV infection and IFD were similar in the 2 cohorts. Our findings may have implications for infection monitoring and prophylaxis in the setting of PTCy, particularly in haploidentical HCT recipients.
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Affiliation(s)
- Jessica S Little
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Rémy Duléry
- Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts; Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMRs 938, Centre de recherche Saint-Antoine, Paris, France
| | - Roman M Shapiro
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Muneerah M Aleissa
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Susan E Prockop
- Harvard Medical School, Boston, Massachusetts; Hematopoietic Stem Cell Transplant Program, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - John Koreth
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jerome Ritz
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph H Antin
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sarah Nikiforow
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rizwan Romee
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicolas C Issa
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vincent T Ho
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert J Soiffer
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mahasweta Gooptu
- Harvard Medical School, Boston, Massachusetts; Stem Cell Transplant and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
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20
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Kassim AA. The range of haploidentical transplant protocols in sickle cell disease: all haplos are not created equally. Hematology Am Soc Hematol Educ Program 2023; 2023:532-541. [PMID: 38066894 PMCID: PMC10727056 DOI: 10.1182/hematology.2023000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The ideal curative therapy for sickle cell disease (SCD) must be applicable across all ages and include individuals with strokes and preexisting heart, lung, and kidney disease. Myeloablative, matched sibling donor hematopoietic stem cell transplant (HCT) for children with SCD has shown excellent outcomes over the past 3 decades but has been restricted due to the limited availability of a human leukocyte antigen-matched sibling donor (10%-15%) and increased treatment-related death in adults with myeloablative conditioning. To overcome these 2 significant barriers to curative therapy in SCD, related haploidentical HCT has become an active area of research. The use of related haploidentical donors (first- and second-degree relatives) increases the donor pool to at least 90% of those eligible across the life span. Importantly, most adults, even with strokes or significant comorbidities, can tolerate the nonmyeloablative conditioning regimen without treatment-related death. Since 2013, at least 3 related haploidentical HCT strategies have emerged as potential curative therapies for SCD: (1) a nonmyeloablative, T-cell replete, bone marrow transplant with thiotepa and posttransplant cyclophosphamide with a goal of complete donor chimerism; (2) a nonmyeloablative, in vivo T-cell depletion, using peripheral blood stem cells (PBSCs) with a goal of stable mixed donor-recipient chimerism; and (3) a myeloablative, ex vivo T-cell depletion using PBSCs and advanced-technology graft manipulation, with a goal of complete donor chimerism. We review the similarities, differences, outcomes, and gaps in knowledge with these 3 haploidentical HCT approaches for SCD.
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Affiliation(s)
- Adetola A. Kassim
- Department of Hematology/Oncology, Vanderbilt University School of Medicine, Nashville, TN
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21
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Watkins B, Qayed M. Novel approaches to acute graft-versus-host disease prevention. Hematology Am Soc Hematol Educ Program 2023; 2023:155-163. [PMID: 38066861 PMCID: PMC10727007 DOI: 10.1182/hematology.2023000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The field of graft-versus-host disease (GvHD) has experienced significant growth, with increased number of clinical trials and the approval of several agents by the US Food and Drug Administration for both acute and chronic GvHD treatment. In addition, the development of prognostic biomarker algorithms has enabled risk stratification in acute GvHD. However, prevention remains the cornerstone of GvHD management. Notable recent changes include the expansion of donor options with the increased use of haploidentical donor and unrelated donor transplantation, the development of ex vivo selective T-cell depletion strategies, recent approval by the Food and Drug Administration of abatacept for GvHD prevention, and the application of posttransplant cyclophosphamide in matched and mismatched donor settings. In this article, we review the results of recent clinical trials in GvHD prophylaxis and discuss the changes in clinical practice and promising emerging strategies driving the field forward.
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Affiliation(s)
- Benjamin Watkins
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA
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22
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Amanam I, Otoukesh S, Al Malki MM, Salhotra A. Chronic GVHD: review advances in prevention, novel endpoints, and targeted strategies. Hematology Am Soc Hematol Educ Program 2023; 2023:164-170. [PMID: 38066845 PMCID: PMC10727045 DOI: 10.1182/hematology.2023000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a curative therapy for many malignant and non-malignant hematologic disorders. Chronic graft-versus-host (cGVHD) disease remains a significant hurdle for long-term survival in patients post allo-HCT, and it remains the leading cause of late non-relapse mortality. The risk factors for development of cGVHD include degree of human leukocyte antigen (HLA) disparity, increasing recipient age, use of peripheral blood stem cells as a source, myeloablative conditioning regimens, prior acute GVHD (aGVHD), and female donor to male recipient. Our biological understanding of cGVHD is mostly derived from transplantation mouse models and patient data. There are three distinct phases in the development of cGVHD. Approaches to prevent GVHD include pharmacologic strategies such as calcineurin inhibitors (cyclosporine, tacrolimus) combined with methotrexate or mTOR inhibitors (sirolimus), and IMP dehydrogenase inhibitors (mycophenolate mofetil). Increasingly, posttransplant cyclophosphamide is emerging as a promising strategy for GVCHD prevention especially in a setting of reduced intensity conditioning. Other approaches include serotherapy (ATG, Campath) and graft manipulation strategies. A significant obstacle to evaluating the response of novel GVHD-directed therapies has been standardized response assessments. This has functioned as a barrier to designing and interpreting clinical trials that are structured around the treatment of cGVHD. Novel endpoints including failure-free survival, Graft-versus-host disease-free, relapse-free survival (GRFS), and current GVHD-free, relapse-free survival (CGRFS) may create a clearer picture for post-HCT outcomes. Targeted therapies including Bruton's tyrosine kinase inhibition, JAK1/2 inhibition, and ROCK2 inhibitors have improved cGVHD therapy, especially in the steroid refractory setting. Continued improvement in prophylactic strategies for cGVHD, identification of accurate cGVHD treatment endpoints, and access to novel therapeutic agents are expected to improve cGVHD outcomes.
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23
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Mishra A. Approaches to optimize outcomes in transplant recipients. Hematology Am Soc Hematol Educ Program 2023; 2023:723-730. [PMID: 38066935 PMCID: PMC10727018 DOI: 10.1182/hematology.2023000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Curative therapy with an allogeneic hematopoietic cell transplant (HCT) can now be offered to a wider patient population due to improvements in donor selection, transplant conditioning regimens, and supportive care measures. However, risk of transplant-related morbidity and mortality remains, and thus appropriate transplant candidate workup pre-HCT for risk stratification and a management plan after HCT is crucial for success of the procedure. These include understanding and identifying risk of underlying malignant disease relapse, graft-versus-host disease, and infectious complications a patient may be predisposed toward, irrespective of allogeneic donor type. Progress in these domains with new therapeutic paradigms allows for development of a treatment plan prior to HCT to mitigate these potential risks tailored to the patient's case. Herein, we present case studies to focus on factors that influence decision-making in HCT and the approaches and strategies used to optimize post-HCT outcomes based on the individual HCT recipient's clinical scenario to improve on these high-risk scenarios.
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Affiliation(s)
- Asmita Mishra
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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24
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Nath K, Lee J, Elko TA, Levy L, Preston E, Devlin SM, Ponce DM, Lin RJ, Shaffer BC, Cho C, Politikos I, Jakubowski AA, Park JH, Rampal R, Perales MA, Tallman MS, Barker JN, Berman E, Tamari R, Stein E, Giralt SA, Gyurkocza B. Prospective analysis to determine barriers to allogeneic hematopoietic cell transplantation in patients with acute leukemia. Am J Hematol 2023; 98:1869-1876. [PMID: 37688521 PMCID: PMC10697699 DOI: 10.1002/ajh.27084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for patients with acute leukemia. Despite this, studies have shown that only a minority of patients ultimately proceed to allo-HCT. The primary objective of this prospective, observational study was to identify the rate of allo-HCT in patients for whom it was recommended, and reasons why patients deemed appropriate and eligible for HCT did not subsequently undergo transplant. Between April 2016 and April 2021, adult patients with newly diagnosed or relapsed/refractory acute leukemia were enrolled at the time of induction/reinduction therapy. Initial transplantation workup and allo-HCT recommendations were made during the early phase of induction/reinduction. Of the 307 enrolled patients, allo-HCT was recommended to 85% (n = 259), of whom 66% (n = 170) underwent transplant. Donor sources comprised 54% human leukocyte antigen (HLA)-matched unrelated donors, 20% HLA-matched sibling donors and HLA-mismatched graft sources with 15% umbilical cord blood units, 8% HLA-mismatched unrelated donors, and 4% HLA-haploidentical donors. The most common reason for transplant disqualification in the 89 patients in whom it was initially recommended was persistent/relapsed disease (70%), followed by early patient death (10%). In this prospective study, we report a high allo-HCT rate, which may be due to early transplant referral and workup. The main allo-HCT barrier was disease control, followed by early patient death. With the increasing availability of HLA-mismatched graft sources, the lack of donor availability was not a transplant barrier. Further development of novel transplant strategies for patients not achieving remission and improvements in induction regimens could result in increased allo-HCT utilization.
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Affiliation(s)
- Karthik Nath
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jasme Lee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theresa A Elko
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lauren Levy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elaina Preston
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Doris M Ponce
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Richard J. Lin
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Brian C. Shaffer
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Christina Cho
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ann A Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Jae H Park
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raajit Rampal
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Miguel-Angel Perales
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Martin S. Tallman
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juliet N. Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ellin Berman
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Eytan Stein
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio A Giralt
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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25
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Seftel MD, Pasic I, Parmar G, Bucher O, Allan DS, Bhella S, Hay KA, Ikuomola O, Musto G, Prica A, Richardson E, Truong TH, Paulson K. Hematopoietic Cell Transplantation Trends and Outcomes in Canada: A Registry-Based Cohort Study. Curr Oncol 2023; 30:9953-9967. [PMID: 37999143 PMCID: PMC10669983 DOI: 10.3390/curroncol30110723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Background: Hematopoietic cell transplantation (HCT) is an established therapy for hematologic malignancies and serious non-malignant blood disorders. Despite its curative potential, HCT is associated with substantial toxicity and health resource utilization. Effective delivery of HCT requires complex hospital-based care, which limits the number of HCT centres in Canada. In Canada, the quantity, indications, temporal trends, and outcomes of patients receiving HCT are not known. Methods: A retrospective cohort study of first transplants reported to the Cell Therapy Transplant Canada (CTTC) registry between 2000 and 2019. We determined overall survival (OS) and non-relapse mortality (NRM), categorizing the cohort into early (2000-2009) and later (2010-2019) eras to investigate temporal changes. Results: Of 18,046 transplants, 7571 were allogeneic and 10,475 were autologous. Comparing the two eras, allogeneic transplants increased in number by 22.3%, with greater use of matched unrelated donors in the later era. Autologous transplants increased by 10.9%. Temporal improvements in NRM were observed in children and adults. OS improved in pediatric patients and in adults receiving autologous HCT. In adults receiving allogeneic HCT, OS was stable despite the substantially older age of patients in the later era. Interpretation: HCT is an increasingly frequent procedure in Canada which has expanded to serve older adults. Noted improvements in NRM and OS reflect progress in patient and donor selection, preparation for transplant, and post-transplant supportive care. In allogeneic HCT, unrelated donors have become the most frequent donor source, highlighting the importance of the continued growth of volunteer donor registries. These results serve as a baseline measure for quality improvement and health services planning in Canada.
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Affiliation(s)
- Matthew D. Seftel
- Canadian Blood Services, Vancouver, BC V6H 2N9, Canada; (G.P.); (D.S.A.)
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Ivan Pasic
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (I.P.); (S.B.); (A.P.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Gaganvir Parmar
- Canadian Blood Services, Vancouver, BC V6H 2N9, Canada; (G.P.); (D.S.A.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Oliver Bucher
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - David S. Allan
- Canadian Blood Services, Vancouver, BC V6H 2N9, Canada; (G.P.); (D.S.A.)
- Department of Medicine and Biochemistry, Microbiology & Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Sita Bhella
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (I.P.); (S.B.); (A.P.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Kevin Anthony Hay
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
| | - Oluwaseun Ikuomola
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - Grace Musto
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - Anca Prica
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (I.P.); (S.B.); (A.P.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Erin Richardson
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - Tony H. Truong
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Kristjan Paulson
- Cell Therapy and Transplant Canada, Winnipeg, MB R3E 0V9, Canada;
- Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
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26
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Duléry R, Brissot E, Mohty M. Combining post-transplant cyclophosphamide with antithymocyte globulin for graft-versus-host disease prophylaxis in hematological malignancies. Blood Rev 2023; 62:101080. [PMID: 37085459 DOI: 10.1016/j.blre.2023.101080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
In search of an ideal partner or alternative to conventional immunosuppressive agents, rabbit anti-thymocyte globulin (ATG) and, more recently, post-transplant cyclophosphamide (PT-Cy) have both emerged as valid and efficient options for preventing graft-versus-host disease (GvHD). To further reduce the risk of GvHD, strategies combining ATG and PT-Cy have recently been investigated. In a haploidentical setting, retrospective studies suggest that combining PT-Cy and ATG may result in a lower incidence of chronic GvHD without increasing the risks of infection or relapse, when compared to PT-Cy without ATG. In haploidentical or unrelated donor settings, adding reduced doses of PT-Cy to ATG may reduce the risk of acute and chronic GvHD and improve survival, particularly GvHD-free, relapse-free survival (GRFS), when compared to ATG without PT-Cy. Overall, the combination of PT-Cy and ATG is a safe and promising approach for patients with hematological malignancies undergoing allogeneic hematopoietic stem cell transplantation (HSCT).
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Affiliation(s)
- Rémy Duléry
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Eolia Brissot
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Mohamad Mohty
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France.
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27
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O'Donnell PV, Jones RJ. The development of post-transplant cyclophosphamide: Half a century of translational team science. Blood Rev 2023; 62:101034. [PMID: 36435690 PMCID: PMC11001251 DOI: 10.1016/j.blre.2022.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/19/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
Close HLA matching of donors and recipients has been the dogma for successful allogeneic blood or marrow transplantation (alloBMT), to limit the complications of graft-versus-host disease (GVHD). However, many patients in need, especially those within certain ethnic groups such as those of African-Americans and Hispanics, remain unable to find a match even with the increased availability of unrelated donors. Over half a century ago, investigators at Johns Hopkins found that cyclophosphamide's immunosuppressive properties made it the ideal replacement for total body irradiation in alloBMT conditioning regimens. They also found it to be the best chemotherapeutic for preventing GVHD in animal models, but its cytotoxic properties scared them from using it clinically in the high doses successful in animal models. Subsequent work showed that cyclophosphamide spared hematopoietic and other stem cells including memory lymphocytes, prompting re-examination at high doses for GVHD prophylaxis. Animal and extensive human studies demonstrated that high-dose post-transplantation cyclophosphamide (PTCy) effectively and safely limited GVHD such that mismatched transplants are now considered standard-of-care worldwide. The beneficial effects of PTCy on GVHD appears to be independent of donor type, graft source, or conditioning regimen intensity.
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Affiliation(s)
- Paul V O'Donnell
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, United States of America
| | - Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, John Hopkins University, Baltimore, MD, United States of America.
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28
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Li Y, Wang N, Zhang X, Cao Y, Zhang L, Liu A, Zhang Y. Post-transplantation cyclophosphamide as GVHD prophylaxis in allogenic hematopoietic stem cell transplantation: Recent advances and modification. Blood Rev 2023; 62:101078. [PMID: 37031067 DOI: 10.1016/j.blre.2023.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/16/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Allogenic hematopoietic stem cell transplantation (allo-HSCT) is the most important therapeutic option for hematological disorders, although graft-versus-host disease (GVHD) remains the main cause of mortality. Post-transplantation cyclophosphamide (PTCY) induces immune tolerance and is associated with a low incidence of GVHD and non-relapse mortality. Therefore, PTCY has emerged as a safe and effective GVHD prophylaxis in haploidentical transplantation and has been expanded to matched related or unrelated donor and mismatched unrelated donor HSCT. On the basis of current understanding of the mechanisms of PTCY and antithymocyte globulin (ATG) in the prevention of GVHD, growing evidence suggests that the combination of ATG and PTCY could improve allo-HSCT clinical outcomes. Further research will focus on optimizing PTCY regimens by modifying the timing of administration or adding other immunosuppressive agents.
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Affiliation(s)
- Yun Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Na Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiaoying Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Lingfeng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Aiguo Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China.
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29
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Chowdhury AS, Maiers M, Spellman SR, Deshpande T, Bolon YT, Devine SM. Existence of HLA-Mismatched Unrelated Donors Closes the Gap in Donor Availability Regardless of Recipient Ancestry. Transplant Cell Ther 2023; 29:686.e1-686.e8. [PMID: 37586457 PMCID: PMC10840626 DOI: 10.1016/j.jtct.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
In patients without a matched sibling donor (MSD) or well-matched unrelated donor (MUD), hematopoietic cell transplantation (HCT) can still be successful when using an HLA-mismatched unrelated donor (MMUD) in combination with post-transplantation cyclophosphamide (PTCy), abatacept, or other novel approaches. This may allow clinicians to choose a suitable donor from a wide range of donor options while optimizing other donor selection characteristics, including donor age. We hypothesized that allowing for a 5/8 HLA match level considering high-resolution matching at HLA-A, -B, -C and -DRB1, there is a potential to close the donor availability gap for all patients regardless of their race/ethnicity. In this work, we estimate the likelihood of matching for all racial/ethnic groups at different HLA match thresholds. Our study aimed to assess the potential for identifying an available MUD or MMUD in the National Marrow Donor Program (NMDP)/Be The Match (BTM) donor registry for 21 detailed and 5 broad racial/ethnic groups, using high-resolution HLA matching for HLA-A, -B, -C, and -DRB1 at various levels (8/8, 7/8, 6/8, and 5/8). We used donor registry population data from the NMDP/BTM in 2020 and redistributed the donor registry data according to existing population ratios, accounting for demonstrated donor availability. Finally, we used a genetic model at the population level to estimate the match likelihood for detailed and broad racial/ethnic groups. Likelihood of 8/8 HLA match ranging from 16% to 74% were obtained for various detailed racial/ethnic groups with available donors age ≤35 years. When considering more mismatches in the HLA loci, registry coverage became >99% with a 5/8 HLA match level for donors of all ages or those age ≤35 years, with HLA-DPB1 T cell epitope permissive matching, or when searching for donors outside of their racial/ethnic group. Our registry models demonstrate the potential for using MMUDs at various HLA match levels to study whether this will expand access to HCT across racial/ethnic groups. Expanded donor options may erase the donor availability gap for all patients while allowing for selection of MMUDs with favorable characteristics, such as younger age.
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Affiliation(s)
- Abu Sayed Chowdhury
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Martin Maiers
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Tushar Deshpande
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Yung-Tsi Bolon
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Steven M Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
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30
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Jones RJ, Bacigalupo A. The next horizon now that everyone has a donor: Precision allogeneic transplantation. Blood Rev 2023; 62:100990. [PMID: 35908981 DOI: 10.1016/j.blre.2022.100990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
Post-transplant cyclophosphamide (PTCy) allows safe and effective partially matched donor allogeneic blood or marrow transplantation (alloBMT), so that almost everyone in need of the procedure now has a donor. Moreover, PTCy and other recent advances have lowered alloBMT mortality rates to less than half of that seen before the turn of the century, at costs that are substantially less than most newly approved anticancer agents. These advances also make tailoring BMT based on patients' unique diseases and characteristics now feasible for further improving outcomes. Personalizing every aspect of alloBMT, including conditioning, donor, graft type, and post-transplant maintenance is now possible. For example, alloBMT's antitumor activity historically was restricted to the allogeneic graft-versus-tumor effect directed against histocompatibility antigens. However, replacing exhausted immune systems with healthy non-exhausted, non-tolerant ones likely can enhance the activity of novel targeted therapies. The impressive results seen with tyrosine kinase inhibitors after alloBMT for patients with both Ph+ acute lymphoblastic leukemia and FLT/ITD+ acute myeloid leukemia herald the potential of precision BMT.
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Affiliation(s)
- Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, John Hopkins University, Baltimore, MD, United States of America.
| | - Andrea Bacigalupo
- Hematology and Bone Marrow Transplant Unit, Fondazione Universitario Policlinico Gemelli IRCCS, Rome, Italy
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31
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Jamy O, Zeiser R, Chen YB. Novel developments in the prophylaxis and treatment of acute GVHD. Blood 2023; 142:1037-1046. [PMID: 37471585 DOI: 10.1182/blood.2023020073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
Acute graft-versus-host disease (aGVHD) is a major life-threatening complication after allogeneic hematopoietic cell transplant. Traditional standard prophylaxis for aGVHD has included a calcineurin inhibitor plus an antimetabolite, whereas treatment has relied mainly on corticosteroids, followed by multiple nonstandard second-line options. In the past decade, this basic framework has been reshaped by approval of antithymocyte globulin products, the emergence of posttransplant cyclophosphamide, and recent pivotal trials studying abatacept and vedolizumab for GVHD prophylaxis, whereas ruxolitinib was approved for corticosteroid-refractory aGVHD treatment. Because of this progress, routine acute GVHD prophylaxis and treatment practices are starting to shift, and results of ongoing trials are eagerly awaited. Here, we review recent developments in aGVHD prevention and therapy, along with ongoing and future planned clinical trials in this space, outlining what future goals should be and the limitations of current clinical trial designs and end points.
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Affiliation(s)
- Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Robert Zeiser
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, Albert Ludwigs University, Freiburg, Germany
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant and Cell Therapy Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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32
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Fingrut WB, Gyurkocza B, Flynn J, Davis E, Devlin S, Scaradavou A, Chinapen S, Quach S, Cho C, Giralt SA, Jakubowski AA, Lin RJ, Papadopoulos EB, Perales MA, Ponce D, Shaffer BC, Tamari R, Young JW, Politikos I, Barker JN. Analysis of disparities in time to allogeneic transplantation in adults with acute myelogenous leukemia. Blood Adv 2023; 7:3824-3833. [PMID: 36240477 PMCID: PMC10393759 DOI: 10.1182/bloodadvances.2022008572] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/20/2022] Open
Abstract
Although alternative donors extend transplant access, whether recipient ancestry affects the time to allogeneic transplant is not established. We analyzed the likelihood of clinically significant delays to allograft by patient ancestry in 313 adult patients with acute myelogenous leukemia (AML) who underwent transplantation. Non-European ancestry patients (n = 99) were more likely than Europeans (n = 214) to receive HLA-mismatched donor allografts (45% vs 24%). Overall, the median time from transplant indication to allograft was 127 days (range, 57-1683). In multivariable analysis, non-Europeans had an increased risk of prolonged indication to transplant time >180 days owing to significant delays in indication to consult >90 days and consult to transplant >120 days. Compared with recipients of HLA-matched unrelated donors (URDs), HLA-mismatched adult donor recipients were at an increased risk of delayed indication to transplant, whereas HLA-identical sibling and cord blood recipients were at a lower risk. Subanalysis showed more indication to transplant delays >180 days in non-European (44%) vs European (19%) 8/8 URD recipients. Finally, the pandemic further exacerbated delays for non-Europeans. In summary, although non-European patients with AML are less likely to receive 8/8 URDs as expected, if they do, their transplants are delayed. HLA-identical siblings and cord blood facilitate the fastest transplants regardless of patient ancestry, whereas other adult donor transplants are delayed. Strategies to mitigate referral barriers, hasten donor evaluation, and use all alternative donor sources are critical to ensure timely transplantation for patients with AML.
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Affiliation(s)
- Warren B. Fingrut
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Davis
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andromachi Scaradavou
- Pediatric Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Chinapen
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean Quach
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Cho
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Sergio A. Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Ann A. Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Richard J. Lin
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Esperanza B. Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Doris Ponce
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Brian C. Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - James W. Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Juliet N. Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
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33
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Farhan S, Holtan SG. Graft-versus-host disease: teaching old drugs new tricks at less cost. Front Immunol 2023; 14:1225748. [PMID: 37600820 PMCID: PMC10435076 DOI: 10.3389/fimmu.2023.1225748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Graft-versus-host disease (GVHD) remains a major cause of morbidity and mortality after allogeneic stem cell transplantation (SCT). Currently, more patients can receive SCT. This is attributed to the use of reduced intensity regimens and the use of different GVHD prophylaxis that breaks the barrier of human leukocyte antigen, allowing an increase in the donor pool. Once an area with relatively few clinical trial options, there has been an increase in interest in GVHD prophylaxis and treatment, which has led to many US Food and Drug Administration (FDA) approvals. Although there is considerable excitement over novel therapies, many patients may not have access to them due to geographical or other resource constraints. In this review article, we summarize the latest evidence on how we can continue to repurpose drugs for GVHD prophylaxis and treatment. Drugs covered by our review include those that have been FDA approved for other uses for at least 15 years (since 2008); thus, they are likely to have generic equivalents available now or in the near future.
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Affiliation(s)
- Shatha Farhan
- Stem Cell Transplant and Cellular Therapy, Henry Ford Health, Detroit, MI, United States
| | - Shernan G. Holtan
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, United States
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34
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Al-Homsi AS, Cirrone F, Wo S, Cole K, Suarez-Londono JA, Gardner SL, Hsu J, Stocker K, Bruno B, Goldberg JD, Levinson BA, Abdul-Hay M. PTCy, abatacept, and a short course of tacrolimus for GVHD prevention after haploidentical transplantation. Blood Adv 2023; 7:3604-3611. [PMID: 37163349 PMCID: PMC10368845 DOI: 10.1182/bloodadvances.2023010545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023] Open
Abstract
Reducing the incidence of graft-versus-host disease (GVHD) after haploidentical hematopoietic stem cell transplantation (HSCT) is warranted. Posttransplant cyclophosphamide (PTCy) is the main agent used for GVHD prevention in this setting. It remains unknown whether costimulation blockade can be safely combined with PTCy and enhance its efficacy. We performed a phase 1b-2 clinical trial to examine the combination of PTCy, abatacept, and a short course of tacrolimus (CAST) after peripheral blood haploidentical HSCT. The primary end point was the incidence of grades 2-4 acute GVHD by day +120. The study enrolled 46 patients with a median age of 60 years (range, 18-74 years). The cumulative incidences of grades 2-4 and 3 or 4 acute GVHD were 17.4% (95% confidence interval [CI], 9.2-32.9) and 4.4% (95% CI, 1.1-17.1), respectively. With a median follow-up of 15.3 months, the cumulative incidence of 1-year treatment-related mortality was 4.4% (95% CI, 1.1-17.1). The estimated 1-year moderate-to-severe chronic GVHD rate, relapse rate, progression-free survival, overall survival, and GVHD- and relapse-free survival were 15.9% (95% CI, 8-31.7), 11.7% (95% CI, 5-27.2), 84.1% (95% CI, 73.8-95.7), 85.9% (95% CI, 75.9-97.2), and 66.1% (95% CI, 53.4-81.8), respectively. Toxicities were similar to those expected in patients receiving haploidentical HSCT. This clinical trial showed that the CAST regimen is safe and effective in reducing the rate of grades 2-4 acute GVHD after haploidentical peripheral blood HSCT. This trial was registered at www.clinicaltrials.gov as #NCT04503616.
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Affiliation(s)
- A. Samer Al-Homsi
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Frank Cirrone
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Stephanie Wo
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Kelli Cole
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - J. Andres Suarez-Londono
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Sharon L. Gardner
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Jingmei Hsu
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Kelsey Stocker
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | | | - Judith D. Goldberg
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Benjamin A. Levinson
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Maher Abdul-Hay
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
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35
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Maurer K, Soiffer RJ. The delicate balance of graft versus leukemia and graft versus host disease after allogeneic hematopoietic stem cell transplantation. Expert Rev Hematol 2023; 16:943-962. [PMID: 37906445 DOI: 10.1080/17474086.2023.2273847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION The curative basis of allogeneic hematopoietic stem cell transplantation (HSCT) relies in part upon the graft versus leukemia (GvL) effect, whereby donor immune cells recognize and eliminate recipient malignant cells. However, alloreactivity of donor cells against recipient tissues may also be deleterious. Chronic graft versus host disease (cGvHD) is an immunologic phenomenon wherein alloreactive donor T cells aberrantly react against host tissues, leading to damaging inflammatory symptoms. AREAS COVERED Here, we discuss biological insights into GvL and cGvHD and strategies to balance the prevention of GvHD with maintenance of GvL in modern HSCT. EXPERT OPINION/COMMENTARY Relapse remains the leading cause of mortality after HSCT with rates as high as 40% for some diseases. GvHD is a major cause of morbidity after HSCT, occurring in up to half of patients and responsible for 15-20% of deaths after HSCT. Intriguingly, the development of chronic GvHD may be linked to lower relapse rates after HSCT, suggesting that GvL and GvHD may be complementary sides of the immunologic foundation of HSCT. The ability to fine tune the balance of GvL and GvHD will lead to improvements in survival, relapse rates, and quality of life for patients undergoing HSCT.
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Affiliation(s)
- Katie Maurer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Robert J Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Espinoza-Gutarra MR, Ailawadhi S. Bridging the gap: how do we enroll more racial-ethnic minority patients in hematological drug trials? Expert Rev Hematol 2023; 16:905-910. [PMID: 37870168 DOI: 10.1080/17474086.2023.2273851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Manuel R Espinoza-Gutarra
- Assistant Professor, Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Sikander Ailawadhi
- Professor of Medicine, Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
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Bolaños-Meade J, Hamadani M, Wu J, Al Malki MM, Martens MJ, Runaas L, Elmariah H, Rezvani AR, Gooptu M, Larkin KT, Shaffer BC, El Jurdi N, Loren AW, Solh M, Hall AC, Alousi AM, Jamy OH, Perales MA, Yao JM, Applegate K, Bhatt AS, Kean LS, Efebera YA, Reshef R, Clark W, DiFronzo NL, Leifer E, Horowitz MM, Jones RJ, Holtan SG. Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis. N Engl J Med 2023; 388:2338-2348. [PMID: 37342922 PMCID: PMC10575613 DOI: 10.1056/nejmoa2215943] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND In patients undergoing allogeneic hematopoietic stem-cell transplantation (HSCT), a calcineurin inhibitor plus methotrexate has been a standard prophylaxis against graft-versus-host disease (GVHD). A phase 2 study indicated the potential superiority of a post-transplantation regimen of cyclophosphamide, tacrolimus, and mycophenolate mofetil. METHODS In a phase 3 trial, we randomly assigned adults with hematologic cancers in a 1:1 ratio to receive cyclophosphamide-tacrolimus-mycophenolate mofetil (experimental prophylaxis) or tacrolimus-methotrexate (standard prophylaxis). The patients underwent HSCT from an HLA-matched related donor or a matched or 7/8 mismatched (i.e., mismatched at only one of the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci) unrelated donor, after reduced-intensity conditioning. The primary end point was GVHD-free, relapse-free survival at 1 year, assessed in a time-to-event analysis, with events defined as grade III or IV acute GVHD, chronic GVHD warranting systemic immunosuppression, disease relapse or progression, and death from any cause. RESULTS In a multivariate Cox regression analysis, GVHD-free, relapse-free survival was significantly more common among the 214 patients in the experimental-prophylaxis group than among the 217 patients in the standard-prophylaxis group (hazard ratio for grade III or IV acute GVHD, chronic GVHD, disease relapse or progression, or death, 0.64; 95% confidence interval [CI], 0.49 to 0.83; P = 0.001). At 1 year, the adjusted GVHD-free, relapse-free survival was 52.7% (95% CI, 45.8 to 59.2) with experimental prophylaxis and 34.9% (95% CI, 28.6 to 41.3) with standard prophylaxis. Patients in the experimental-prophylaxis group appeared to have less severe acute or chronic GVHD and a higher incidence of immunosuppression-free survival at 1 year. Overall and disease-free survival, relapse, transplantation-related death, and engraftment did not differ substantially between the groups. CONCLUSIONS Among patients undergoing allogeneic HLA-matched HSCT with reduced-intensity conditioning, GVHD-free, relapse-free survival at 1 year was significantly more common among those who received cyclophosphamide-tacrolimus-mycophenolate mofetil than among those who received tacrolimus-methotrexate. (Funded by the National Heart, Lung, and Blood Institute and others; BMT CTN 1703 ClinicalTrials.gov number, NCT03959241.).
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Affiliation(s)
- Javier Bolaños-Meade
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Mehdi Hamadani
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Juan Wu
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Monzr M Al Malki
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Michael J Martens
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Lyndsey Runaas
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Hany Elmariah
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Andrew R Rezvani
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Mahasweta Gooptu
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Karilyn T Larkin
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Brian C Shaffer
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Najla El Jurdi
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Alison W Loren
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Melhem Solh
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Aric C Hall
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Amin M Alousi
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Omer H Jamy
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Miguel-Angel Perales
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Janny M Yao
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Kristy Applegate
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Ami S Bhatt
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Leslie S Kean
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Yvonne A Efebera
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Ran Reshef
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - William Clark
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Nancy L DiFronzo
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Eric Leifer
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Mary M Horowitz
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Richard J Jones
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Shernan G Holtan
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
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Abstract
Acute graft-versus-host disease (GVHD) is a common immune complication that can occur after allogeneic haematopoietic cell transplantation (alloHCT). Acute GVHD is a major health problem in these patients, and is associated with high morbidity and mortality. Acute GVHD is caused by the recognition and the destruction of the recipient tissues and organs by the donor immune effector cells. This condition usually occurs within the first 3 months after alloHCT, but later onset is possible. Targeted organs include the skin, the lower and upper gastrointestinal tract and the liver. Diagnosis is mainly based on clinical examination, and complementary examinations are performed to exclude differential diagnoses. Preventive treatment for acute GVHD is administered to all patients who receive alloHCT, although it is not always effective. Steroids are used for first-line treatment, and the Janus kinase 2 (JAK2) inhibitor ruxolitinib is second-line treatment. No validated treatments are available for acute GVHD that is refractory to steroids and ruxolitinib, and therefore it remains an unmet medical need.
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Affiliation(s)
- Florent Malard
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
| | - Ernst Holler
- University Hospital of Regensburg, Department of Internal Medicine 3, Regensburg, Germany
| | - Brenda M Sandmaier
- Fred Hutchinson Cancer Center, Translational Science and Therapeutics Division, Seattle, WA, USA
- University of Washington School of Medicine, Division of Medical Oncology, Seattle, WA, USA
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
- Engineering Laboratory for Stem Cell and Immunity Therapy, Institute of Hematology, Zhejiang University, Hangzhou, China
- Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
| | - Mohamad Mohty
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Crivello P, Arrieta-Bolaños E, He M, Wang T, Fingerson S, Gadalla SM, Paczesny S, Marsh SG, Lee SJ, Spellman SR, Bolon YT, Fleischhauer K. Impact of the HLA Immunopeptidome on Survival of Leukemia Patients After Unrelated Donor Transplantation. J Clin Oncol 2023; 41:2416-2427. [PMID: 36669145 PMCID: PMC10150892 DOI: 10.1200/jco.22.01229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/10/2022] [Accepted: 11/15/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Immunopeptidome divergence between mismatched HLA-DP is a determinant of T-cell alloreactivity and clinical tolerability after fully HLA-A, -B, -C, -DRB1, -DQB1 matched unrelated donor hematopoietic cell transplantation (UD-HCT). Here, we tested this concept in HLA-A, -B, and -C disparities after single class I HLA-mismatched UD-HCT. PATIENTS AND METHODS We studied 2,391 single class I HLA-mismatched and 14,426 fully HLA-matched UD-HCT performed between 2008 and 2018 for acute leukemia or myelodysplastic syndromes. Hierarchical clustering of experimentally determined peptide-binding motifs (PBM) was used as a proxy for immunopeptidome divergence of HLA-A, -B, or -C disparities, allowing us to classify 1,629/2,391 (68.1%) of the HLA-mismatched UD-HCT as PBM-matched or PBM-mismatched. Risks associated with PBM-matching status were assessed by Cox proportional hazards models, with overall survival (OS) as the primary end point. RESULTS Relative to full matches, bidirectional or unidirectional PBM mismatches in graft-versus-host (GVH) direction (PBM-GVH mismatches, 60.7%) were associated with significantly lower OS (hazard ratio [HR], 1.48; P < .0001), while unidirectional PBM mismatches in host-versus-graft direction or PBM matches (PBM-GVH matches, 39.3%) were not (HR, 1.13; P = .1017). PBM-GVH mismatches also had significantly lower OS than PBM-GVH matches in direct comparison (HR, 1.32; P = .0036). The hazards for transplant-related mortality and acute and chronic graft-versus-host disease but not relapse increased stepwise from full HLA matches to single PBM-GVH matches, and single PBM-GVH mismatches. A webtool for PBM-matching of single class I HLA-mismatched donor-recipient pairs was developed. CONCLUSION PBM-GVH mismatches inform mortality risks after single class I HLA-mismatched UD-HCT, suggesting that prospective consideration of directional PBM-matching status might improve outcome. These findings highlight immunopeptidome divergence between mismatched HLA as a driver of clinical tolerability in UD-HCT.
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Affiliation(s)
- Pietro Crivello
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany
| | - Esteban Arrieta-Bolaños
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany
- German Cancer Consortium, partner site Essen/Düsseldorf (DKTK), Heidelberg, Germany
| | - Meilun He
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Tao Wang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine, Medical College of Wisconsin, CIBMTR (Center for International Blood and Marrow Transplant Research), Milwaukee, WI
| | - Stephanie Fingerson
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Shahinaz M. Gadalla
- Division of Cancer Epidemiology and Genetics, NIH-NCI Clinical Genetics Branch, Rockville, MD
| | - Sophie Paczesny
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Steven G.E. Marsh
- Anthony Nolan Research Institute and University College London Cancer Institute, Royal Free Campus, London, United Kingdom
| | - Stephanie J. Lee
- Department of Medicine, Medical College of Wisconsin, CIBMTR (Center for International Blood and Marrow Transplant Research), Milwaukee, WI
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Stephen R. Spellman
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Yung-Tsi Bolon
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Katharina Fleischhauer
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany
- German Cancer Consortium, partner site Essen/Düsseldorf (DKTK), Heidelberg, Germany
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Lai C, Bhansali RS, Kuo EJ, Mannis G, Lin RJ. Older Adults With Newly Diagnosed AML: Hot Topics for the Practicing Clinician. Am Soc Clin Oncol Educ Book 2023; 43:e390018. [PMID: 37155946 DOI: 10.1200/edbk_390018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, our understanding of AML pathogenesis and pathophysiology has improved significantly with mutational profiling. This has led to translational advances in therapeutic options, as there have been 10 new US Food and Drug Administration (FDA) approvals for AML therapies since 2017, half of which target specific driver mutations in FLT3, IDH1, or IDH2. These new agents have expanded the therapeutic armamentarium for AML, particularly for patients who are considered ineligible for intensive chemotherapy with anthracycline- and cytarabine-containing regimens. These new treatment options are relevant because the median age at diagnosis is 68 years, and outcomes for patients older than 60 years have historically been dismal. However, the optimal approach to incorporating novel agents into frontline regimens remains a clinical challenge, particularly with regard to sequencing of therapies, considering the role of allogeneic hematopoietic stem cell transplantation and managing toxicities.
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Affiliation(s)
- Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Rahul S Bhansali
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Eric J Kuo
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Gabriel Mannis
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Richard J Lin
- Memorial Sloan Kettering Cancer Center, New York, NY
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41
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Leserer S, Graf T, Franke M, Bogdanov R, Arrieta-Bolaños E, Buttkereit U, Leimkühler N, Fleischhauer K, Reinhardt HC, Beelen DW, Turki AT. Time series clustering of T cell subsets dissects heterogeneity in immune reconstitution and clinical outcomes among MUD-HCT patients receiving ATG or PTCy. Front Immunol 2023; 14:1082727. [PMID: 37020562 PMCID: PMC10067907 DOI: 10.3389/fimmu.2023.1082727] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/02/2023] [Indexed: 03/22/2023] Open
Abstract
IntroductionAnti-T-lymphocyte globulin (ATG) or post-transplant cyclophosphamide (PTCy) prevent graft-versus-host disease (GVHD) after hematopoietic cell transplantation (HCT), yet individual patients benefit differentially.MethodsGiven the sparse comparative data on the impact of cellular immune reconstitution in this setting, we studied flow cytometry and clinical outcomes in 339 recipients of 10/10 matched-unrelated donor (MUD) HCT using either ATG (n=304) or PTCy (n=35) for in vivo T cell manipulation along with a haploidentical PTCy control cohort (n=45). Longitudinal cellular immune reconstitution data were analyzed conventionally and with a data science approach using clustering with dynamic time warping to determine the similarity between time-series of T cell subsets.ResultsConsistent with published studies, no significant differences in clinical outcomes were observed at the cohort level between MUD-ATG and MUD-PTCy. However, cellular reconstitution revealed preferences for distinct T cell subpopulations associating with GVHD protection in each setting. Starting early after HCT, MUD-PTCy patients had higher regulatory T cell levels after HCT (p <0.0001), while MUD-ATG patients presented with higher levels of γδ T- or NKT cells (both p <0.0001). Time-series clustering further dissected the patient population’s heterogeneity revealing distinct immune reconstitution clusters. Importantly, it identified phenotypes that reproducibly associated with impaired clinical outcomes within the same in vivo T cell manipulation platform. Exemplarily, patients with lower activated- and αβ T cell counts had significantly higher NRM (p=0.032) and relapse rates (p =0.01).DiscussionThe improved understanding of the heterogeneity of cellular reconstitution in MUD patients with T cell manipulation both at the cohort and individual level may support clinicians in managing HCT complications.
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Affiliation(s)
- Saskia Leserer
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Computational Hematology Lab, Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Institute for Experimental Cellular Therapy, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Theresa Graf
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Computational Hematology Lab, Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martina Franke
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Rashit Bogdanov
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Computational Hematology Lab, Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Esteban Arrieta-Bolaños
- Institute for Experimental Cellular Therapy, West-German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner site Essen/Düsseldorf, Essen, Germany
| | - Ulrike Buttkereit
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Nils Leimkühler
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Katharina Fleischhauer
- Institute for Experimental Cellular Therapy, West-German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner site Essen/Düsseldorf, Essen, Germany
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Cancer Research Center Cologne Essen (CCCE), Essen, Germany
| | - Dietrich W. Beelen
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Amin T. Turki
- Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Computational Hematology Lab, Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
- Institute for Experimental Cellular Therapy, West-German Cancer Center, University Hospital Essen, Essen, Germany
- *Correspondence: Amin T. Turki,
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Dybko J, Sobczyk-Kruszelnicka M, Makuch S, Agrawal S, Dudek K, Giebel S, Gil L. The Benefits of the Post-Transplant Cyclophosphamide in Both Haploidentical and Mismatched Unrelated Donor Setting in Allogeneic Stem Cells Transplantation. Int J Mol Sci 2023; 24:ijms24065764. [PMID: 36982839 PMCID: PMC10051342 DOI: 10.3390/ijms24065764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Allogeneic hematopoietic cell transplantation (alloHSCT) is a standard therapeutic approach for acute leukemias and many other hematologic malignancies. The proper choice of immunosuppressants applicable to different types of transplantations still requires strict and careful consideration, and data in this regard are divergent. For this reason, in this single-centered, retrospective study, we aimed to compare the outcome of 145 patients who received post-transplant cyclophosphamide (PTCy) for MMUD and haplo-HSCT or GvHD prophylaxis for MMUD-HSCT alone. We attempted to verify if PTCy is an optimal strategy in MMUD setting. Ninety-three recipients (93/145; 64.1%) underwent haplo-HSCT while 52 (52/145; 35.9%) underwent MMUD-HSCT. There were 110 patients who received PTCy (93 in haplo and 17 in MMUD group) and 35 patients received conventional GvHD prophylaxis based on antithymocyte globulin (ATG), cyclosporine (CsA), and methotrexate (Mtx) in the MMUD group only. Our study revealed that patients receiving post-transplant cyclophosphamide (PTCy) show decreased acute GvHD rates and CMV reactivation as well as a statistically lower number of CMV copies before and after antiviral treatment compared to the CsA + Mtx + ATG group. Taking into account chronic GvHD, the main predictors are donor age, ≥40 years, and haplo-HSCT administration. Furthermore, the survival rate of patients following MMUD-HSCT and receiving PTCy with tacrolimus and mycophenolate mofetil was more than eight times greater in comparison to patients receiving CsA + Mtx + ATG (OR = 8.31, p = 0.003). These data taken together suggest that the use of PTCy displays more benefits in terms of survival rate compared to ATG regardless of the type of transplantation performed. Nevertheless, more studies with a larger sample size are required to confirm the conflicting results in the literature studies.
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Affiliation(s)
- Jarosław Dybko
- Department of Hematology and Cellular Transplantation, Lower Silesian Oncology Center, 53-413 Wroclaw, Poland
| | - Małgorzata Sobczyk-Kruszelnicka
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Sebastian Makuch
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Krzysztof Dudek
- Statistical Analysis Center, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Sebatian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznań, Poland
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Auletta JJ, Kou J, Chen M, Bolon YT, Broglie L, Bupp C, Christianson D, Cusatis RN, Devine SM, Eapen M, Flynn KE, Hamadani M, Hengen M, Lee SJ, Moskop A, Page KM, Pasquini MC, Perez WS, Phelan R, Riches ML, Rizzo JD, Saber W, Spellman SR, Stefanski HE, Steinert P, Tuschl E, Yusuf R, Zhang MJ, Shaw BE. Real-world data showing trends and outcomes by race and ethnicity in allogeneic hematopoietic cell transplantation: a report from the Center for International Blood and Marrow Transplant Research. Transplant Cell Ther 2023:S2666-6367(23)01165-X. [PMID: 36924931 DOI: 10.1016/j.jtct.2023.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Use of human leukocyte antigen (HLA)-mismatched donors could enable more patients with ethnically diverse backgrounds to receive allogeneic hematopoietic cell transplantation (HCT) in the United States. However, real-world trends and outcomes following mismatched donor HCT for diverse patients remain largely undefined. OBJECTIVE To determine whether mismatched donor platforms have increased access to allogeneic HCT for ethnically diverse patients, particularly through the application of novel graft-versus-host disease (GvHD) prophylaxis regimens, and if outcomes for diverse patients were comparable to those of non-Hispanic White patients. DESIGN Observational cross-sectional study using real-world data from the Center for International Blood and Marrow Transplant Research (CIBMTR) registry. All patients receiving their first allogeneic HCT in the U.S. from 2009-2020 with focus on transplants performed in 2020 were included. Data from patients receiving allogeneic HCT using bone marrow, peripheral blood or cord blood from HLA-matched or mismatched related and unrelated donors was analyzed. Specifically, relative proportions of allogeneic HCT were generated as percent of total for donor type and for patient age, disease indication, GvHD prophylaxis, and race and ethnicity. Causes of death were summarized using frequencies, and the Kaplan-Meier estimator was used for estimating overall survival. RESULTS Compared to matched related donor and matched unrelated donor HCT, more ethnically diverse patients received mismatched unrelated donor, haploidentical donor, and cord blood HCT. Matched unrelated donor remains the most common donor type, but use of haploidentical donors has increased significantly over the last 5 years. Paralleling the increase in haploidentical HCT is the increased use of post-transplant cyclophosphamide (PTCy) as GvHD prophylaxis. Relative to older transplant eras, the most contemporary transplant era associates with the highest survival rates following allogeneic HCT irrespective of patient race and ethnicity. However, disease relapse remains the primary cause of death for both adult and pediatric allogeneic HCT recipients by donor type and across all patient race and ethnicity groups. CONCLUSIONS Ethnically diverse patients are undergoing allogeneic HCTs at higher rates largely through the use of alternative donor platforms incorporating PTCy. Maintaining access to potential life-saving allogeneic HCT using alternative donors and novel GvHD prophylaxis strategies and improving HCT outcomes, particularly disease relapse, are urgent clinical needs.
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Affiliation(s)
- Jeffery J Auletta
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN; Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH.
| | - Jianqun Kou
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Min Chen
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Yung-Tsi Bolon
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Larisa Broglie
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Caitrin Bupp
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Debra Christianson
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Rachel N Cusatis
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Steven M Devine
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Mary Eapen
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Kathryn E Flynn
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Mehdi Hamadani
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Mary Hengen
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Stephanie J Lee
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Fred Hutchinson Cancer Center, Seattle, WA
| | - Amy Moskop
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Kristin M Page
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Marcelo C Pasquini
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Waleska S Perez
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Rachel Phelan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Marcie L Riches
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - J Douglas Rizzo
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Wael Saber
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Stephen R Spellman
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Heather E Stefanski
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Patricia Steinert
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Eileen Tuschl
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Rafeek Yusuf
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Mei-Jie Zhang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Hamada M, Muramatsu H, Torii Y, Suzuki K, Narita A, Yoshida T, Imaya M, Yamamori A, Wakamatsu M, Miwata S, Narita K, Kataoka S, Kawashima N, Taniguchi R, Nishikawa E, Nishio N, Ito Y, Kojima S, Takahashi Y. Human leukocyte antigen 7/8-matched unrelated bone marrow transplantation using anti-thymocyte globulin in children. Int J Hematol 2023:10.1007/s12185-023-03571-5. [PMID: 36881377 DOI: 10.1007/s12185-023-03571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
Human leukocyte antigen (HLA) mismatched unrelated donor transplantation is associated with an increased risk of graft-versus-host disease, graft failure, and infection, which increases post-transplant morbidity and mortality. In this single-center retrospective study, outcomes were evaluated in 30 consecutive children who underwent bone marrow transplantation (BMT) from HLA 1 allele-mismatched (HLA 7/8-matched) unrelated donors with rabbit anti-thymocyte globulin (rATG) as graft-versus-host disease (GVHD) prophylaxis. The 3-year overall survival (OS), event-free survival (EFS), and GVHD-relapse-free survival rates were 91.7% (95% CI 70.5%-91.9%), 88.3% (95% CI 67.5%-96.1%), and 73.9% (95% CI 52.4%-86.8%), respectively. Grade II-IV and III-IV acute GVHD occurred in 10 (33%) and 2 (7.0%) patients, respectively. The 3-year cumulative incidence of chronic GVHD was 7.8%. No fatal viral infections occurred. The study results show the feasibility of HLA 7/8-matched unrelated BMT with ATG to achieve favorable outcomes and acceptable GVHD, especially for patients who lack a fully matched donor.
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Affiliation(s)
- Motoharu Hamada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Kyogo Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Atsushi Narita
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Taro Yoshida
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Masayuki Imaya
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Ayako Yamamori
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Manabu Wakamatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Shunsuke Miwata
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Kotaro Narita
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Shinsuke Kataoka
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Nozomu Kawashima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Rieko Taniguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Eri Nishikawa
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Nobuhiro Nishio
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.,Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
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45
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Shaw BE, Jimenez-Jimenez AM, Burns LJ, Logan BR, Khimani F, Shaffer BC, Shah NN, Mussetter A, Tang XY, McCarty JM, Alavi A, Farhadfar N, Jamieson K, Hardy NM, Choe H, Ambinder RF, Anasetti C, Perales MA, Spellman SR, Howard A, Komanduri KV, Luznik L, Norkin M, Pidala JA, Ratanatharathorn V, Confer DL, Devine SM, Horowitz MM, Bolaños-Meade J. Three-Year Outcomes in Recipients of Mismatched Unrelated Bone Marrow Donor Transplants Using Post-Transplantation Cyclophosphamide: Follow-Up from a National Marrow Donor Program-Sponsored Prospective Clinical Trial. Transplant Cell Ther 2023; 29:208.e1-208.e6. [PMID: 36584941 PMCID: PMC9992261 DOI: 10.1016/j.jtct.2022.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
The use of post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis has resulted in reductions in GVHD and improved outcomes in allogeneic hematopoietic cell transplantation (HCT) using HLA-mismatched related donors. We report the 3-year outcomes of the first multicenter prospective clinical trial using PTCy in the setting of mismatched unrelated donor (MMUD) bone marrow HCT. The study enrolled 80 patients, treated with either myeloablative conditioning (MAC; n = 40) or reduced-intensity conditioning (RIC; n = 40), with the primary endpoint of 1-year overall survival (OS). The median follow-up for this study was 34 months (range, 12 to 46 months) in the RIC group and 36 months (range, 18 to 49 months) in the MAC group. Three-year OS and nonrelapse mortality were 70% and 15%, respectively, in the RIC group and 62% and 10% in the MAC group. No GVHD was reported after 1 year. The incidence of relapse was 29% in the RIC group and 51% in the MAC group. OS did not differ based on HLA match grade (63% in the 7/8 strata and 71% in the 4 to 6/8 strata). These encouraging outcomes, which were sustained for 3 years post-HCT, support the continued exploration of MMUD HCT using a PTCy platform. Important future areas to address include relapse reduction and furthering our understanding of optimal donor selection based on HLA and non-HLA factors.
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Affiliation(s)
- Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | | | - Linda J Burns
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Farhad Khimani
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Brian C Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nirav N Shah
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alisha Mussetter
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Xiao-Ying Tang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John M McCarty
- Cellular Immunotherapies and Transplant Program, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Asif Alavi
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Katarzyna Jamieson
- University of North Carolina Hospitals-Chapel Hill, Chapel Hill, North Carolina
| | - Nancy M Hardy
- Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Hannah Choe
- Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Richard F Ambinder
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Claudio Anasetti
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Alan Howard
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Krishna V Komanduri
- Division of Hematology and Oncology, UCSF Health and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Leo Luznik
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Maxim Norkin
- Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Joseph A Pidala
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Steven M Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
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46
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Ritacco C, Köse MC, Courtois J, Canti L, Beguin C, Dubois S, Vandenhove B, Servais S, Caers J, Beguin Y, Ehx G, Baron F. Post-transplant cyclophosphamide prevents xenogeneic graft-versus-host disease while depleting proliferating regulatory T cells. iScience 2023; 26:106085. [PMID: 36843851 PMCID: PMC9947306 DOI: 10.1016/j.isci.2023.106085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/12/2022] [Accepted: 01/25/2023] [Indexed: 02/02/2023] Open
Abstract
Graft-versus-host disease (GVHD) remains a serious limitation of allogeneic hematopoietic cell transplantation (allo-HCT). While post-transplant administration of cyclophosphamide (PTCy) is increasingly used as GVHD prophylaxis, its precise mechanisms of action and its impact on graft-versus-leukemia effects have remained debated. Here, we studied the mechanisms of xenogeneic GVHD (xGVHD) prevention by PTCy in different humanized mouse models. We observed that PTCy attenuated xGVHD. Using flow cytometry and single-cell RNA-sequencing, we demonstrated that PTCy depleted proliferative CD8+ and conventional CD4+ T cells but also proliferative regulatory T cells (Treg). Further, T-cell receptor β variable region sequencing (TCRVB) analyses demonstrated that highly xenoreactive T-cell clones were depleted by PTCy. Although Treg frequencies were significantly higher in PTCy-treated than in control mice on day 21, xGVHD attenuation by PTCy was not abrogated by Treg depletion. Finally, we observed that PTCy did not abrogate graft-versus-leukemia effects.
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Affiliation(s)
- Caroline Ritacco
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium
| | - Murat Cem Köse
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium
| | - Justine Courtois
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium
| | - Lorenzo Canti
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium
| | - Charline Beguin
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium
| | - Sophie Dubois
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium
| | - Benoît Vandenhove
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium
| | - Sophie Servais
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium,Department of Medicine, Division of Hematology, CHU of Liège, Liège 4000, Belgium
| | - Jo Caers
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium,Department of Medicine, Division of Hematology, CHU of Liège, Liège 4000, Belgium
| | - Yves Beguin
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium,Department of Medicine, Division of Hematology, CHU of Liège, Liège 4000, Belgium
| | - Grégory Ehx
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium,Corresponding author
| | - Frédéric Baron
- Hematology Research Unit, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA)-I³, University of Liège, Liège 4000, Belgium,Department of Medicine, Division of Hematology, CHU of Liège, Liège 4000, Belgium,Corresponding author
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47
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Puckrin R, Shafey M, Storek J. The role of allogeneic hematopoietic cell transplantation for chronic lymphocytic leukemia: A review. Front Oncol 2023; 12:1105779. [PMID: 36741737 PMCID: PMC9889653 DOI: 10.3389/fonc.2022.1105779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Although the use of allogeneic hematopoietic cell transplantation (HCT) for chronic lymphocytic leukemia (CLL) has declined with the development of novel targeted agents, it continues to play an important role for eligible patients with high-risk or heavily pretreated CLL who lack other treatment options. CLL is susceptible to a potent graft-versus-leukemia (GVL) effect which produces long-lasting remissions in 30-50% of transplanted patients. While allogeneic HCT is associated with significant risks of graft-versus-host disease (GVHD), infection, and non-relapse mortality (NRM), improvements in patient and donor selection, reduced intensity conditioning (RIC), GVHD prophylaxis, and supportive care have rendered this an increasingly safe and effective procedure in the current era. In this review, we discuss recent advances in allogeneic HCT for CLL, with a focus on the optimal evidence-based strategies to maximize benefit and minimize toxicity of this potentially curative cellular therapy.
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Affiliation(s)
| | | | - Jan Storek
- Department of Hematology and Hematologic Malignancies, Tom Baker Cancer Centre and University of Calgary, Calgary, AB, Canada
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48
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Rimando J, McCurdy SR, Luznik L. How I prevent GVHD in high-risk patients: posttransplant cyclophosphamide and beyond. Blood 2023; 141:49-59. [PMID: 35405017 DOI: 10.1182/blood.2021015129] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 01/10/2023] Open
Abstract
Advances in conditioning, graft-versus-host disease (GVHD) prophylaxis and antimicrobial prophylaxis have improved the safety of allogeneic hematopoietic cell transplantation (HCT), leading to a substantial increase in the number of patients transplanted each year. This influx of patients along with progress in remission-inducing and posttransplant maintenance strategies for hematologic malignancies has led to new GVHD risk factors and high-risk groups: HLA-mismatched related (haplo) and unrelated (MMUD) donors; older recipient age; posttransplant maintenance; prior checkpoint inhibitor and autologous HCT exposure; and patients with benign hematologic disorders. Along with the changing transplant population, the field of HCT has dramatically shifted in the past decade because of the widespread adoption of posttransplantation cyclophosphamide (PTCy), which has increased the use of HLA-mismatched related donors to levels comparable to HLA-matched related donors. Its success has led investigators to explore PTCy's utility for HLA-matched HCT, where we predict it will be embraced as well. Additionally, combinations of promising new agents for GVHD prophylaxis such as abatacept and JAK inhibitors with PTCy inspire hope for an even safer transplant platform. Using 3 illustrative cases, we review our current approach to transplantation of patients at high risk of GVHD using our modern armamentarium.
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49
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Arslan S, Al Malki MM. New strategies for mismatched unrelated donor (MMUD) hematopoietic cell transplant (HCT). Hematology Am Soc Hematol Educ Program 2022; 2022:74-82. [PMID: 36485163 PMCID: PMC9819983 DOI: 10.1182/hematology.2022000398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
With increasing numbers of patients with hematologic malignancies requiring allogeneic hematopoietic cell transplant (HCT), including minority racial and ethnic groups, the limited availability of matched related donors and matched unrelated donors remains a significant obstacle. Hence, the use of alternative donors such as haploidentical and mismatched unrelated donors (MMUDs) is on the rise. Herein, we present case studies to outline a rational and stepwise approach with a focus on the use of MMUD for HCT in patients with hematologic malignancies. We also review novel approaches used to reduce the incidence of severe graft-versus-host disease and improve HCT outcomes in patients undergoing MMUD HCT.
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50
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Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) often represents the only curative treatment for various malignant and nonmalignant disorders. Initially, the only suitable donors were considered human leukocyte antigen (HLA)-matched or partially matched relatives. The founding of international unrelated donor and umbilical cord blood registries expanded unrelated donor options and access for patients. In the absence of a matched sibling donor (MSD) with 13% to 51% availability, the current consensus recommends use of a matched unrelated donor (MUD) at HLA-A, B, C, and DRB1 with consideration of matching at HLA-DPB1 and -DQB1. MUD donor availability (donor willing and available to donate) ranges from 29% to 78% with African American patients on the lower end and white non-Hispanic patients with the highest likelihood of a match. Recent studies comparing donor to no-donor treatment options in malignant disease consistently point to substantially better outcomes following alloHCT. In the absence of an MSD or MUD, alternative donor choices turn to haploidentical related (Haplo), mismatched unrelated donor (MMUD), and umbilical cord blood (UCB). Novel strategies for alloHCT, including the use of posttransplant cyclophosphamide-based graft vs host disease prophylaxis, have expanded the safety and effectiveness of transplant procedures across HLA barriers using Haplo and MMUD. The less restrictive matching requirements for UCB transplant are well documented and allow for transplant across multiply mismatched HLA alleles. When all donor options are considered, nearly all patients have an available donor. Here we discuss the likelihood of donor availability, complete HLA match by available donor type, and current controversies warranting future research.
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Affiliation(s)
- Stephen R. Spellman
- Correspondence Stephen R. Spellman, Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, 500 5th N Street, Minneapolis, MN 55401-1206; e-mail:
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