1
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Farina M, Chiarini M, Almici C, Accorsi Buttini E, Zuccalà F, Piva S, Volonghi I, Poli L, Bernardi S, Colnaghi F, Re F, Leoni A, Polverelli N, Turra A, Morello E, Galvagni A, Moratto D, Brugnoni D, Cattaneo C, Ferrari E, Bianchetti A, Malagola M, Re A, Russo D. Timely Leukapheresis May Interfere with the "Fitness" of Lymphocytes Collected for CAR-T Treatment in High Risk DLBCL Patients. Cancers (Basel) 2022; 14:5276. [PMID: 36358694 PMCID: PMC9655620 DOI: 10.3390/cancers14215276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 07/26/2023] Open
Abstract
The development of chimeric antigen receptor (CAR)-T cell therapy has revolutionized the treatment of hematological diseases. However, approximately 60% of patients relapse after CAR-T cell therapy, and no clear cause for this failure has been identified. The objective of the Bio-CAR-T BS study (ClinicalTrials.gov: NCT05366569) is to improve our understanding of the lymphocyte harvest to maximize the quality of the CAR-T cell product. Of the 14 patients enrolled, 11 were diagnosed with DLBCL, 2 with PMBCL, and 1 with ALL. Five of 11 DLBCL patients met the criteria for "pre-emptive" Lymphocytes-apheresis (being at high risk of second relapse), and 6 were included in the standard-of-care Lymphocytes-apheresis group. Previous autologous stem cell transplantation (ASCT) and age were significantly different between the two groups. At the time of Lymphocyte-apheresis, patients in the "pre-emptive" group had more "fit" lymphocytes (higher CD4+/CD8+ ratio; higher naïve T cells levels) compared with standard group, probably due to the impact of ASCT. At the same time, also being older than 60 years results in a more "exhausted" lymphocyte profile. Overall, "pre-emptive" Ly-apheresis in DLBCL patients at high risk of relapse appears to be feasible and may allow the timely collection of "fit" lymphocytes for CAR-T cell manufacturing.
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Affiliation(s)
- Mirko Farina
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Marco Chiarini
- Diagnostics Department, Clinical Chemistry Laboratory, Flow Cytometry Section, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Camillo Almici
- Laboratory for Stem Cells Manipulation and Cryopreservation, Department of Transfusion Medicine, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Eugenia Accorsi Buttini
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Francesco Zuccalà
- First Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Simone Piva
- University Division of Anesthesiology and Critical Care Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Irene Volonghi
- U.O.C. Neurology Center for Neuromuscular Diseases, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Loris Poli
- U.O.C. Neurology Center for Neuromuscular Diseases, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Simona Bernardi
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
- Research Center Ail (CREA), Chair of Hematology-Department of Clinical and Experimental Sciences, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Federica Colnaghi
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Federica Re
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
- Research Center Ail (CREA), Chair of Hematology-Department of Clinical and Experimental Sciences, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alessandro Leoni
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Nicola Polverelli
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alessandro Turra
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Enrico Morello
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Anna Galvagni
- Diagnostics Department, Clinical Chemistry Laboratory, Flow Cytometry Section, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Daniele Moratto
- Diagnostics Department, Clinical Chemistry Laboratory, Flow Cytometry Section, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Duilio Brugnoni
- Diagnostics Department, Clinical Chemistry Laboratory, Flow Cytometry Section, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Chiara Cattaneo
- U.O.C. Hematology, Department of Clinical Oncology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Emilio Ferrari
- Laboratory for Stem Cells Manipulation and Cryopreservation, Department of Transfusion Medicine, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Andrea Bianchetti
- Laboratory for Stem Cells Manipulation and Cryopreservation, Department of Transfusion Medicine, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Michele Malagola
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Alessandro Re
- U.O.C. Hematology, Department of Clinical Oncology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Domenico Russo
- Unit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
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2
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Feasibility of Leukemia-Derived Exosome Enrichment and Co-isolated dsDNA Sequencing in Acute Myeloid Leukemia Patients: A Proof of Concept for New Leukemia Biomarkers Detection. Cancers (Basel) 2022; 14:cancers14184504. [PMID: 36139664 PMCID: PMC9497185 DOI: 10.3390/cancers14184504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary The present pilot study aimed at investigating the feasibility of a leukemia-derived exosome enrichment approach followed by exosomal dsDNA target re-sequencing for adult Acute Myeloid Leukemias (AML) marker detection. To our knowledge, this is the first time that a proof-of-concept combining a leukemia-derived exosome enrichment strategy based on a commercial CE-IVD kit and next-generation sequencing was applied in a cohort of adult AML patients. The reported approach is easy, quick and user friendly and gives the possibility of obtaining a good quantity of exosomal dsDNA (composed of exosomal cargo and surrounding DNA) suitable for further analysis. The time-effective procedure opens up future effective clinical applications. This pilot study presents the potential of a proof-of-concept based on exosome analysis to be applied in clinical practice, as well as the feasibility of this kind of investigations using a certified kit, avoiding many additional analyses. It may encourage further studies regarding extracellular vesicles in myeloid neoplasia. Abstract Exosomes are extracellular vesicles playing a pivotal role in the intercellular communication. They shuttle different cargoes, including nucleic acids from their cell of origin. For this reason, they have been studied as carriers of tumor markers in different liquid biopsy approaches, in particular for solid tumors. Few data are available concerning exosomes as markers of myeloid neoplasia. To better understand their real potential and the best approach to investigate leukemic exosomes, we present the results of a pilot feasibility study evaluating the application of next-generation sequencing analysis of dsDNA derived from exosomes isolated in 14 adult patients affected by acute myeloid leukemias. In particular, leukemia-derived exosome fractions have been analyzed. The concentration of dsDNA co-extracted with exosomes and the number and types of mutations detected were considered and compared with ones identified in the Bone Marrow (BM) and Peripheral Blood (PB) cells. Exosomal DNA concentration, both considering the cargo and the DNA surrounding the lipid membrane resulted in a linear correlation with leukemic burden. Moreover, exosomal DNA mutation status presented 86.5% of homology with BM and 75% with PB. The results of this pilot study confirmed the feasibility of a leukemia-derived exosome enrichment approach followed by exosomal dsDNA NGS analysis for AML biomarker detection. These data point to the use of liquid biopsy in myeloid neoplasia for the detection of active leukemic cells resident in the BM via a painless procedure.
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3
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Spadea M, Saglio F, Tripodi SI, Menconi M, Zecca M, Fagioli F. Multivariate Analysis of Immune Reconstitution and Relapse Risk Scoring in Children Receiving Allogeneic Stem Cell Transplantation for Acute Leukemias. Transplant Direct 2021; 7:e774. [PMID: 34646937 PMCID: PMC8500617 DOI: 10.1097/txd.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022] Open
Abstract
A timely and effective immune reconstitution after hematopoietic stem cell transplantation (HSCT) is of crucial importance to enhance graft-versus-leukemia reaction in hematological malignancies. Several factors can influence the yield of this process, and new mathematical models are needed to describe this complex phenomenon.
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Affiliation(s)
- Manuela Spadea
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O.U. Città della Salute e della Scienza-Regina Margherita Children's Hospital, Turin, Italy
| | - Francesco Saglio
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O.U. Città della Salute e della Scienza-Regina Margherita Children's Hospital, Turin, Italy
| | - Serena I Tripodi
- Pediatric Hematology-Oncology, Fondazione Istituti di ricovero e cura a carattere scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Mariacristina Menconi
- Haematopoietic Stem Cell Transplantation Unit, Paediatric Clinic, University Hospital of Pisa, Pisa, Italy
| | - Marco Zecca
- Pediatric Hematology-Oncology, Fondazione Istituti di ricovero e cura a carattere scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Franca Fagioli
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O.U. Città della Salute e della Scienza-Regina Margherita Children's Hospital, Turin, Italy
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4
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Diana JS, Bouazza N, Couzin C, Castelle M, Magnani A, Magrin E, Rosain J, Treluyer JM, Picard C, Moshous D, Blanche S, Neven B, Cavazzana M. Bayesian Modeling Immune Reconstitution Apply to CD34+ Selected Stem Cell Transplantation for Severe Combined Immunodeficiency. Front Pediatr 2021; 9:804912. [PMID: 35242727 PMCID: PMC8885722 DOI: 10.3389/fped.2021.804912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
Severe combined immunodeficiencies (SCIDs) correspond to the most severe form of primary immunodeficiency. Allogeneic hematopoietic stem cell transplantation (HSCT) and gene therapy are curative treatments, depending on the donor's availability and molecular diagnostics. A partially human leukocyte antigen (HLA)-compatible donor used has been developed for this specific HSCT indication in the absence of a matched donor. However, the CD34+ selected process induces prolonged post-transplant T-cell immunodeficiency. The aim here was to investigate a modeling approach to predict the time course and the extent of CD4+ T-cell immune reconstitution after CD34+ selected transplantation. We performed a Bayesian approach based on the age-related changes in thymic output and the cell proliferation/loss model. For that purpose, we defined specific individual covariates from the data collected from 10 years of clinical practice and then evaluated the model's predicted performances and accuracy. We have shown that this Bayesian modeling approach predicted the time course and extent of CD4+ T-cell immune reconstitution after SCID transplantation.
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Affiliation(s)
- Jean-Sebastien Diana
- Biotherapy Department, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Naïm Bouazza
- Université de Paris, Paris, France.,Clinical Research Unit, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chloe Couzin
- Biotherapy Department, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martin Castelle
- Pediatric Hematology-Immunology-Rheumatology Unit, Hôpital Necker Enfants Malades Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alessandra Magnani
- Biotherapy Department, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elisa Magrin
- Biotherapy Department, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jeremie Rosain
- Laboratory of Human Genetics of Infectious Diseases, Hôpital Necker Enfants Malades Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Marc Treluyer
- Université de Paris, Paris, France.,Clinical Research Unit, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Capucine Picard
- Université de Paris, Paris, France.,Laboratory of Human Genetics of Infectious Diseases, Hôpital Necker Enfants Malades Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Despina Moshous
- Université de Paris, Paris, France.,Pediatric Hematology-Immunology-Rheumatology Unit, Hôpital Necker Enfants Malades Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Blanche
- Université de Paris, Paris, France.,Pediatric Hematology-Immunology-Rheumatology Unit, Hôpital Necker Enfants Malades Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bénédicte Neven
- Université de Paris, Paris, France.,Pediatric Hematology-Immunology-Rheumatology Unit, Hôpital Necker Enfants Malades Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marina Cavazzana
- Biotherapy Department, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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5
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Farina M, Bernardi S, Gandolfi L, Zanaglio C, Morello E, Turra A, Zollner T, Gramegna D, Rambaldi B, Cattina F, Polverelli N, Malagola M, Russo D. Case Report: Late Onset of Myelodysplastic Syndrome From Donor Progenitor Cells After Allogeneic Stem Cell Transplantation. Which Lessons Can We Draw From the Reported Case? Front Oncol 2020; 10:564521. [PMID: 33178592 PMCID: PMC7591784 DOI: 10.3389/fonc.2020.564521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/21/2020] [Indexed: 01/22/2023] Open
Abstract
Background Myelodysplastic syndromes and acute leukemias after allogeneic stem cell transplantation (allo-SCT) are mainly caused by recurrence of the primitive leukemic clones. More rarely, they originate from donor hematopoietic stem cells, developing the so-called donor cell leukemia (DCL) or myelodysplastic syndromes (DC-MDSs). DCL and DC-MDS can be considered as an in vivo model of leukemogenesis, and even if the pathogenetic mechanisms remain speculative, a genetic predisposition of donor progenitor cells, an altered host microenvironment, and the impairment of immune surveillance are considered the main causes. Case Presentation We report a case of DC-MDS diagnosed 5 years after an allo-SCT from a matched related donor (patient’s sister) in a patient with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia (Ph+ B-ALL). The sex-mismatch allowed us to identify the donor cell origin. At the onset, the DC-MDS was characterized by chromosome seven monosomy and NRAS, RUNX1, and BCOR mutations. Because of a familiar history of colorectal neoplasia and the variant allele frequency (VAF) of NRAS mutation at the onset, this mutation was searched on germline DNA in both the donor and the recipient, but the result was negative. Moreover, after transplant (+4 months), the patient developed severe and long-lasting chronic graft-versus-host disease (cGVHD), requiring multiple lines of treatments. Because of the severe immunosuppression, recurrent infections occurred and, lately, the patient died due to septic shock. Conclusion This case report highlights the need, whenever possible, to evaluate the donor origin of the posttransplant myelodysplasia and acute leukemias. The potential key role of the impaired immune surveillance and of long-lasting immunosuppression appears to be emerging in the development of this case of DC-MDS. Finally, this case reminds the importance to investigate the familiar genetic predisposition in donors with a familiar history of neoplasia.
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Affiliation(s)
- Mirko Farina
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Simona Bernardi
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.,CREA Laboratory (Centro di Ricerca Emato-Oncologica AIL), ASST Spedali Civili di Brescia, Brescia, Italy
| | - Lisa Gandolfi
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Camilla Zanaglio
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.,CREA Laboratory (Centro di Ricerca Emato-Oncologica AIL), ASST Spedali Civili di Brescia, Brescia, Italy
| | - Enrico Morello
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessandro Turra
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Tatiana Zollner
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Doriana Gramegna
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Benedetta Rambaldi
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Federica Cattina
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Nicola Polverelli
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Michele Malagola
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Domenico Russo
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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6
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Mankarious M, Matthews NC, Snowden JA, Alfred A. Extracorporeal Photopheresis (ECP) and the Potential of Novel Biomarkers in Optimizing Management of Acute and Chronic Graft vs. Host Disease (GvHD). Front Immunol 2020; 11:81. [PMID: 32082329 PMCID: PMC7005102 DOI: 10.3389/fimmu.2020.00081] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022] Open
Abstract
As the use of hematopoietic stem cell transplantation (HSCT) has become a more widespread and effective treatment for hematological malignant and non-malignant conditions, the need to minimize the harmful effects of graft- vs.-host disease (GvHD) has become more important in achieving good outcomes. With diagnosis of GvHD reliant on its clinical manifestations, research into biomarkers for the diagnosis, progression, and even for the prediction of disease, is imperative to combating the high levels of morbidity and mortality post-HSCT. Despite the development of novel treatment approaches to GvHD, corticosteroids remain the standard first-line treatment, with immunosuppressant therapies as second-line options. These strategies however have significant limitations and associated complications. Extracorporeal Photopheresis (ECP) has shown to be effective and safe in treating patients with symptomatic GvHD. ECP has been shown to have varied effects on multiple parts of the immune system and does not appear to increase the risk of relapse or infection in the post HSCT setting. Even so, ECP can be logistically more complex to organize and requires patients to be sufficiently stable. This review aims to summarize the potential role of biomarkers to help guide individualized treatment decisions in patients with acute and chronic GvHD. In relation to ECP, robust biomarkers of GvHD will be highly useful in informing patient selection, intensity and duration of the ECP schedule, monitoring of response and other treatment decisions alongside the concurrent administration of other GvHD therapies. Further research is warranted to establish how GvHD biomarkers are best incorporated into ECP treatment pathways with the goal of tailoring ECP to the needs of individual patients and maximizing benefit.
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Affiliation(s)
- Matthew Mankarious
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Nick C Matthews
- Department of Photopheresis, The Rotherham NHS Foundation Trust, Rotherham, United Kingdom
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Arun Alfred
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom.,Department of Photopheresis, The Rotherham NHS Foundation Trust, Rotherham, United Kingdom
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7
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Mikhael NL, Elsorady M. Clinical significance of T cell receptor excision circle (TREC) quantitation after allogenic HSCT. Blood Res 2019; 54:274-281. [PMID: 31915654 PMCID: PMC6942145 DOI: 10.5045/br.2019.54.4.274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/15/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
Background Hematopoietic stem cell transplantation (HSCT) is a well-established treatment modality for a variety of diseases. Immune reconstitution is an important event that determines outcomes. The immune recovery of T cells relies on peripheral expansion of mature graft cells, followed by differentiation of donor-derived hematopoietic stem cells. The formation of new T cells occurs in the thymus and as a byproduct, T cell receptor excision circles (TRECs) are released. Detection of TRECs by PCR is a reliable method for estimating the amount of newly formed T cells in the circulation and, indirectly, for estimating thymic function. The aim of this study was to determine the role of TREC quantitation in predicting outcomes of human leucocyte antigen (HLA) identical allogenic HSCT. Methods The study was conducted on 100 patients receiving allogenic HSCT from an HLA identical sibling. TREC quantification was done by real time PCR using a standard curve. Results TREC levels were inversely related to age (P=0.005) and were significantly lower in patients with malignant diseases than in those with benign diseases (P=0.038). TREC levels could predict relapse as an outcome but not graft versus host disease (GvHD) and infections. Conclusion Age and nature of disease determine the TREC levels, which are related to relapse.
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Affiliation(s)
- Neveen Lewis Mikhael
- Clinical Pathology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Manal Elsorady
- Clinical Hematology Department, Head of BMT Unit, Alexandria Faculty of Medicine, Alexandria, Egypt
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8
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Mellgren K, Nierop AF, Abrahamsson J. Use of Multivariate Immune Reconstitution Patterns to Describe Immune Reconstitution after Allogeneic Stem Cell Transplantation in Children. Biol Blood Marrow Transplant 2019; 25:2045-2053. [DOI: 10.1016/j.bbmt.2019.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 05/08/2019] [Accepted: 06/19/2019] [Indexed: 01/12/2023]
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9
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Nakamae H, Fujii K, Nanno S, Okamura H, Nakane T, Koh H, Nakashima Y, Nakamae M, Hirose A, Teshima T, Hino M. A prospective observational study of immune reconstitution following transplantation with post‐transplant reduced‐dose cyclophosphamide from
HLA
‐haploidentical donors. Transpl Int 2019; 32:1322-1332. [DOI: 10.1111/tri.13494] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/06/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Hirohisa Nakamae
- Hematology Graduate School of Medicine Osaka City University Osaka Japan
| | - Kazuki Fujii
- Department of Clinical Laboratory Osaka City University Hospital Osaka Japan
| | - Satoru Nanno
- Hematology Graduate School of Medicine Osaka City University Osaka Japan
| | - Hiroshi Okamura
- Hematology Graduate School of Medicine Osaka City University Osaka Japan
| | - Takahiko Nakane
- Hematology Graduate School of Medicine Osaka City University Osaka Japan
| | - Hideo Koh
- Hematology Graduate School of Medicine Osaka City University Osaka Japan
| | - Yasuhiro Nakashima
- Hematology Graduate School of Medicine Osaka City University Osaka Japan
| | - Mika Nakamae
- Hematology Graduate School of Medicine Osaka City University Osaka Japan
| | - Asao Hirose
- Hematology Graduate School of Medicine Osaka City University Osaka Japan
| | - Takanori Teshima
- Department of Hematology Faculty of Medicine Hokkaido University Sapporo Japan
| | - Masayuki Hino
- Hematology Graduate School of Medicine Osaka City University Osaka Japan
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Studying the Replication History of Human B Lymphocytes by Real-Time Quantitative (RQ-)PCR. Methods Mol Biol 2019. [PMID: 30779033 DOI: 10.1007/978-1-4939-9151-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
The cells of the adaptive immune system, B and T lymphocytes, each generate a unique antigen receptor through V(D)J recombination of their immunoglobulin (Ig) and T-cell receptor (TCR) loci, respectively. Such rearrangements join coding elements to form a coding joint and delete the intervening DNA as circular excision products containing the signal joint. These excision circles are stable structures that cannot replicate and have no function in the cell. Since the coding joint in the genome is replicated with each cell division, the ratio between coding joints and signal joints in a population of B cells can be used as a measure for proliferation. This chapter describes a real-time quantitative (RQ-)PCR-based approach to quantify proliferation through calculating the ratio between coding joints and signal joints of the frequently occurring intronRSS-Kde rearrangements in the IGK light chain locus. Besides its use in normal B-cell biology, quantification of B-cell replication can inform on abnormal proliferation in human diseases and in B-cell neogenesis following depletion therapy.
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Ranti J, Kurki S, Salmenniemi U, Putkonen M, Salomäki S, Itälä-Remes M. Early CD8+-recovery independently predicts low probability of disease relapse but also associates with severe GVHD after allogeneic HSCT. PLoS One 2018; 13:e0204136. [PMID: 30235281 PMCID: PMC6147489 DOI: 10.1371/journal.pone.0204136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/04/2018] [Indexed: 11/18/2022] Open
Abstract
In this single-center study we retrospectively evaluated the impact of early reconstitution of different lymphocyte subsets on patient outcomes after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We found that CD8+ T-cell counts exceeding 50x10(6)/l as early as on day 28 post-transplantation correlated significantly with decreased relapse risk, with three-year relapse rates of 17.0% and 55.6% (P = 0.002), but were also associated with severe acute and chronic GVHD. Incidence of grade III-IV acute GVHD was 30.5% for those with early CD8+ T-cell recovery compared to 2.1% for those with lower CD8+ T-cell counts on day 28 post-transplant (HR = 20.24, P = 0.004). Early CD8+ T-cell reconstitution did not, however, affect the overall survival. Multivariate analysis showed that slow CD8+ T-cell reconstitution was strongly associated with increased risk of relapse (HR = 3.44, P = 0.026). A weaker correlation was found between CD4+ reconstitution and relapse-risk, but there was no such association with CD19+ B-cells or NK-cells. In conclusion, the early CD8+ T-cell recovery on day 28 post-transplant is associated with the lower risk of relapse but also predicts the impending severe GVHD, and thus could be useful in guiding timely treatment decisions.
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Affiliation(s)
- Juha Ranti
- Department of Hematology and Stem Cell Transplantation Unit, Division of Medicine, Turku University Hospital, Turku, Finland
- * E-mail:
| | - Samu Kurki
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Urpu Salmenniemi
- Department of Hematology and Stem Cell Transplantation Unit, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mervi Putkonen
- Department of Hematology and Stem Cell Transplantation Unit, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Soile Salomäki
- Department of Hematology and Stem Cell Transplantation Unit, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Maija Itälä-Remes
- Department of Hematology and Stem Cell Transplantation Unit, Division of Medicine, Turku University Hospital, Turku, Finland
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Resolving the diagnostic dilemma of T-cell clonal expansion after hematopoietic stem cell transplantation in T-cell lymphoma patients by TCR-gamma next generation sequencing. Bone Marrow Transplant 2018; 54:159-163. [PMID: 30116015 DOI: 10.1038/s41409-018-0268-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 11/09/2022]
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Polverelli N, Malagola M, Turra A, Skert C, Perucca S, Chiarini M, Cattina F, Rambaldi B, Cancelli V, Morello E, Schieppati F, Bernardi S, Zanaglio C, Sottini A, Giustini V, Imberti L, Montanelli A, Russo D. Comparative study on ATG-thymoglobulin versus ATG-fresenius for the graft-versus-host disease (GVHD) prophylaxis in allogeneic stem cell transplantation from matched unrelated donor: a single-centre experience over the contemporary years. Leuk Lymphoma 2018. [PMID: 29527964 DOI: 10.1080/10428194.2018.1439584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Nicola Polverelli
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Michele Malagola
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Alessandro Turra
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Cristina Skert
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Simone Perucca
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy.,b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Marco Chiarini
- c Clinical Chemistry Laboratory, Department of Diagnostics , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Federica Cattina
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Benedetta Rambaldi
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Valeria Cancelli
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Enrico Morello
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Francesca Schieppati
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Simona Bernardi
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy.,b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Camilla Zanaglio
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy.,b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Alessandra Sottini
- b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Viviana Giustini
- b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Luisa Imberti
- b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Alessandro Montanelli
- c Clinical Chemistry Laboratory, Department of Diagnostics , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Domenico Russo
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
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