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Piekarska A, Pawelec K, Szmigielska-Kapłon A, Ussowicz M. The state of the art in the treatment of severe aplastic anemia: immunotherapy and hematopoietic cell transplantation in children and adults. Front Immunol 2024; 15:1378432. [PMID: 38646536 PMCID: PMC11026616 DOI: 10.3389/fimmu.2024.1378432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Acquired aplastic anemia (AA) is an immune-mediated bone marrow (BM) failure where marrow disruption is driven by a cytotoxic T-cell-mediated autoimmune attack against hematopoietic stem cells. The key diagnostic challenge in children, but also in adults, is to exclude the possible underlying congenital condition and myelodysplasia. The choice of treatment options, either allogeneic hematopoietic cell transplantation (alloHCT) or immunosuppressive therapy (IST), depends on the patient's age, comorbidities, and access to a suitable donor and effective therapeutic agents. Since 2022, horse antithymocyte globulin (hATG) has been available again in Europe and is recommended for IST as a more effective option than rabbit ATG. Therefore, an update on immunosuppressive strategies is warranted. Despite an improved response to the new immunosuppression protocols with hATG and eltrombopag, some patients are not cured or remain at risk of aplasia relapse or clonal evolution and require postponed alloHCT. The transplantation field has evolved, becoming safer and more accessible. Upfront alloHCT from unrelated donors is becoming a tempting option. With the use of posttransplant cyclophosphamide, haploidentical HCT offers promising outcomes also in AA. In this paper, we present the state of the art in the management of severe AA for pediatric and adult patients based on the available guidelines and recently published studies.
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Affiliation(s)
- Agnieszka Piekarska
- Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Pawelec
- Department of Oncology, Pediatric Hematology, Clinical Transplantology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | | | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
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Zaimoku Y, Katagiri T, Nakagawa N, Imi T, Maruyama H, Takamatsu H, Ishiyama K, Yamazaki H, Miyamoto T, Nakao S. HLA Class I Allele Loss and Bone Marrow Transplantation Outcomes in Immune Aplastic Anemia. Transplant Cell Ther 2024; 30:281.e1-281.e13. [PMID: 37972732 DOI: 10.1016/j.jtct.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/23/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
In patients with immune-mediated acquired aplastic anemia (AA), HLA class I alleles often disappear from the surface of hematopoietic progenitor cells, potentially enabling evasion from cytotoxic T lymphocyte-mediated pathogenesis. Although HLA class I allele loss has been studied in AA patients treated with immunosuppressive therapy (IST), its impact on allogeneic bone marrow transplantation (BMT) has not been thoroughly investigated. The purpose of this study was to evaluate the clinical implications of HLA class I allele loss in patients with acquired AA undergoing allogeneic BMT. The study enrolled acquired AA patients who underwent initial BMT from unrelated donors through the Japan Marrow Donor Program between 1993 and 2011. The presence of HLA class I allele loss due to loss of heterozygosity (HLA-LOH) was assessed using pretransplantation blood DNA and correlated with clinical data obtained from the Japanese Transplant Registry Unified Management Program. A total of 432 patients with acquired AA were included in the study, and HLA-LOH was detected in 20 of the 178 patients (11%) available for analysis. Patients with HLA-LOH typically presented with more severe AA at diagnosis (P = .017) and underwent BMT earlier (P < .0001) compared to those without HLA-LOH. They also showed a slight but significant recovery in platelet count from the time of diagnosis to BMT (P = .00085). However, HLA-LOH status had no significant effect on survival, engraftment, graft failure, chimerism status, graft-versus-host disease, or other complications following BMT, even when the 20 HLA-LOH+ patients were compared with the 40 propensity score-matched HLA-LOH- patients. Nevertheless, patients lacking HLA-A*02:06 or HLA-B*40:02, the alleles most frequently lost and associated with a better IST response, showed higher survival rates compared to those lacking other alleles, with estimated 5-year overall survival (OS) rates of 100% and 44%, respectively (P = .0042). In addition, in a specific subset of HLA-LOH- patients showing clinical features similar to HLA-LOH+ patients, the HLA-A*02:06 and HLA-B*40:02 allele genotypes correlated with better survival rates compared with other allele genotypes, with estimated 5-year OS rates of 100% and 43%, respectively (P = .0096). However, this genotype correlation did not extend to all patients, suggesting that immunopathogenic mechanisms linked to the loss of certain HLA alleles, rather than the HLA genotypes themselves, influence survival outcomes. The survival benefit associated with the loss of these two alleles was confirmed in a multivariable Cox regression model. The observed correlations between HLA loss and the pretransplantation clinical manifestations and between loss of specific HLA class I alleles and survival outcomes in AA patients may improve patient selection for unrelated BMT and facilitate further investigations into the immune pathophysiology of the disease.
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Affiliation(s)
- Yoshitaka Zaimoku
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan; Department of Infection Control and Prevention, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
| | - Takamasa Katagiri
- Department of Clinical Laboratory Science, Graduate School of Medical Science, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Noriharu Nakagawa
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Tatsuya Imi
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Maruyama
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Takamatsu
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan; Faculty of Transdisciplinary Sciences for Innovation, Institute of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ken Ishiyama
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hirohito Yamazaki
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan; Division of Transfusion Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Toshihiro Miyamoto
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Shinji Nakao
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan; Japanese Red Cross Ishikawa Blood Center, Kanazawa, Ishikawa, Japan
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Kulasekararaj A, Cavenagh J, Dokal I, Foukaneli T, Gandhi S, Garg M, Griffin M, Hillmen P, Ireland R, Killick S, Mansour S, Mufti G, Potter V, Snowden J, Stanworth S, Zuha R, Marsh J. Guidelines for the diagnosis and management of adult aplastic anaemia: A British Society for Haematology Guideline. Br J Haematol 2024; 204:784-804. [PMID: 38247114 DOI: 10.1111/bjh.19236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/26/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
Pancytopenia with hypocellular bone marrow is the hallmark of aplastic anaemia (AA) and the diagnosis is confirmed after careful evaluation, following exclusion of alternate diagnosis including hypoplastic myelodysplastic syndromes. Emerging use of molecular cyto-genomics is helpful in delineating immune mediated AA from inherited bone marrow failures (IBMF). Camitta criteria is used to assess disease severity, which along with age and availability of human leucocyte antigen compatible donor are determinants for therapeutic decisions. Supportive care with blood and platelet transfusion support, along with anti-microbial prophylaxis and prompt management of opportunistic infections remain key throughout the disease course. The standard first-line treatment for newly diagnosed acquired severe/very severe AA patients is horse anti-thymocyte globulin and ciclosporin-based immunosuppressive therapy (IST) with eltrombopag or allogeneic haemopoietic stem cell transplant (HSCT) from a matched sibling donor. Unrelated donor HSCT in adults should be considered after lack of response to IST, and up front for young adults with severe infections and a readily available matched unrelated donor. Management of IBMF, AA in pregnancy and in elderly require special attention. In view of the rarity of AA and complexity of management, appropriate discussion in multidisciplinary meetings and involvement of expert centres is strongly recommended to improve patient outcomes.
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Affiliation(s)
- Austin Kulasekararaj
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Jamie Cavenagh
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Inderjeet Dokal
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Barts Health NHS Trust, London, UK
| | - Theodora Foukaneli
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NHS Blood and Transplant, Bristol, UK
| | - Shreyans Gandhi
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
- British Society Haematology Task Force Representative, London, UK
| | | | | | - Robin Ireland
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Sally Killick
- University Hospitals Dorset NHS Foundation Trust, The Royal Bournemouth Hospital, Bournemouth, UK
| | - Sahar Mansour
- St George's Hospital/St George's University of London, London, UK
| | - Ghulam Mufti
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Victoria Potter
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - John Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Simon Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Roslin Zuha
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, England
| | - Judith Marsh
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
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Gale RP, Hinterberger W, Young NS, Gennery AR, Dvorak CC, Hebert KM, Heim M, Broglie L, Eapen M. What causes aplastic anaemia? Leukemia 2023; 37:1191-1193. [PMID: 37106162 PMCID: PMC10353698 DOI: 10.1038/s41375-023-01892-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Robert Peter Gale
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College of Science, Technology and Medicine, London, UK.
| | | | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew R Gennery
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology & Bone Marrow Transplantation, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Kyle M Hebert
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael Heim
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Larisa Broglie
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Mary Eapen
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Sánchez-Sierra N, Perez-Somarriba M, Santa-Maria V, Cruz O, García-Rey E, Martorell L, Rovira M, Margarit A, Marsal J. Syngeneic hematopoietic stem cell transplantation after mobilization failure in an adolescent with intracranial germ cell tumor. Pediatr Blood Cancer 2023; 70:e30177. [PMID: 36625393 DOI: 10.1002/pbc.30177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Nazaret Sánchez-Sierra
- Department of Pediatric Oncology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Marta Perez-Somarriba
- Neuro-Oncology Unit, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Vicente Santa-Maria
- Neuro-Oncology Unit, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Ofelia Cruz
- Neuro-Oncology Unit, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Enric García-Rey
- Transfusion Service, Banc de Sang i Teixits, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Loreto Martorell
- Department of Molecular Genetics, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Montserrat Rovira
- Haematology Department, Hospital Clínic, Barcelona, Spain
- Stem Cell Transplant Unit and Department of Hematology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Adriana Margarit
- Stem Cell Transplant Unit and Department of Hematology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Julia Marsal
- Stem Cell Transplant Unit and Department of Hematology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
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Pınar IE, Özkalemkaş F, Ersal T, Gürsoy V, Gülderen E, Özkocaman V. Severe aplastic anemia and a healthy pregnancy immediately following syngeneic transplantation: An extremely rare case report. Transplant Proc 2023; 55:715-717. [PMID: 36931953 DOI: 10.1016/j.transproceed.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
Aplastic anemia is potentially fatal, particularly if the disease does not respond to immunotherapy and progresses to severe pancytopenia. Allogeneic hematopoietic stem cell transplant from an HLA-matched sibling donor, the first-line treatment in patients younger than 40 years, is used as a curative treatment option in severe aplastic anemia. The availability of an identical twin donor is infrequent, and there is limited experience in this context. Additionally, the choices for a conditioning regimen for a syngeneic transplant to prevent engraftment failure and the necessity of graft-vs-host disease prophylaxis are controversial. Although long-term survival gradually increases after an allogeneic hematopoietic stem cell transplant, hypogonadism and infertility are the main problems that significantly affect patients' quality of life. We present a patient diagnosed with severe aplastic anemia who has had a healthy pregnancy immediately after a syngeneic transplant.
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Affiliation(s)
- Ibrahim Ethem Pınar
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey.
| | - Fahir Özkalemkaş
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Tuba Ersal
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Vildan Gürsoy
- Department of Internal Medicine, Division of Hematology, Bursa City Hospital, Bursa, Turkey
| | - Esra Gülderen
- Department of Internal Medicine, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Vildan Özkocaman
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
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7
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Gale R, Hinterberger W, Young NS, Gennery A, Dvorak C, Hebert K, Heim M, Broglie L, Eapen M. What Causes Aplastic Anaemia: Results of Transplants from Genetically-Identical Twins. RESEARCH SQUARE 2023:rs.3.rs-2540187. [PMID: 36778326 PMCID: PMC9915784 DOI: 10.21203/rs.3.rs-2540187/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Aplastic anaemia has diverse aetiologies. Distinguishing between these is, in part, testable by analyzing results of haematopoietic cells transplants between genetically-identical twins one of whom has aplastic anaemia. Objective Describe outcomes of genetically-identical twin transplants for aplastic anaemia with and without pretransplant conditioning. Methods We interrogated data from an observational database of 59 consecutive recipients of genetically-identical twin transplants for aplastic anaemia reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) 2000-2019. Results 38 subjects were male. Median age was 18 years (Interquartile Range [IQR], 11-32 years). Median interval from diagnosis to transplant was 2 months (IQR 1-3 months). 11 subjects received a 1st transplant without pretransplant conditioning. 2 of recovered normal bone marrow function. The other 9 received a 2nd transplant with pretransplant conditioning 7 of whom recovered. 48 subjects received pretransplant conditioning before a 1st or 2nd transplant all of whom recovered. Conclusion Only some genetically-identical twins with aplastic anaemia recover normal bone marrow function after a 1st haematopoietic cell transplant without pretransplant conditioning whereas most subjects recover when a transplant is preceded by pretransplant conditioning. These data are consistent with an immune-mediated aetiology of aplastic anaemia in most cases.
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Affiliation(s)
| | | | | | | | | | - Kyle Hebert
- CIBMTR Statistical Center, Medical College of Wisconsin
| | - Michael Heim
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin
| | - Larisa Broglie
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin
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Dmitrova AA, Kuz'mina LA, Vasil'eva VA, Drokov MY, Parovichnikova EN. The late outcomes of syngeneic hematopoietic stem cell transplantation in patients with blood disorders. BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2022.5.tx.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction. Syngeneic hematopoietic stem cell transplantation is a type of allogeneic stem cell transplantation when the donor of stem cells is a genetically identical (monozygotic) twin of the recipient. After this type of transplantation, there is no immunological conflict as the graft versus host disease, but at the same time, there is no positive effect of the graft-versus-leukemia effect.Aim: to assess the overall survival, event-free survival, probability of relapse, and transplant-related mortality rates associated with syngeneic stem cell transplantation.Patients and methods. In the National Research Center for Hematology from January 1988 to December 2018 we performed 654 allo-HSCT: 17 (2.5%) of them from a syngeneic donor. We performed a «paired analysis» with patients after allo-HSCT from a HLA-identical sibling donor. We included patients after allo-HSCT from an HLA-identical related donor (n = 28) in Group 1 and patients after syngeneic stem cell transplantation in group 2 (n = 14). Patients with aplastic anemia (n = 3) were excluded from the «paired analysis».Results. Patients after syngeneic stem cell transplantation did not develop a graft-versus-host disease. The relapse developed in 50% of cases (n = 7). Five patients (35.7%) died: 4 of them due to the relapse of the disease, and 1 – due to the graft failure. The relapse probability in patients after syngeneic HSCT was higher and amounted to 18.4% versus 54.2% (p = 0.047) for allo-HSCT from HLA-identical sibling donor and a syngeneic donor, respectively. Overall and event-free survival in patients after syngeneic HSCT is comparable to those in patients after allo-HSCT from an HLA-identical sibling donor.Conclusion. Syngeneic hematopoietic stem cell transplantation is justified in the absence of another related or unrelated donor of hematopoietic stem cells. The use of myeloablative conditioning regimens, peripheral blood stem cells as a source of stem cells, or high doses of nucleated cells/kg in the case of using bone marrow will improve post-transplant parameters in patients after syngeneic hematopoietic stem cell transplantation.
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Zhang Y, Yang DL, Zhang RL, Zhai WH, Pang AM, He Y, Jiang EL, Feng SZ, Han MZ. [Syngeneic hematopoietic stem cell transplantation for aplastic anemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:474-479. [PMID: 34384153 PMCID: PMC8295615 DOI: 10.3760/cma.j.issn.0253-2727.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 11/30/2022]
Abstract
Objective: To evaluate the efficacy of syngeneic hematopoietic stem cell transplantation in the treatment of aplastic anemia. Methods: The clinic data of 11 patients with aplastic anemia undergoing syngeneic HSCT were retrospectively analyzed. Results: Among all of the 11 patients with AA, 4 males and 7 females were determined, with a median age of 22 (7-44) years old. All of the 11 patients achieved engraftment after the first transplantation: neutrophils engraftment occurred after a median of 10 days (range 8-23) , and platelet engraftment occurred after a median of 11 days (range 8-28) . Eight patients achieved long-term stable engraftment: three patients had graft failure, and two of them underwent secondary transplantation (1 case achieved long-term stable engraftment, but graft failure occurred again after hematopoietic reconstruction in another case) . The median follow-up time was 53 (5-135) months. All of the 11 patients survived, and the blood routine of 9 patients was normal for a long time. Conclusion: Syngeneic hematopoietic stem cell transplantation has a good long-term survival rate in the treatment of aplastic anemia, and graft failure is still the most significant problem.
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Affiliation(s)
- Y Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - D L Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - R L Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - W H Zhai
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - A M Pang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y He
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - E L Jiang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - S Z Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - M Z Han
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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10
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Iftikhar R, Chaudhry QUN, Anwer F, Neupane K, Rafae A, Mahmood SK, Ghafoor T, Shahbaz N, Khan MA, Khattak TA, Shamshad GU, Rehman J, Farhan M, Khan M, Ansar I, Ashraf R, Marsh J, Satti TM, Ahmed P. Allogeneic hematopoietic stem cell transplantation in aplastic anemia: current indications and transplant strategies. Blood Rev 2020; 47:100772. [PMID: 33187812 DOI: 10.1016/j.blre.2020.100772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/12/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022]
Abstract
Treatment options for newly diagnosed aplastic anemia (AA) patient includes upfront allogeneic hematopoietic stem cell transplant (HSCT) or immunosuppressive therapy (IST). With recent advances in supportive care, conditioning regimens and post-transplant immunosuppression the overall survival for HSCT approaches 70-90%. Transplant eligibility needs to be assessed considering age, comorbidities, donor availability and probability of response to immunosuppressive therapy (IST). Upfront HSCT should be offered to children and young adults with matched related donor (MRD). Upfront HSCT may also be offered to children and young adults with rapidly available matched unrelated donor (MUD) who require urgent HSCT. Bone marrow (BM) graft source and cyclosporine (CsA) plus methotrexate (MTX) as graft versus host disease (GVHD) prophylaxis are preferable when using anti-thymocyte globulin (ATG) based conditioning regimens. Alemtuzumab is an acceptable alternative to ATG and is used with CsA alone and with either BM or peripheral blood stem cells (PBSC). Cyclophosphamide (CY) plus ATG conditioning is preferable for patients receiving MRD transplant, while Fludarabine (Flu) based conditioning is reserved for older adults, those with risk factors of graft failure and those receiving MUD HSCT. For haploidentical transplant, use of low dose radiotherapy and post-transplant cyclophosphamide has resulted in a marked reduction in graft failure and GVHD.
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Affiliation(s)
- Raheel Iftikhar
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan.
| | - Qamar Un Nisa Chaudhry
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Faiz Anwer
- Department of Hematology, Medical Oncology, Tausig Cancer Center, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Karun Neupane
- Department of Internal Medicine, Manipal College of Medical Sciences, Pokhara 33700, Nepal
| | - Abdul Rafae
- Department of Internal Medicine, McLaren Flint Michigan State University, United States
| | - Syed Kamran Mahmood
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Tariq Ghafoor
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Nighat Shahbaz
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Mehreen Ali Khan
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Tariq Azam Khattak
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Ghassan Umair Shamshad
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Jahanzeb Rehman
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Muhammad Farhan
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Maryam Khan
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Iqraa Ansar
- Shifa College of Medicine, Islamabad 44000, Pakistan
| | - Rabia Ashraf
- King Edward Medical University, Lahore 54000, Pakistan
| | - Judith Marsh
- Department of Hematological Medicine, King's College Hospital, Denmark Hill, London SE59RS, UK
| | | | - Parvez Ahmed
- Department of Hematology Oncology and Stem Cell Transplant, Quaid-e-Azam International Hospital, Islamabad 44000, Pakistan
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11
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McCann S. Graft failure. Bone Marrow Transplant 2020; 55:1888-1889. [PMID: 32161320 DOI: 10.1038/s41409-020-0860-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Shaun McCann
- University of Dublin Trinity College, Haematology Emeritus, Dublin, Ireland.
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12
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Liu B, Chen W, Jiang J, Zhou W, Zhang Y, He R, Wang Y, Li J, Liang D, Chen J, Wang W, Luo D, Wang Y. Treatment Effect of Low-Intensity Pulsed Ultrasound on Benzene- and Cyclophosphamide-Induced Aplastic Anemia in Rabbits. Phys Ther 2019; 99:1443-1452. [PMID: 31087076 DOI: 10.1093/ptj/pzz074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 03/23/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Transplantation and immunosuppressive therapies are the available treatments for aplastic anemia; however, each strategy has its advantages and disadvantages. OBJECTIVE The aim of this study was to find a new strategy for aplastic anemia treatment. DESIGN This was an experimental and comparative study. METHODS The aplastic anemia model was established by injecting rabbits with benzene and cyclophosphamide. The rabbits with aplastic anemia were divided into low-intensity pulsed ultrasound (LIPUS) and control groups. The distal femoral metaphysis of rabbits in the LIPUS group was treated with ultrasound for 30 days (20 min/d), whereas the control group received a sham treatment. Diarrhea, mortality, and blood cell count were evaluated. The levels of forkhead box P3, interleukin 17, interleukin 4, and interferon gamma were measured using an enzyme-linked immunosorbent assay. Bone marrow hyperplasia was observed by hematoxylin-eosin staining and scanning electron microscopy. RESULTS The numbers of red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs) were lower, the amount of hematopoietic tissue was lower, and the amount of adipose tissue was higher in the rabbit aplastic anemia model than in the normal rabbits. The numbers of RBCs, WBCs, and PLTs increased after LIPUS treatment. The interleukin 17 level decreased, whereas the forkhead box P3 level increased. The amount of hematopoietic tissue increased, whereas the amount of adipose tissue decreased. LIMITATIONS The number of hematopoietic stem cells could not be evaluated. CONCLUSIONS LIPUS improved the hematopoietic microenvironment, accelerated the reconstruction of bone marrow cells, and increased the quantity and quality of RBCs, WBCs, and PLTs in the peripheral blood. Hence, it can serve as a novel treatment strategy for aplastic anemia in the future.
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Affiliation(s)
- Baoru Liu
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Wenzhi Chen
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Jingwei Jiang
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Weichen Zhou
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Yu Zhang
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Ruixin He
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Yong Wang
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Junshu Li
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Dandan Liang
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Junlin Chen
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Wei Wang
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Dong Luo
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
| | - Yan Wang
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, and Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing Medical University, Chongqing, China
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13
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El-Cheikh J, Atoui A, Moukalled N, Ghaoui N, El Darsa H, Kanj SS, Bazarbachi A. Successful treatment of severe aplastic anemia with syngeneic stem cell transplantation in the setting of active disseminated mucormycosis. Med Mycol Case Rep 2019; 23:68-71. [PMID: 30705813 PMCID: PMC6349008 DOI: 10.1016/j.mmcr.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/28/2018] [Accepted: 01/11/2019] [Indexed: 12/19/2022] Open
Abstract
Severe aplastic anemia (SAA) is a hematological disease resulting in pancytopenia due to bone marrow failure. Treatment consists of immunosppressive therapy, or allo-SCT. Patients with aplastic anemia are predisposed to invasive fungal infections due to mucormycosis. Till now, syngeneic SCT in the context of active mucormycosis infection for patients with severe aplastic anemia is lacking in the literature. Here, we report a case of severe aplastic anemia with disseminated mucormycosis infection undergoing syngeneic transplant.
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Affiliation(s)
- Jean El-Cheikh
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Medical Center, 113-6044 Beirut, Lebanon
| | - Ali Atoui
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Medical Center, 113-6044 Beirut, Lebanon
| | - Nour Moukalled
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Medical Center, 113-6044 Beirut, Lebanon
| | - Nohra Ghaoui
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Medical Center, 113-6044 Beirut, Lebanon
| | - Haidar El Darsa
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Medical Center, 113-6044 Beirut, Lebanon
| | - Souha S Kanj
- Infectious Disease, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Medical Center, 113-6044 Beirut, Lebanon
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14
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Yamei W, Rongmu L, Yongbin C, Yingjian S, Xiaohong L, Xiaomei Z, Pei Y, Zhenlan D, Haitao W, Jing W, Bojing W, Xiaoxiong W, Wanming D. Improved outcome of haploidentical transplantation in severe aplastic anemia using reduced-intensity fludarabine-based conditioning. Oncotarget 2017; 8:83817-83830. [PMID: 29137385 PMCID: PMC5663557 DOI: 10.18632/oncotarget.19745] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022] Open
Abstract
Significant improvements in hematopoietic stem cell transplantation (HSCT) with haploidentical family donors (HFD) have confirmed its therapeutic role in severe aplastic anemia (SAA) and led to the evolution of treatment algorithms. However, the optimal conditioning regimen for HFD-HSCT remains undefined, especially the dosage of cyclophosphamide (Cy). A total of 77 patients with SAA from two research centers, who received HFD-HSCT with reduced-intensity fludarabine + cyclophosphamide + thymoglobulin ± busulfan conditioning regimen plus third-party cells infusion were included in this study, of which 67 pairs had 4-5 loci mismatched. We were particularly interested in whether the dosage of Cy significantly impacted graft failure (GF) and overall survival (OS). All patients showed sustained hematopoietic engraftment without any increase in severe aGVHD and transplantation-related mortality (TRM). The incidences of grade II-IV aGVHD, grade III-IV aGVHD and extensive cGVHD were 18%, 10% and 7%, respectively. The probabilities of 1-year and 5-year OS were 93.1% and 87.9%, respectively. Furthermore, patient age <15 years, MNC cells >8×108/kg and donor age <45 years were associated with better survival (P=0.043, P=0.023, and P=0.037, respectively) and engraftment (P=0.019, P=0.008, and P=0.001, respectively). Our findings indicated that SAA patients lack MSD benefited the most if HFD-HSCT was performed with reduced-intensity fludarabine-based conditioning regimen. Improved outcomes with HFD-HSCT may lead to a salvaged therapy and an expanded direct role for SAA in the future.
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Affiliation(s)
- Wu Yamei
- Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China
| | - Luo Rongmu
- Department of Hematology, Affiliated BaYi Children's Hospital, PLA Army General Hospital, Beijing 100700, China
| | - Cao Yongbin
- Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China
| | - Si Yingjian
- Department of Hematology, Affiliated BaYi Children's Hospital, PLA Army General Hospital, Beijing 100700, China
| | - Li Xiaohong
- Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China
| | - Zhang Xiaomei
- Department of Hematology, Affiliated BaYi Children's Hospital, PLA Army General Hospital, Beijing 100700, China
| | - Yan Pei
- Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China
| | - Du Zhenlan
- Department of Hematology, Affiliated BaYi Children's Hospital, PLA Army General Hospital, Beijing 100700, China
| | - Wang Haitao
- Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China
| | - Wang Jing
- Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China
| | - Wang Bojing
- Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China
| | - Wu Xiaoxiong
- Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China
| | - Da Wanming
- Department of Hematology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China.,Department of Hematology, Affiliated BaYi Children's Hospital, PLA Army General Hospital, Beijing 100700, China.,Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China
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15
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Jauregui-Amezaga A, Rovira M, López A, Marín P, Rodriguez S, Rimola J, Ordás I, Alfaro I, Panés J, Ricart E. Long-lasting Remission Induced by Syngeneic Haematopoietic Stem Cell Transplantation in a Patient with Refractory Crohn's Disease. J Crohns Colitis 2016; 10:1122-4. [PMID: 26933030 DOI: 10.1093/ecco-jcc/jjw062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/23/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Autologous haematopoietic stem cell transplantation (HSCT) is considered a salvage therapy for patients with refractory immune-mediated diseases. Syngeneic HSCT may be an alternative to autologous HSCT, with potential advantages in terms of safety and efficacy. METHODS A patient with severe Crohn's disease refractory to available medical therapies underwent a syngeneic HSCT from her identical twin sister. Cyclophosphamide and rabbit anti-thymocyte globulin were administered for conditioning. RESULTS After transplant, the patient presented successful engraftment, complete haematological and immunological reconstitution, and no severe complications. The patient achieved complete remission after transplant which is sustained 4 years after transplantation without any active treatment for Crohn's disease. CONCLUSIONS Patients with refractory immune-mediated diseases who have an identical disease-free twin may benefit from a syngeneic HSCT.
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Affiliation(s)
| | | | - Alicia López
- Gastroenterology Department, Hospital Clínic a, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Pedro Marín
- Haemotherapy and Haemostasis Department, Hospital Clínic, Barcelona, Spain
| | | | - Jordi Rimola
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - Ingrid Ordás
- Gastroenterology Department, Hospital Clínic a, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Ignacio Alfaro
- Gastroenterology Department, Hospital Clínic a, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Julian Panés
- Gastroenterology Department, Hospital Clínic a, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic a, IDIBAPS, CIBERehd, Barcelona, Spain
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16
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Hu Y, Cui Q, Luo C, Luo Y, Shi J, Huang H. A promising sword of tomorrow: Human γδ T cell strategies reconcile allo-HSCT complications. Blood Rev 2015; 30:179-88. [PMID: 26654098 DOI: 10.1016/j.blre.2015.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/06/2015] [Accepted: 11/20/2015] [Indexed: 12/15/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is potentially a curative therapeutic option for hematological malignancies. In clinical practice, transplantation associated complications greatly affected the final therapeutical outcomes. Currently, primary disease relapse, graft-versus-host disease (GVHD) and infections remain the three leading causes of a high morbidity and mortality in allo-HSCT patients. Various strategies have been investigated in the past several decades including human γδ T cell-based therapeutical regimens. In different microenvironments, human γδ T cells assume features reminiscent of classical Th1, Th2, Th17, NKT and regulatory T cells, showing diverse biological functions. The cytotoxic γδ T cells could be utilized to target relapsed malignancies, and recently regulatory γδ T cells are defined as a novel implement for GVHD management. In addition, human γδ Τ cells facilitate control of post-transplantation infections and participate in tissue regeneration and wound healing processes. These features potentiate γδ T cells a versatile therapeutical agent to target transplantation associated complications. This review focuses on insights of applicable potentials of human γδ T cells reconciling complications associated with allo-HSCT. We believe an improved understanding of pertinent γδ T cell functions would be further exploited in the design of innovative immunotherapeutic approaches in allo-HSCT, to reduce mortality and morbidity, as well as improve quality of life for patients after transplantation.
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Affiliation(s)
- Yongxian Hu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China.
| | - Qu Cui
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.
| | - Chao Luo
- Department of Hematology, Jinhua Central Hospital, No. 351 Mingyue Road, Jinhua 312000, China.
| | - Yi Luo
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Jimin Shi
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China.
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17
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Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hill A, Hillmen P, Ireland R, Kulasekararaj A, Mufti G, Snowden JA, Samarasinghe S, Wood A, Marsh JCW. Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol 2015; 172:187-207. [PMID: 26568159 DOI: 10.1111/bjh.13853] [Citation(s) in RCA: 470] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sally B Killick
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Nick Bown
- Northern Genetics Service, Newcastle upon Tyne, UK
| | - Jamie Cavenagh
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Inderjeet Dokal
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Barts Health NHS Trust, London, UK
| | | | | | | | - Robin Ireland
- Kings College Hospital NHS Foundation Trust, London, UK
| | | | - Ghulam Mufti
- Kings College Hospital NHS Foundation Trust, London, UK
| | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Anna Wood
- West Hertfordshire NHS Trust, Watford, UK
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18
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Hamidieh AA, Mozafari M, Noshad S, Alimoghaddam K, Behfar M, Ghavamzadeh A. Matched related donor hematopoietic stem cell transplantation results in a long-term follow-up of a pediatric acquired severe aplastic anemia subset: A stem cell source perspective. Pediatr Transplant 2015; 19:399-407. [PMID: 25824340 DOI: 10.1111/petr.12458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2015] [Indexed: 01/01/2023]
Abstract
HSCT has substantially improved pediatric acquired SAA patients' outcomes. Retrospectively, we attempted to assess the outcome of MRD HSCT in 65 pediatric patients referred to a single center from 1992 to 2012. We were particularly interested to find out whether source of SC (PB, n = 40 and BM, n = 25) significantly impacts EFS and GVHD incidence. With a median follow-up of 45 months, total EFS was 87.7%; EFS for PB and BM groups was 87.5% and 88%, respectively. Acute GVHD (grades 3-4) occurred in 13 patients (PB, n = 10 [25%] and BM, n = 3 [12%]), acute GVHD (grades 2-4) occurred in 24 (PB, n = 16 [40%] and BM, n = 8 [32%]). Extensive chronic GVHD occurred in five patients (PB, n = 3 [7.5%] and BM, n = 2 [8%]). Cox regression revealed that elapsed time of <10 months between diagnosis and HSCT is associated with improved survival (hazard ratio, 95% CI = 1.204, 1.010-1.434, p = 0.038). SC source did not significantly affect EFS, incidence of acute GVHD (grades 3-4), or extensive chronic GVHD (p = 0.938, 0.121, and 0.487, respectively). Based on our findings, pediatric acquired SAA patients are benefitted most if MRD-HSCT is carried out early in disease process and SC source does not affect outcome of MRD-HSCT in these patients.
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Affiliation(s)
- Amir Ali Hamidieh
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
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19
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Timing of allogeneic stem cell transplantation for myelodysplastic syndromes and aplastic anemia. Hematology 2014; 2014:77-81. [DOI: 10.1182/asheducation-2014.1.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) for myelodysplastic syndrome (MDS) is a potentially curative procedure, but is associated with a significant risk of morbidity and mortality. With the recent approval of disease-modifying agents, the appropriate timing of allogeneic HSCT needs to be addressed. Similarly, the optimal use of these disease-modifying agents before HSCT needs to be determined. In severe aplastic anemia, HSCT is a proven cure, but HLA-matched sibling donors are found in fewer than 25% of newly diagnosed patients. The use of early unrelated donor HSCT is an evolving concept that will become more accepted as improvements in HSCT outcomes continue.
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20
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Bueno C, Roldan M, Anguita E, Romero-Moya D, Martín-Antonio B, Rosu-Myles M, del Cañizo C, Campos F, García R, Gómez-Casares M, Fuster JL, Jurado M, Delgado M, Menendez P. Bone marrow mesenchymal stem cells from patients with aplastic anemia maintain functional and immune properties and do not contribute to the pathogenesis of the disease. Haematologica 2014; 99:1168-75. [PMID: 24727813 DOI: 10.3324/haematol.2014.103580] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aplastic anemia is a life-threatening bone marrow failure disorder characterized by peripheral pancytopenia and marrow hypoplasia. The majority of cases of aplastic anemia remain idiopathic, although hematopoietic stem cell deficiency and impaired immune responses are hallmarks underlying the bone marrow failure in this condition. Mesenchymal stem/stromal cells constitute an essential component of the bone marrow hematopoietic microenvironment because of their immunomodulatory properties and their ability to support hematopoiesis, and they have been involved in the pathogenesis of several hematologic malignancies. We investigated whether bone marrow mesenchymal stem cells contribute, directly or indirectly, to the pathogenesis of aplastic anemia. We found that mesenchymal stem cell cultures can be established from the bone marrow of aplastic anemia patients and display the same phenotype and differentiation potential as their counterparts from normal bone marrow. Mesenchymal stem cells from aplastic anemia patients support the in vitro homeostasis and the in vivo repopulating function of CD34(+) cells, and maintain their immunosuppressive and anti-inflammatory properties. These data demonstrate that bone marrow mesenchymal stem cells from patients with aplastic anemia do not have impaired functional and immunological properties, suggesting that they do not contribute to the pathogenesis of the disease.
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Affiliation(s)
- Clara Bueno
- Josep Carreras Leukemia Research Institute, Cell Therapy Program of the University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Mar Roldan
- GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, Granada, Spain
| | - Eduardo Anguita
- Servicio de Hematología, Hospital Clínico San Carlos, Madrid, Spain
| | - Damia Romero-Moya
- Josep Carreras Leukemia Research Institute, Cell Therapy Program of the University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Beatriz Martín-Antonio
- Josep Carreras Leukemia Research Institute, Cell Therapy Program of the University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Michael Rosu-Myles
- Biologics and Genetic Therapies Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Consuelo del Cañizo
- Department of Hematology, University Hospital of Salamanca and Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Francisco Campos
- Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico-Health Research Institute of Santiago de Compostela, Spain
| | - Regina García
- Servicio de Hematología, Hospital Clínico de Málaga, Málaga, Spain
| | - Maite Gómez-Casares
- Servicio de Hematología, Hospital Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Jose Luis Fuster
- Sección de Oncohematología Pediátrica, Hospital Virgen de Arrixaca, Murcia, Spain
| | - Manuel Jurado
- Servicio de Hematología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Mario Delgado
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain
| | - Pablo Menendez
- Josep Carreras Leukemia Research Institute, Cell Therapy Program of the University of Barcelona, Faculty of Medicine, Barcelona, Spain Instituciò Catalana de Reserca i Estudis Avançats (ICREA), Barcellona, Spain
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