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Abboud R, Wan F, Mariotti J, Arango M, Castagna L, Romee R, Hamadani M, Chhabra S. Cytokine release syndrome after haploidentical hematopoietic cell transplantation: an international multicenter analysis. Bone Marrow Transplant 2021; 56:2763-2770. [PMID: 34262142 DOI: 10.1038/s41409-021-01403-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 11/09/2022]
Abstract
Haploidentical related donor transplantation (haplo-HCT) is associated with cytokine release syndrome (CRS). We conducted a multicenter retrospective study to analyze risk factors for CRS and outcomes after haplo-HCT. We included 451 patients from four academic centers receiving both peripheral blood and bone marrow grafts. Severe CRS was more common with PB vs. BM grafts (19.5% vs 4.9%, OR 2.9, p = 0.05). Multivariable analysis identified recipient CMV sero-positivity, prior transplant, HCT-CI score and donor-recipient sex mismatch as risk factors for severe CRS. Outcomes were analyzed with no CRS as the comparison group. Overall survival (OS) was superior with mild CRS (HR 0.64, p = 0.05) and worst with severe CRS (HR 2.12, p = 0.0038). Relapse risk was significantly decreased in both mild CRS (HR 0.38, p < 0.0001) and severe CRS (HR 0.17, p < 0.0001) groups. The risk of non-relapse mortality was notably higher in severe CRS group (HR 8.0, p < 0.0001), but not in mild CRS group. Acute GVHD was similar among groups. Chronic GVHD at 1 year was 18.5% for no CRS, 23% for mild CRS, and 4.3% for severe CRS (p = 0.0023), with the competing risk of early mortality and short follow up of surviving patients contributing to the low chronic GVHD rates in the severe CRS group.
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Affiliation(s)
- Ramzi Abboud
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Fei Wan
- Biostatistics Shared Resource Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacopo Mariotti
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Marcos Arango
- Hematology and Stem Cell Transplantation, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Luca Castagna
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Rizwan Romee
- BMT and Cellular Therapy Program, Dana Farber Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Mehdi Hamadani
- BMT and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saurabh Chhabra
- BMT and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Abboud R, Slade M, Abboud C, DiPersio JF. Can planned CD34+ stem cell boost prevent poor graft function after peripheral blood haploidentical hematopoietic transplantation? Leuk Lymphoma 2020; 62:749-751. [PMID: 33135522 DOI: 10.1080/10428194.2020.1839657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ramzi Abboud
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Slade
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Camille Abboud
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - John F DiPersio
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
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Huselton E, Slade M, Trinkaus KM, DiPersio JF, Westervelt P, Romee R. Propensity Score Analysis of Conditioning Intensity in Peripheral Blood Haploidentical Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:2047-2055. [PMID: 29803753 DOI: 10.1016/j.bbmt.2018.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/21/2018] [Indexed: 02/04/2023]
Abstract
T cell replete HLA-haploidentical hematopoietic cell transplantation (haplo-HCT) with post-transplant cyclophosphamide was originally described using a reduced-intensity conditioning (RIC) regimen. Given that myeloablative conditioning (MAC) is more effective at preventing disease relapse, we compared outcomes of patients receiving MAC and RIC regimens. We evaluated overall survival (OS), disease-free survival (DFS), relapse, nonrelapse mortality (NRM), and graft-versus-host disease (GVHD) of 148 patients that underwent haplo-HCT with either MAC (n = 61) or RIC (n = 87). Propensity score adjustment (PSA) was used to balance baseline characteristics between groups and more effectively compare outcomes based on conditioning intensity. After the PSA analysis, relapse was significantly decreased with MAC (hazard ratio [HR], .47; 95% confidence interval [CI], .31 to .70), but was associated with higher NRM (HR, 1.74; 95% CI, 1.13 to 2.67). OS and DFS were not significantly different between groups (HRs for MAC versus RIC were .87 [95% CI, .64 to 1.18] and .90 [95% CI, .68 to 1.18] for OS and DFS, respectively). Rates of acute and chronic GVHD were not significantly different between groups. This analysis suggests that both MAC and RIC regimens are effective in haplo-HCT and that MAC regimens may result in less relapse in selected patients. These results need to be verified in a larger registry study.
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Affiliation(s)
- Eric Huselton
- BMT and Leukemia Program, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Slade
- BMT and Leukemia Program, Washington University School of Medicine, St. Louis, Missouri
| | - Kathryn M Trinkaus
- Siteman Cancer Center, Biostatistics Shared Resource, Washington University School of Medicine, St. Louis, Missouri
| | - John F DiPersio
- BMT and Leukemia Program, Washington University School of Medicine, St. Louis, Missouri
| | - Peter Westervelt
- BMT and Leukemia Program, Washington University School of Medicine, St. Louis, Missouri
| | - Rizwan Romee
- BMT and Leukemia Program, Washington University School of Medicine, St. Louis, Missouri.
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