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Paviglianiti A, Ngoya M, Peña M, Boumendil A, Gülbas Z, Ciceri F, Bonifazi F, Russo D, Fegueux N, Stolzel F, Bulabois CE, Socié G, Forcade E, Solano C, Finel H, Robinson S, Glass B, Montoto S. Graft-versus-host-disease prophylaxis with ATG or PTCY in patients with lymphoproliferative disorders undergoing reduced intensity conditioning regimen HCT from one antigen mismatched unrelated donor. Bone Marrow Transplant 2024; 59:597-603. [PMID: 38331980 DOI: 10.1038/s41409-024-02225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
Post-transplant cyclophosphamide (PTCY) has been introduced as graft-versus-host disease (GvHD) prophylaxis in mismatched and matched unrelated hematopoietic cell transplant (HCT). However, data comparing outcomes of PTCY or ATG in patients undergoing a 1 antigen mismatched HCT for lymphoproliferative disease are limited. We compared PTCY versus ATG in adult patients with lymphoproliferative disease undergoing a first 9/10 MMUD HCT with a reduced intensity conditioning regimen from 2010 to 2021. Patients receiving PTCY were matched to patients receiving ATG according to: age, disease status at transplant, female to male matching, stem cell source and CMV serology. Grade II-IV acute GvHD at 100 day was 26% and 41% for the ATG and PTCY group, respectively (p = 0.08). Grade III-IV acute GvHD was not significantly different between the two groups. No differences were observed in relapse incidence, non-relapse mortality, progression-free survival, overall survival and GvHD-relapse-free survival at 1 year. The cumulative incidence of 1-year extensive chronic GvHD was 18% in the ATG and 5% in the PTCY group, respectively (p = 0.06). In patients with lymphoproliferative diseases undergoing 9/10 MMUD HCT, PTCY might be a safe option providing similar results to ATG prophylaxis. Due to the limited number of patients, prospective randomized trials are needed.
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Affiliation(s)
- Annalisa Paviglianiti
- Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Maud Ngoya
- Lymphoma Working Party, EBMT, Paris, France
| | - Marta Peña
- Duran i Reynals Hospital, Catalan Institute of Oncology, Barcelona, Spain Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | | | - Zafer Gülbas
- Bone Marrow Transplantation Department, Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Domenico Russo
- Unit of Blood Diseases and Bone Marrow Transplantation, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Nathalie Fegueux
- Department of Hematology and Oncology, CHU Lapeyronie, Montpellier, France
| | - Friedrich Stolzel
- University Hospital, Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Claude Eric Bulabois
- CHU Grenoble Alpes - Université Grenoble Alpes, Service d'Hématologie, Grenoble, France
| | - Gerard Socié
- Hopital Saint Louis, Department of Hematology - BMT, Paris, France
| | | | - Carlo Solano
- Hospital Clínico de Valencia, Servicio de Hematología, University of Valencia, Valencia, Spain
| | | | | | | | - Silvia Montoto
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
- Department of Haemato-oncology St.Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Paviglianiti A. Nipping cytomegalovirus in the bud for umbilical cord blood transplantation. Br J Haematol 2024. [PMID: 38650369 DOI: 10.1111/bjh.19488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
Real data confirm an excellent toxicity profile and effectiveness of letermovir prophylaxis with decreased cytomegalovirus reactivation and resistance in umbilical cord blood transplantation for both paediatric and adult patients. Commentary on: Yan et al. Letermovir prophylaxis reduced cytomegalovirus reactivation and resistance post umbilical cord blood transplantation. Br J Haematol 2024 (Online ahead of print). doi: 10.1111/bjh.19451.
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Affiliation(s)
- Annalisa Paviglianiti
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- Research Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
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3
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Salvino MA, Mussetti A, Peña M, Paviglianiti A, Carreira AS, Rizky D, Sureda A. CAR T-cell therapy and the onco-nephrologist. Front Nephrol 2024; 4:1378250. [PMID: 38706889 PMCID: PMC11066316 DOI: 10.3389/fneph.2024.1378250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/25/2024] [Indexed: 05/07/2024]
Abstract
Cell therapy, specifically the revolutionary chimeric antigen receptor (CAR) T-cell therapy, has transformed the landscape of oncology, making substantial strides in practical treatment approaches. Today, established guidelines for diseases such as lymphomas, myelomas, and leukemias actively advocate the utilization of these once-unconventional therapies. The practical impact of these therapies is underscored by their unparalleled efficacy, reshaping the way we approach and implement treatments in the realm of oncology. However, CAR T-cell therapy, with its performance in anti-tumor aggression through cellular action and inflammatory response, also comes with various adverse events, one of which is kidney injury. Therefore, the management of these side effects is extremely important. The integration of knowledge between oncologists and specialized nephrologists has led to the emergence of a new sub-area of expertise for onco-nephrologists specializing in managing kidney complications from immune effector therapies.
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Affiliation(s)
- Marco Aurelio Salvino
- Programa Pos Graduacao Medicina Saude (PPGMS), Universidade Federal da Bahia, Salvador, Brazil
- L’Hospitalet, Institut Català de Oncologia, Barcelona, Spain
- Hematology Department, Instituto D´or de Pesquisa e Ensino-Bahia (IDOR Ba), Salvador, Brazil
| | | | - Marta Peña
- L’Hospitalet, Institut Català de Oncologia, Barcelona, Spain
| | | | | | - Daniel Rizky
- L’Hospitalet, Institut Català de Oncologia, Barcelona, Spain
- Hematology Medical Oncology, Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Anna Sureda
- L’Hospitalet, Institut Català de Oncologia, Barcelona, Spain
- Institut d’Investigació Biomédica de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
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Battisti S, Pedone C, Tramontana F, Napoli N, Alhamar G, Russo E, Agnoletti V, Paolucci E, Galgani M, Giampalma E, Paviglianiti A, Strollo R. Abdominal adipose tissue distribution assessed by computed tomography and mortality in hospitalised patients with COVID-19: a retrospective longitudinal cohort study. Endocrine 2024; 83:597-603. [PMID: 37736820 DOI: 10.1007/s12020-023-03530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Visceral adiposity has been associated with an increased risk of critical illness in COVID-19 patients. However, if it also associates to a poor survival is still not well established. The aim of the study was to assess the relationship between abdominal fat distribution and COVID-19 mortality. METHODS In this six-month longitudinal cohort study, abdominal visceral (VAT) and subcutaneous adipose tissues (SAT) were measured by computed tomography in a cohort of 174 patients admitted to the emergency department with a diagnosis of COVID-19, during the first wave of pandemic. The primary exposure and outcome measures were VAT and SAT at hospital admission, and death at 30 and 180 days, respectively. RESULTS Overall survival was not different according to VAT (p = 0.94), SAT (p = 0.32) and VAT/SAT ratio (p = 0.64). However, patients in the lowest SAT quartile (thickness ≤ 11.25 mm) had a significantly reduced survival compared to those with thicker SAT (77 vs. 94% at day 30; 74 vs. 91% at day 180, p = 0.01). Similarly, a thinner SAT was associated with lower survival in Intensive Care Unit (ICU) admitted patients, independently of sex or age (p = 0.02). The VAT/SAT ratio showed a non-linear increased risk of ICU admission, which plateaued out and tended for inversion at values greater than 1.9 (p = 0.001), although was not associated with increased mortality rate. CONCLUSIONS In our cohort, visceral adiposity did not increase mortality in patients with COVID-19, but low SAT may be associated with poor survival.
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Affiliation(s)
- Sofia Battisti
- Radiology Department, AUSL Romagna M. Bufalini Hospital, Cesena, Italy
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Alma Mater Studiorum-Università di Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Pedone
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Geriatrics, Rome, Italy
| | - Flavia Tramontana
- Department of Medicine and Surgery, Research Unit of Endocrinology & Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Nicola Napoli
- Department of Medicine and Surgery, Research Unit of Endocrinology & Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Ghadeer Alhamar
- Department of Medicine and Surgery, Research Unit of Endocrinology & Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Emanuele Russo
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Elisa Paolucci
- Internal Medicine Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Mario Galgani
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy
- Institute for Endocrinology and Experimental Oncology "G. Salvatore", Consiglio Nazionale delle Ricerche (C.N.R.), Naples, Italy
| | | | - Annalisa Paviglianiti
- Department of Medicine and Surgery, Research Unit of Endocrinology & Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, 08908, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08908, Barcelona, Spain
| | - Rocky Strollo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Piñana JL, Tridello G, Xhaard A, Wendel L, Montoro J, Vazquez L, Heras I, Ljungman P, Mikulska M, Salmenniemi U, Perez A, Kröger N, Cornelissen J, Sala E, Martino R, Geurten C, Byrne J, Maertens J, Kerre T, Martin M, Pascual MJ, Yeshurun M, Finke J, Groll AH, Shaw PJ, Blijlevens N, Arcese W, Ganser A, Suarez-Lledo M, Alzahrani M, Choi G, Forcade E, Paviglianiti A, Solano C, Wachowiak J, Zuckerman T, Bader P, Clausen J, Mayer J, Schroyens W, Metafuni E, Knelange N, Averbuch D, de la Camara R. Upper and/or Lower Respiratory Tract Infection Caused by Human Metapneumovirus After Allogeneic Hematopoietic Stem Cell Transplantation. J Infect Dis 2024; 229:83-94. [PMID: 37440459 DOI: 10.1093/infdis/jiad268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Human metapneumovirus (hMPV) epidemiology, clinical characteristics and risk factors for poor outcome after allogeneic stem cell transplantation (allo-HCT) remain a poorly investigated area. METHODS This retrospective multicenter cohort study examined the epidemiology, clinical characteristics, and risk factors for poor outcomes associated with human metapneumovirus (hMPV) infections in recipients of allo-HCT. RESULTS We included 428 allo-HCT recipients who developed 438 hMPV infection episodes between January 2012 and January 2019. Most recipients were adults (93%). hMPV infections were diagnosed at a median of 373 days after allo-HCT. The infections were categorized as upper respiratory tract disease (URTD) or lower respiratory tract disease (LRTD), with 60% and 40% of cases, respectively. Patients with hMPV LRTD experienced the infection earlier in the transplant course and had higher rates of lymphopenia, neutropenia, corticosteroid use, and ribavirin therapy. Multivariate analysis identified lymphopenia and corticosteroid use (>30 mg/d) as independent risk factors for LRTD occurrence. The overall mortality at day 30 after hMPV detection was 2% for URTD, 12% for possible LRTD, and 21% for proven LRTD. Lymphopenia was the only independent risk factor associated with day 30 mortality in LRTD cases. CONCLUSIONS These findings highlight the significance of lymphopenia and corticosteroid use in the development and severity of hMPV infections after allo-HCT, with lymphopenia being a predictor of higher mortality in LRTD cases.
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Affiliation(s)
- Jose Luis Piñana
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
| | - Gloria Tridello
- Azienda Ospedaliera, Universitaria Integrata Verona, Verona, Italy
| | - Aliénor Xhaard
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, Université Paris-Diderot, Paris, France
| | - Lotus Wendel
- Leiden Study Unit, EBMT, Leiden, The Netherlands
| | - Juan Montoro
- Hematology División, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lourdes Vazquez
- Hematology Department, Hospital Clinico Universitario de Salamanca, Salamanca, Spain
| | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Dipartimento di scienze della salute, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Urpu Salmenniemi
- Hematology Department, Comprehensive Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Ariadna Perez
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
| | - Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Cornelissen
- Hematology Department, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Elisa Sala
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Claire Geurten
- Hematology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
- Centre Hospitalier Universitaire de Liege, Liege, Belgium
| | - Jenny Byrne
- Hematology Department, Nottingham University, Nottingham, United Kingdom
| | - Johan Maertens
- Hematology Department, University Hospital Gasthuisberg, Leuven, Belgium
| | - Tessa Kerre
- Hematology Department, Ghent University Hospital, Gent, Belgium
| | - Murray Martin
- Hematology Department, Leicester Royal Infirmary, Leicester, United Kingdom
| | | | - Moshe Yeshurun
- Institution of Hematology, Rabin Medical Center, Petach-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jürgen Finke
- Hematology Department, University of Freiburg, Freiburg, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Department of Pediatric Hemtology and Oncology and Center for Bone Marrow Transplantation, University Children's Hospital, Muenster, Germany
| | - Peter J Shaw
- The Children`s Hospital at Westmead, Sydney, Australia
| | | | - William Arcese
- Hematology Department, Tor Vergata University of Rome, Rome, Italy
| | | | | | - Mohsen Alzahrani
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Goda Choi
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | | | - Carlos Solano
- Hematology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria, Hospital Clínico, Universitario de Valencia, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology, and Hematopoietic Cell Transplantation, University of Medical Sciences, Poznan, Poland
| | | | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Pediatrics and Adolescent Medicine, University Hospital, Goethe University, Frankfurt, Germany
| | - Johannes Clausen
- Department of Internal Medicine I, Ordensklinikum Linz-Elisabethinen, Johannes Kepler University, Linz, Austria
| | - Jiri Mayer
- Masaryk University Hospital Brno, Brno, Czech Republic
| | | | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e EmatologiaGemelli Research Institute, Fondazione Policlinico Universitario Agostino Gemelli Research Institute, Roma, Italy
| | | | - Dina Averbuch
- Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Rafael de la Camara
- Hematology Department, Hospital de la Princesa, Madrid, Spain
- Hematology Department, Hospital Universitario Sanitas La Zarzuela, Madrid, Spain
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6
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Peña M, Montané C, Paviglianiti A, Hurtado L, González S, Carro I, Maluquer C, Domingo-Domenech E, Gonzalez-Barca E, Sureda A, Mussetti A. Outcomes of allogeneic hematopoietic cell transplantation after bispecific antibodies in non-Hodgkin lymphomas. Bone Marrow Transplant 2023; 58:1282-1285. [PMID: 37626265 DOI: 10.1038/s41409-023-02069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Affiliation(s)
- M Peña
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - C Montané
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Paviglianiti
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - L Hurtado
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - S González
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - I Carro
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - C Maluquer
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - E Domingo-Domenech
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - E Gonzalez-Barca
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain
| | - A Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain
| | - A Mussetti
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
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7
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Fernandez-Sojo J, Valdivia E, Esquirol A, Portos JM, Rovira M, Suarez M, Diaz-de-Heredia C, Uría ML, Ortí G, Ferra C, Mussetti A, Paviglianiti A, Marsal J, Badell I, Lozano M, Gomez D, Azqueta C, Martorell L, Rubio N, Garcia-Buendia A, Villa J, Carreras E, Querol S. Development of an in-house bone marrow collection kit: The Catalan bone marrow transplantation group experience. Vox Sang 2023; 118:783-789. [PMID: 37533171 DOI: 10.1111/vox.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/28/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Bone marrow (BM) harvesting is one of the essential sources of stem cells for haematopoietic stem cell transplantation. In 2019, commercial BM collection kits became unavailable in Europe. Consequently, we created an in-house BM collection kit as an alternative. MATERIALS AND METHODS We compared two groups of BM collections. The first collections were taken using an in-house kit from June 2022 through February 2023 and the second with a commercial kit from February 2021 through May 2022. These all took place at seven collection centres (CC). We analysed the harvest quality (cell blood count, CD34+ cells, viability, potency and sterility), the incidents occurring with each kit and the time to neutrophil and platelet engraftment in recipients. RESULTS A total of 23 donors underwent BM harvesting with the in-house kit and 23 with the commercial one. Both cohorts were comparable regarding donor characteristics, CC and time to procedure. No statistical differences were found in harvest quality between the in-house and commercial kits. A new transfusion set was required in three BM harvests (13%) with the in-house kit because of filter clogging. The median time to neutrophil and platelet engraftment was 21 days for both cohorts and 29 days (in-house) and 33 days (commercial), p = 0.284, respectively. CONCLUSION The in-house BM collection kit offers a real approach to solve the diminished supply of commercial kits. A higher risk of filter clogging was observed compared with commercial kits due to the lack of 850 and 500 μm filters.
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Affiliation(s)
- Jesus Fernandez-Sojo
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
- Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Elena Valdivia
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Albert Esquirol
- Adult Haematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose-Manuel Portos
- Adult Haematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montse Rovira
- BMT Unit, Haematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Maria Suarez
- BMT Unit, Haematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Cristina Diaz-de-Heredia
- Paediatric Oncology and Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Maria-Luz Uría
- Paediatric Oncology and Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Guillermo Ortí
- Adult Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Christelle Ferra
- Adult Haematology Department, Institut Català d'Oncologia-Badalona, Barcelona, Spain
| | - Alberto Mussetti
- Adult Haematology Department, Institut Catala d'Oncologia-Hospitalet, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Annalisa Paviglianiti
- Adult Haematology Department, Institut Catala d'Oncologia-Hospitalet, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Julia Marsal
- Paediatric SCT Unit, Haematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Isabel Badell
- Paediatric Haematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Haemotherapy and Haemostasis ICMHO, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - David Gomez
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Carmen Azqueta
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Lluis Martorell
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Nuria Rubio
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Ana Garcia-Buendia
- Statistical Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Juliana Villa
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Enric Carreras
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Sergio Querol
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
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8
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Paviglianiti A, Rampi N. Advances and Clinical Outcomes in Hodgkin Lymphoma in the Era of Novel Therapies. J Clin Med 2023; 12:jcm12051928. [PMID: 36902715 PMCID: PMC10003903 DOI: 10.3390/jcm12051928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
Hodgkin lymphoma (HL) is traditionally considered one of the hematological malignancies with the highest rate of cure, ranging from 70 to 90% depending on the disease and patient features [...].
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Affiliation(s)
- Annalisa Paviglianiti
- Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, 08908 Barcelona, Spain
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), 08908 Barcelona, Spain
- Correspondence:
| | - Nicolò Rampi
- Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, 08908 Barcelona, Spain
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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9
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Chauvet P, Paviglianiti A, Labopin M, Labussière H, Boissel N, Robin M, Maillard N, Ouachée-Chardin M, Forcade E, Poiré X, Chantepie S, Huynh A, Bulabois CE, Leclerc M, Maury S, Chevallier P, Cluzeau T, Mear JB, Cornillon J, Bilger K, Simand C, Beguin Y, Rubio MT, Yakoub-Agha I, Brissot E. Combining blinatumomab and donor lymphocyte infusion in B-ALL patients relapsing after allogeneic hematopoietic cell transplantation: a study of the SFGM-TC. Bone Marrow Transplant 2023; 58:72-79. [PMID: 36261707 DOI: 10.1038/s41409-022-01846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 01/07/2023]
Abstract
Relapsed B-cell acute lymphoblastic leukemia (B-ALL) after allogeneic stem cell transplantation (allo-HCT) still represents a major concern with poor outcomes. The aim of this study is to compare the efficacy and safety of blinatumomab and donor lymphocyte infusion (DLI) versus blinatumomab alone in this setting. This is a multicenter retrospective study from centers of SFGM-TC. All transplanted patients who received blinatumomab salvage therapy were included. Patients who received DLI from 1 month before to 100 days after the starting of blinatumomab were included in the blina-DLI group. Seventy-two patients were included. Medium follow-up was 38 months. Fifty received blinatumomab alone and 22 the association blinatumomab-DLI. Two-year overall survival (OS) was 31% in the blinatumomab group and 43% in the blinatumomab-DLI group (p = 0.31). Studying DLI as a time dependent variable, PFS did not significantly differ between the 2 groups (HR:0.7, 95% CI: 0.4-1.5). In multivariate analysis, DLI was not a prognostic factor for OS, progression-free survival and progression/relapse incidence. Adverse events and graft-versus-disease rates were comparable in the 2 groups. In conclusion, adding DLI between 1 month before and 100 days after start of blinatumomab is safe and does not seem to improve outcomes in B-ALL patients who relapsed after allo-HCT.
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Affiliation(s)
- Paul Chauvet
- CHU de Lille, Maladies du Sang, Université de Lille, 59000, Lille, France.
| | - Annalisa Paviglianiti
- Sorbonne University, INSERM UMR-S 938, Saint-Antoine Research Centre, AP-PH, Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, Paris, France.,Institut Català d'Oncologia, Cell Transplant/Cell Therapy Unit, Barcelona, Spain
| | - Myriam Labopin
- Sorbonne University, INSERM UMR-S 938, Saint-Antoine Research Centre, AP-PH, Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, Paris, France
| | - Hélène Labussière
- Hospices Civils de Lyon, Lyon-Sud Hospital, Clinical Hematology, Pierre-Bénite, France
| | - Nicolas Boissel
- Université de Paris Cité, Institut de Recherche Saint-Louis, URP-3518, Assistance Publique-Hôpitaux de Paris, University Hospital Saint-Louis, 75010, Paris, France.,Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marie Robin
- Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | | | | | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | - Xavier Poiré
- Section of Hematology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Anne Huynh
- CHU - IUCT O, 31059, Toulouse, Toulouse, France
| | | | - Mathieu Leclerc
- Service d'Hématologie et de Thérapie Cellulaire, Hôpital Henri Mondor, Créteil, France
| | - Sébastien Maury
- Service d'Hématologie et de Thérapie Cellulaire, Hôpital Henri Mondor, Créteil, France
| | | | | | | | - Jérôme Cornillon
- Département d'Hématologie Clinique et de Thérapie Cellulaire, CHU de Saint Etienne, Saint-Priest-en-Jarez, France
| | - Karin Bilger
- Service d'Hématologie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Célestine Simand
- Service d'Hématologie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Yves Beguin
- Division of Haematology, Department of Medicine, University and CHU of Liège, Liège, Belgium
| | - Marie-Thérèse Rubio
- Service d'Hématologie, Hôpital Brabois, CHRU Nancy, Equipe 6 IMoPa, Biopole de L'université de Lorraine, CNRS UMR 7563, Nancy, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Maladies du Sang, Université de Lille, 59000, Lille, France.,CHU de Lille, université de Lille, Inserm U1286, Infinite, 59000, Lille, France
| | - Eolia Brissot
- Sorbonne University, INSERM UMR-S 938, Saint-Antoine Research Centre, AP-PH, Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, Paris, France.
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10
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Pantano F, Tramontana F, Iuliani M, Leanza G, Simonetti S, Piccoli A, Paviglianiti A, Cortellini A, Spinelli GP, Longo UG, Strollo R, Vincenzi B, Tonini G, Napoli N, Santini D. Changes in bone turnover markers in patients without bone metastases receiving immune checkpoint inhibitors: An exploratory analysis. J Bone Oncol 2022; 37:100459. [PMID: 36338920 PMCID: PMC9633734 DOI: 10.1016/j.jbo.2022.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are correlated with immune-related adverse events (irAEs) that may potentially affect all host tissues. The effects of ICIs on the skeleton are poorly investigated, thus we evaluated the changes of specific markers of bone resorption and formation. We found an increase of type I collagen C-terminal telopeptide (CTX-I) levels after 3 months of ICIs treatment with a concomitant reduction of N-terminal propeptide of type I procollagen (PINP) levels with a trend toward statistical significance. CTX-I increase was also associated with poor prognosis in terms of treatment response and survival.
Immune checkpoint inhibitors (ICIs) has revolutionized the treatment of different advanced solid tumors, but most patients develop severe immune-related adverse events (irAEs). Although a bi-directional crosstalk between bone and immune systems is widely described, the effect of ICIs on the skeleton is poorly investigated. Here, we analyze the changes in plasma levels of type I collagen C-terminal telopeptide (CTX-I) and N-terminal propeptide of type I procollagen (PINP), reference makers of bone turnover, in patients treated with ICIs and their association with clinical outcome. A series of 44 patients affected by advanced non-small cell lung cancer or renal cell carcinoma, without bone metastases, and treated with ICIs as monotherapy were enrolled. CTX-I and PINP plasma levels were assessed at baseline and after 3 months of ICIs treatment by ELISA kits. A significant increase of CTX-I with a concomitant decreasing trend towards the reduction of PINP was observed after 3 months of treatment. Intriguingly, CTX-I increase was associated with poor prognosis in terms of treatment response and survival. These data suggest a direct relationship between ICIs treatment, increased osteoclast activity and potential fracture risk. Overall, this study reveals that ICIs may act as triggers for skeletal events, and if confirmed in larger prospective studies, it would identify a new class of skeletal-related irAEs.
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Key Words
- APRIL, a proliferation-inducing ligand
- Bone health
- CT-scan, Computed Tomography Scan
- CTX-I, type I collagen C-Terminal telopeptide
- ECOG, Eastern Cooperative Oncology Group
- ELISA, Enzyme-Linked Immunosorbent Assay
- ICIs, Immune Checkpoint Inhibitors
- IFN-γ, Interferon-γ
- IL-6, Interleukin-6
- Immune checkpoint inhibitors (ICIs)
- N-terminal propeptide of type I procollagen (PINP)
- NSCLC, Non-Small Cell Lung Cancer
- OPG, Osteoprotegerin
- OS, Overall Survival
- PD-L1, Programmed cell Death Ligand 1
- PINP, N-terminal Propeptide of type I Procollagen
- RANKL, nuclear factor kappa-B ligand
- RCC, Renal Cell Carcinoma
- RECIST, Response Evaluation Criteria in Solid Tumors
- T0, Time 0
- T1, Time 1
- TNF-α, Tumor Necrosis Factor-α
- TTF, Time to Treatment Failure
- Th17, T helper 17
- Type I Collagen C-Terminal Telopeptide (CTX-I)
- irAEs, Immune-Related Adverse Events
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Affiliation(s)
- Francesco Pantano
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Flavia Tramontana
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Michele Iuliani
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy,Corresponding author.
| | - Giulia Leanza
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sonia Simonetti
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Alessandra Piccoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Annalisa Paviglianiti
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy,Hematology Department, Institut Català d’Oncologia Hospitalet, Barcelona, Spain,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Alessio Cortellini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gian Paolo Spinelli
- UOC Oncologia Universitaria, Sapienza University of Rome- Polo Pontino, Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocky Strollo
- Dipartimento di Scienze e Tecnologie per l'Uomo e l'Ambiente, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Bruno Vincenzi
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giuseppe Tonini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy,UOC Oncologia Universitaria, Sapienza University of Rome- Polo Pontino, Italy
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11
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Martino M, Pitino A, Gori M, Bruno B, Crescimanno A, Federico V, Picardi A, Tringali S, Ingrosso C, Carluccio P, Pastore D, Musuraca G, Paviglianiti A, Vacca A, Serio B, Storti G, Mordini N, Leotta S, Cimminiello M, Prezioso L, Loteta B, Ferreri A, Colasante F, Merla E, Giaccone L, Busca A, Musso M, Scalone R, Di Renzo N, Marotta S, Mazza P, Musto P, Attolico I, Selleri C, Canale FA, Pugliese M, Tripepi G, Porto G, Martinelli G, Carella AM, Cerchione C. Letermovir Prophylaxis for Cytomegalovirus Infection in Allogeneic Stem Cell Transplantation: A Real-World Experience. Front Oncol 2021; 11:740079. [PMID: 34616684 PMCID: PMC8489185 DOI: 10.3389/fonc.2021.740079] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
Despite effective treatments, cytomegalovirus (CMV) continues to have a significant impact on morbidity and mortality in allogeneic stem cell transplant (allo-SCT) recipients. This multicenter, retrospective, cohort study aimed to evaluate the reproducibility of the safety and efficacy of commercially available letermovir for CMV prophylaxis in a real-world setting. Endpoints were rates of clinically significant CMV infection (CSCI), defined as CMV disease or CMV viremia reactivation within day +100-+168. 204 adult CMV-seropositive allo-SCT recipients from 17 Italian centres (median age 52 years) were treated with LET 240 mg/day between day 0 and day +28. Overall, 28.9% of patients underwent a haploidentical, 32.4% a matched related, and 27.5% a matched unrelated donor (MUD) transplant. 65.7% were considered at high risk of CSCI and 65.2% had a CMV seropositive donor. Low to mild severe adverse events were observed in 40.7% of patients during treatment [gastrointestinal toxicity (36.3%) and skin rash (10.3%)]. Cumulative incidence of CSCI at day +100 and day +168 was 5.4% and 18.1%, respectively, whereas the Kaplan-Meier event rate was 5.8% (95% CI: 2.4-9.1) and 23.3% (95% CI: 16.3-29.7), respectively. Overall mortality was 6.4% at day +100 and 7.3% at day +168. This real-world experience confirms the efficacy and safety of CMV.
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Affiliation(s)
- Massimo Martino
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Annalisa Pitino
- Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche (CNR), Roma, Italy
| | - Mercedes Gori
- Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche (CNR), Roma, Italy
| | - Benedetto Bruno
- Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, AOU Città della Salute e della Scienza di Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Divisione di Ematologia, Università di Torino, Torino, Italy
| | | | - Vincenzo Federico
- Ematologia e Trapianto di Cellule Staminali, Polo Ospedaliero "Vito Fazzi", Lecce, Italy
| | - Alessandra Picardi
- UOC Ematologia con Trapianto CSE, AORN "Antonio Cardarelli", Napoli, Italy.,Dipartimento di Biomedicina e Prevenzione, Università di Roma Tor Vergata, Roma, Italy
| | | | - Claudia Ingrosso
- Ematologia e Trapianto di Midollo Osseo, Ospedale "San Giuseppe Moscati", Taranto, Italy
| | - Paola Carluccio
- UOC di Ematologia con Trapianto, Dipartimento di Emergenza e Trapianti d'Organo, Università degli Studi "Aldo Moro" e AOUC Policlinico di Bari, Bari, Italy
| | - Domenico Pastore
- Divisione di Ematologia, Ospedale "Antonio Perrino", Brindisi, Italy
| | - Gerardo Musuraca
- Unità di Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Annalisa Paviglianiti
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Adriana Vacca
- UO Ematologia - CTMO, Polo Ospedaliero "Armando Businco", Cagliari, Italy
| | - Bianca Serio
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, Salerno, Italy
| | - Gabriella Storti
- Unità di Ematologia, Azienda Ospedaliera "San Giuseppe Moscati", Avellino, Italy
| | - Nicola Mordini
- SC Ematologia, Azienda Ospedaliera "S. Croce e Carle", Cuneo, Italy
| | - Salvatore Leotta
- Programma di Trapianto Emopoietico, Azienda Policlinico "Vittorio Emanuele", Catania, Italy
| | | | - Lucia Prezioso
- Ematologia e Centro Trapianti Midollo Osseo (CTMO), Dipartimento ad Attività Integrata Medicina Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Barbara Loteta
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Anna Ferreri
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Fabrizia Colasante
- Ospedale I.R.C.C.S. Casa Sollievo della Sofferenza - Centro Trapianti di Cellule Staminali, San Giovanni Rotondo, Italy
| | - Emanuela Merla
- Ospedale I.R.C.C.S. Casa Sollievo della Sofferenza - Centro Trapianti di Cellule Staminali, San Giovanni Rotondo, Italy
| | - Luisa Giaccone
- Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, AOU Città della Salute e della Scienza di Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Divisione di Ematologia, Università di Torino, Torino, Italy
| | - Alessandro Busca
- Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maurizio Musso
- Unità Operativa di Oncoematologia e TMO, Istituto "La Maddalena", Palermo, Italy
| | - Renato Scalone
- Unità Operativa di Oncoematologia e TMO, Istituto "La Maddalena", Palermo, Italy
| | - Nicola Di Renzo
- Ematologia e Trapianto di Cellule Staminali, Polo Ospedaliero "Vito Fazzi", Lecce, Italy
| | - Serena Marotta
- UOC Ematologia con Trapianto CSE, AORN "Antonio Cardarelli", Napoli, Italy
| | - Patrizio Mazza
- Ematologia e Trapianto di Midollo Osseo, Ospedale "San Giuseppe Moscati", Taranto, Italy
| | - Pellegrino Musto
- UOC di Ematologia con Trapianto, Dipartimento di Emergenza e Trapianti d'Organo, Università degli Studi "Aldo Moro" e AOUC Policlinico di Bari, Bari, Italy
| | - Immacolata Attolico
- UOC di Ematologia con Trapianto, Dipartimento di Emergenza e Trapianti d'Organo, Università degli Studi "Aldo Moro" e AOUC Policlinico di Bari, Bari, Italy
| | - Carmine Selleri
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, Salerno, Italy
| | - Filippo Antonio Canale
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Marta Pugliese
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giovanni Tripepi
- Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche (CNR), Reggio Calabria, Italy
| | - Gaetana Porto
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giovanni Martinelli
- Unità di Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Angelo Michele Carella
- Ospedale I.R.C.C.S. Casa Sollievo della Sofferenza - Centro Trapianti di Cellule Staminali, San Giovanni Rotondo, Italy
| | - Claudio Cerchione
- Unità di Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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12
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Paviglianiti A, Sestili S, Bianchessi A, Memoli M, Dulery R, Banet A, Van De Wyngaert Z, Belhocine R, Ledraa T, Malard F, Mohty M, Brissot E. Stable pulmonary function after haploidentical stem cell transplantation with post-transplant cyclophosphamide: a single center experience. Leuk Lymphoma 2021; 63:443-449. [PMID: 34587856 DOI: 10.1080/10428194.2021.1984460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prior studies have reported pulmonary function tests (PFT) before and after related and unrelated allogeneic hematopoietic stem cell transplantation (HSCT). However, limited data exist on the evaluation of lung function after haploidentical stem cell transplantation (HAPLO) with post-transplant cyclophosphamide (PTCY). We retrospectively reported the evaluation of PFTs at screening before HAPLO in 80 patients at 100 days and 1 year of follow-up. The proportion of surviving patients with available PFTs at 100 days and 1 year were 86% and 68%, respectively. During the follow-up period, four patients met the criteria for bronchiolitis obliterans syndrome and two for interstitial lung disease. Overall survival was 73% (95% CI 62-82%) at 2 years. We observed a significant reduction in diffusing capacity of the lungs for carbon monoxide (DLCO) corrected for the most recent hemoglobin concentration (DLCOc) at 100 days after HAPLO. However, an overall substantial stable pulmonary function was observed at 1 year.
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Affiliation(s)
- Annalisa Paviglianiti
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France.,University Campus Bio-Medico, Rome, Italy
| | - Simona Sestili
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Antonio Bianchessi
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France.,Department of Molecular Medicine, University of Pavia and Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mara Memoli
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France.,Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Remy Dulery
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Anne Banet
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Zoe Van De Wyngaert
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Ramdane Belhocine
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Tounes Ledraa
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Florent Malard
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Mohamad Mohty
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Eolia Brissot
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Paris, France
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13
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Mussetti A, Bosch Vilaseca A, Parody R, Paviglianiti A, Domingo-Domenech E, Sureda AM. Synchronizing the use of allogeneic hematopoietic cell transplantation in checkpoint blockade therapy for Hodgkin lymphoma. Expert Rev Hematol 2021; 14:809-818. [PMID: 34369849 DOI: 10.1080/17474086.2021.1965874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The use of checkpoint blockade therapy (CBT) has shown impressive results for the treatment of relapsed/refractory Hodgkin lymphoma (cHL). The impact of CBT depends on the reversal of an exhausted T-cell immune phenotype and a consequential increase in the immunological, anti-tumor effect derived from a patient's adaptive immunity. As most patients with classical Hodgkin lymphoma will relapse during or after this treatment, clinicians often provide consolidation with allogeneic hematopoietic cell transplantation (alloHCT) in fit patients. However, the mechanisms responsible for CBT efficacy can also be those that increase the risk of immunological complications after alloHCT. AREAS COVERED We carried out in-depth research on the current medical literature to report and discuss the mechanism of action of CBT within a cHL setting; clinical results of CBT in cHL setting pre-alloHCT and post-alloHCT; interactions between CBT and alloHCT; and further clinical considerations. EXPERT OPINION Checkpoint blockade therapy is an effective strategy for relapsed/refractory cHL. Its use is associated with higher immunological toxicities when administered before or after alloHCT. Whenever alloHCT is planned, clinicians should follow international recommendations such as using post-transplant cyclophosphamide GVHD prophylaxis.
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Affiliation(s)
- Alberto Mussetti
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Anna Bosch Vilaseca
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Rocío Parody
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Annalisa Paviglianiti
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Eva Domingo-Domenech
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Ana Maria Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
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14
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Mussetti A, Paviglianiti A, Parody R, Sureda A. Is Post-Transplant Cyclophosphamide the New Methotrexate? J Clin Med 2021; 10:3548. [PMID: 34441843 PMCID: PMC8397193 DOI: 10.3390/jcm10163548] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 01/05/2023] Open
Abstract
Introducing post-transplant, cyclophosphamide (PT-Cy) graft-versus-host disease (GVHD) prophylaxis in the setting of haploidentical donor transplantation has marked the most important advance in allogeneic hematopoietic cell transplantation (alloHCT) within the past 15 years. The efficacy of this procedure and its simple features have allowed for the significantly widespread application of alloHCT worldwide. Indeed, the procedure's effectiveness in reducing immunological complications in the haploidentical setting has even challenged the status quo use of calcineurin-inhibitor, methotrexate-based GVHD prophylaxis in the setting of HLA-identical donors. Currently, however, prospective clinical trials in support of PT-Cy-based GVHD prophylaxis in the HLA-matched setting are striving to resolve the matter of its potential role. This review will briefly report the overall outcomes of PT-Cy-based GVHD prophylaxis in the haploidentical setting and summarize results obtained in the HLA-identical field. We will present future perspectives at the end of the manuscript.
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Affiliation(s)
- Alberto Mussetti
- Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, 08908 Barcelona, Spain; (A.P.); (R.P.); (A.S.)
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Annalisa Paviglianiti
- Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, 08908 Barcelona, Spain; (A.P.); (R.P.); (A.S.)
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Rocio Parody
- Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, 08908 Barcelona, Spain; (A.P.); (R.P.); (A.S.)
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, 08908 Barcelona, Spain; (A.P.); (R.P.); (A.S.)
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), 08908 Barcelona, Spain
- Medicine Department, Universitat de Barcelona (UB), 08007 Barcelona, Spain
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15
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Loteta B, Paviglianiti A, Naso V, Ferreri A, Moscato T, Console G, Canale FA, Irrera G, Pugliese M, Di Costanzo A, Provenzano PF, Loddo V, Porto G, Cusumano G, Russo L, Meliambro N, Romeo V, Porcino D, Gallo S, Gangemi T, Rossetti AM, Martino M. Netupitant/palonosetron without dexamethasone for preventing nausea and vomiting in patients with multiple myeloma receiving high-dose melphalan for autologous stem cell transplantation: a single-center experience. Support Care Cancer 2021; 30:585-591. [PMID: 34347181 PMCID: PMC8331991 DOI: 10.1007/s00520-021-06472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is one of the most frequent adverse events compromising quality of life (QoL) in patients undergoing autologous stem cell transplantation (ASCT). However, CINV prophylaxis is still lacking uniformity for high-dose melphalan (HDM), which is used to condition patients with multiple myeloma (MM). Netupitant/palonosetron (NEPA) is administered with dexamethasone (DEXA) for CINV prevention in several chemotherapy regimens. Our study aims to assess the efficacy of NEPA, without DEXA, in preventing CINV in 106 adult patients with MM receiving HDM and ASCT. All patients had antiemetic prophylaxis with multiple doses of NEPA 1 h before the start of conditioning and after 72 h and 120 h. A complete response (CR) was observed in 99 (93%) patients at 120 h (overall phase). The percentage of patients with complete control was 93%. The CR rate during the acute phase was 94% (n = 100). During the delayed phase, the CR rate was 95% (n = 101). Grade 1 nausea and vomiting were experienced by 82% and 12% of the patients, respectively. Grade 2 nausea was reported in 18% and vomiting in 10% of patients. Our results showed, for the first time, that NEPA, without DEXA, was a well-tolerated and effective antiemetic option for MM patients receiving HDM followed by ASCT.
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Affiliation(s)
- Barbara Loteta
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Virginia Naso
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Anna Ferreri
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Tiziana Moscato
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Giuseppe Console
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Filippo Antonio Canale
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Giuseppe Irrera
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Marta Pugliese
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | | | - Pasquale Fabio Provenzano
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Viviana Loddo
- Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetana Porto
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Giuseppa Cusumano
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Letteria Russo
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Nicola Meliambro
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Valentina Romeo
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Domenico Porcino
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Salvatore Gallo
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Tiziana Gangemi
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Antonio Maria Rossetti
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy
| | - Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Viale Europa, 89133, Reggio Calabria, Italy.
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16
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Abstract
Introduction: B-cell maturation antigen (BCMA) targeted therapy (BCMA-TT) has emerged as a promising treatment for Multiple Myeloma (MM). the three most common treatment modalities for targeting BCMA are antibody-drug conjugates (ADCs), bispecific antibody constructs, including BiTE (bispecific T-cell engager) immuno-oncology therapies, and chimeric antigen receptor (CAR)-modified T-cell therapy.Areas covered: The review provides an overview of the main published studies on clinical and pre-clinical data from trials using BCMA-TT.Expert opinion: Despite progresses in survival outcomes and the availability of new drugs, MM remains an incurable disease. ADC is a promising antibody-based treatment and Belantamab mafodotin showed an anti-myeloma effect alone or in combination with other drugs. The major issue of ADC is the occurrence of events interfering with the efficacy and the off-target cytotoxicity. Bispecific antibody constructs are off-the-shelf therapies characterized by a potential rapid availability. The most critical limitation of bispecific antibody constructs is their short half-life necessitating prolonged intravenous infusion. CAR-T cells produced unprecedented results in heavily pretreated RRMM. The most common toxicities include neurologic toxicity and cytokine release syndrome, B-cell aplasia, cytopenias, and hypogammaglobulinemia. Further studies are needed to detect which are the eligible patients who could benefit from one treatment more than another.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
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17
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Martino M, Pitino A, Tripepi G, Paviglianiti A, Russo L, Cusumano G, Rossetti A, Provenzano PF, Porto G, Meliambro N, Gallo S, Porcino D, Romeo V, Gangemi T, D'Arrigo G, Imbalzano L, Console G, Gori M. The Burden in Caregivers of Multiple Myeloma Patients Undergoing Outpatient Autologous Stem-Cell Transplantation Compared to Inpatient Transplantation. Clin Lymphoma Myeloma Leuk 2020; 21:e402-e409. [PMID: 33288484 DOI: 10.1016/j.clml.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The application of different models of autologous stem-cell transplantation (ASCT) in multiple myeloma has demonstrated the feasibility and safety of outpatient-based programs of care. Although several systematic reviews have evaluated the burden of caregivers, only a few studies have included outpatient ASCT. PATIENTS AND METHODS The feelings of lack of family support, daily activities, and general health were compared between caregivers of 2 groups of patients with multiple myeloma who underwent inpatient (n = 71) or outpatient (n = 25) ASCT. RESULTS The 3 features did not significantly differ between the 2 study groups at baseline, before, and 3 months after ASCT. Multivariate modeling showed that the baseline values were significantly related to the changes in study outcomes independent of patient and caregiver characteristics. Other correlates were caregivers' work and patient age for impact on daily activities and disease burden across time for impact on general health (all P < .05). CONCLUSION The outpatient model neither improves nor impairs global caregivers' burden compared to standard ASCT care. Further research is needed to confirm this observation and to better assess the burden and quality of life of caregivers and their influence on patient outcomes and quality of life.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
| | | | - Giovanni Tripepi
- CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Letteria Russo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuseppa Cusumano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Antonio Rossetti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Pasquale Fabio Provenzano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Gaetana Porto
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Nicola Meliambro
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Salvatore Gallo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Domenico Porcino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Valentina Romeo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Tiziana Gangemi
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | - Lucrezia Imbalzano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuseppe Console
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
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18
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Martino M, Paviglianiti A, Memoli M, Martinelli G, Cerchione C. Multiple Myeloma Outpatient Transplant Program in the Era of Novel Agents: State-of-the-Art. Front Oncol 2020; 10:592487. [PMID: 33262948 PMCID: PMC7686536 DOI: 10.3389/fonc.2020.592487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023] Open
Abstract
Multiple myeloma (MM) is the most common indication for autologous stem cell transplantation (ASCT), and outpatient models have been widely developed in this setting. Although numerous studies have demonstrated the safety and feasibility of outpatient ASCT, it is not a routine procedure. Stringent guidelines for patient selection and clinical management, including functional status, caregiver support, and psychological aspects, are essential to identify eligible patients. However, there is still no general agreement on these criteria. Quality of life data are limited and contradictory. There is considerable variability in outpatient transplant models, and there are no randomised studies supporting the use of one over the other. Studies evaluating results in terms of long-term survival, transplant toxicity in comparison with a standard approach are lacking. The procedure is cost-effective within the context of a hospital budget, but an in-depth analysis of the real cost of these programmes has yet to be performed.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Mara Memoli
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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19
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Paviglianiti A, Labopin M, Blaise D, Socié G, Bulabois CE, Lioure B, Ceballos P, Blau IW, Guillerm G, Maertens J, Chevallier P, Huynh A, Turlure P, Deconinck E, Forcade E, Nagler A, Mohty M. Comparison of mycophenolate mofetil and calcineurin inhibitor versus calcineurin inhibitor-based graft-versus-host-disease prophylaxis for matched unrelated donor transplant in acute myeloid leukemia. A study from the ALWP of the EBMT. Bone Marrow Transplant 2020; 56:1077-1085. [PMID: 33249424 DOI: 10.1038/s41409-020-01155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/13/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022]
Abstract
The association of Cyclosporine A (CsA) and mycophenolate mofetil (MMF) has increased in the setting of reduced intensity conditioning (RIC). Nevertheless, the use of CsA or CsA+MMF has not been reported in a large and uniform cohort. We analyzed 497 patients with acute myeloid leukemia in complete remission (CR) who underwent matched unrelated donor (MUD) hematopoietic stem cell transplantation (HSCT). All patients received a fludarabine busulfan RIC regimen and anti-thymocyte globulin (ATG) with either CsA alone or in combination with MMF. The cumulative incidence (CI) of grade II-IV acute GvHD was 27% (95% CI 21-33%) for CsA and 33% (95% CI 27-38%) for CsA+MMF (p = 0.25). The 2-year CI of chronic GvHD was 38% (95% CI 31-45%) and 33% (95% CI 28-39%) for the CsA and the CsA+MMF group, respectively (p = 0.26). On multivariate analysis, no statistically significant differences with respect to relapse incidence (RI), non-relapse mortality (NRM), leukemia-free survival (LFS), overall survival (OS), acute and chronic GvHD were found between the two groups, also when conducting a subgroup analysis in peripheral blood stem cells (PBSC) recipients. Our results support the importance of randomized trial to identify patients who could benefit from the addition of MMF in MUD HSCT.
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Affiliation(s)
- Annalisa Paviglianiti
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France.
| | - Myriam Labopin
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France
| | - Didier Blaise
- Programme de Transplantation & Thérapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Gerard Socié
- Hopital St. Louis, Department of Hematology - BMT, Paris, France
| | - Claude Eric Bulabois
- CHU Grenoble Alpes - Université Grenoble Alpes, Service d'Hématologie, Grenoble, France
| | - Bruno Lioure
- Hopital de Hautepierre, CHU de Strasbourg, Service Hématologie adulte, F-67200, Strasbourg, France
| | - Patrice Ceballos
- CHU Lapeyronie, Département d'Hématologie Clinique, Montpellier, France
| | - Igor Wolfgang Blau
- Charité Universitaetsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Hämatologie/Onkologie, Berlin, Germany
| | | | - Johan Maertens
- University Hospital Gasthuisberg, Department of Hematology, Leuven, Belgium
| | | | - Anne Huynh
- CHU - Institut Universitaire du Cancer Toulouse, Oncopole, I.U.C.T-O, Toulouse, France
| | - Pascal Turlure
- CHRU Limoges Service d'Hématologie Clinique, Limoges, France
| | - Eric Deconinck
- Hopital Jean Minjoz, Service d'Hématologie, Besancon, France
| | - Edouard Forcade
- CHU Bordeaux, Service d'hematologie et thérapie Cellulaire, F-, 33000, Bordeaux, France
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel-Aviv, Israel.,Acute Leukemia Working Party Office, Paris, France
| | - Mohamad Mohty
- Sorbonne University, Service d'Hématologie Clinique et Thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France
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20
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Memoli M, Paviglianiti A, Malard F, Battipaglia G, Brissot E, Médiavilla C, Bianchessi A, Banet A, Van de Wyngaert Z, Ledraa T, Belhocine R, Sestili S, Lapusan S, Hirsch P, Favale F, Boussaroque A, Bonnin A, Vekhoff A, Legrand O, Mohty M, Duléry R. Thiotepa-busulfan-fludarabine as a conditioning regimen for patients with myelofibrosis undergoing allogeneic hematopoietic transplantation: a single center experience. Leuk Lymphoma 2020; 62:419-427. [DOI: 10.1080/10428194.2020.1827246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Mara Memoli
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Annalisa Paviglianiti
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Florent Malard
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Giorgia Battipaglia
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Eolia Brissot
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Clémence Médiavilla
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Antonio Bianchessi
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Anne Banet
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Zoé Van de Wyngaert
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Tounes Ledraa
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Ramdane Belhocine
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Simona Sestili
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Simona Lapusan
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Pierre Hirsch
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
- AP-HP, Service d'Hématologie biologique, Hôpital Saint Antoine, Paris, France
| | - Fabrizia Favale
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
- AP-HP, Service d'Hématologie biologique, Hôpital Saint Antoine, Paris, France
| | - Agathe Boussaroque
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
- AP-HP, Service d'Hématologie biologique, Hôpital Saint Antoine, Paris, France
| | - Agnès Bonnin
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Anne Vekhoff
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Ollivier Legrand
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Mohamad Mohty
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Rémy Duléry
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
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21
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Stocker N, Gaugler B, Labopin M, Farge A, Ye Y, Ricard L, Brissot E, Duléry R, Sestili S, Battipaglia G, Médiavilla C, Paviglianiti A, Banet A, Van De Wyngaert Z, Ledraa T, Mohty M, Malard F. High-dose post-transplant cyclophosphamide impairs γδ T-cell reconstitution after haploidentical haematopoietic stem cell transplantation using low-dose antithymocyte globulin and peripheral blood stem cell graft. Clin Transl Immunology 2020; 9:e1171. [PMID: 33005413 PMCID: PMC7511259 DOI: 10.1002/cti2.1171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/16/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives Haploidentical haematopoietic cell transplantation (Haplo‐HCT) using peripheral blood stem cell (PBSC) grafts and post‐transplant cyclophosphamide (PTCy) is being increasingly used; however, data on immunological reconstitution (IR) are still scarce. Methods This retrospective study evaluated T‐cell immunological reconstitution in 106 adult patients who underwent allogeneic haematopoietic cell transplantation for haematologic malignancies between 2013 and 2016. Results At D30, while conventional T cells reached similar median counts in Haplo‐HCT recipients (n = 19) and controls (n = 87), γδ and Vδ2+ T‐cell median counts were significantly lower in Haplo‐HCT recipients and it persists at least until D360 for Vδ2+ T cells. PTCy induces a significant reduction in early γδ and Vδ2+ T‐cell proliferation at D 7. At one year, the rate of increase in Epstein–Barr virus (EBV) viral load was significantly higher in Haplo‐HCT recipients as compared to controls (61% versus 34%, P = 0.02). In multivariate analysis, a higher γδ T‐cell count (> 4.63 μL−1) at D30 was the only independent parameter significantly associated with a reduced risk of increase in EBV viral load (RR 0.34; 95% CI, 0.15–0.76, P = 0.009). Conclusion Immunological reconstitution of γδ T cells is significantly delayed after Haplo‐HCT using PTCy and low‐dose ATG and is associated with an increased risk of increase in EBV viral load.
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Affiliation(s)
- Nicolas Stocker
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Béatrice Gaugler
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France
| | - Myriam Labopin
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France.,Acute Leukemia Working Party Paris Study Office European Society for Blood and Marrow Transplantation Paris France
| | - Agathe Farge
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France
| | - Yishan Ye
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Bone Marrow Transplantation Center The First Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
| | - Laure Ricard
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France
| | - Eolia Brissot
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Remy Duléry
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Simona Sestili
- Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Giorgia Battipaglia
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Clémence Médiavilla
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Annalisa Paviglianiti
- Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Anne Banet
- Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Zoe Van De Wyngaert
- Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Tounes Ledraa
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
| | - Mohamad Mohty
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France.,Acute Leukemia Working Party Paris Study Office European Society for Blood and Marrow Transplantation Paris France
| | - Florent Malard
- INSERM, Centre de Recherche Saint-Antoine (CRSA) Sorbonne Université Paris France.,Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint-Antoine, AP-HP Paris France
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22
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Martino M, Paviglianiti A, Gentile M, Martinelli G, Cerchione C. Allogenic stem cell transplantation in multiple myeloma: dead or alive and kicking? Panminerva Med 2020; 62:234-243. [PMID: 32955185 DOI: 10.23736/s0031-0808.20.04142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Multiple myeloma (MM) accounts for about 1.8% of all cancers and slightly over 17% of hematologic malignancies. Despite improvements in outcomes in recent years, currently, there is still no cure for this disease. Although allogeneic stem cell transplantation (Allo-SCT) is a potentially curative treatment, given the armamentarium of highly effective therapeutic options and a pipeline of novel agents, many opinion leaders sustain that there is no longer a role for this approach. Of note, several studies that did not include novel agents reported long-term molecular remissions, and possibly a cure, in a subset of patients after reduced-intensity conditioning/nonmyeloablative (RIC/NM) Allo-SCT. However, there are no current data supporting upfront Allo-SCT. Prospective trials combining the so-called "graft-versus-myeloma" effect and new drugs are an unmet medical need in high-risk patients. Early relapse after first-line treatment, which identifies patients with poor prognosis independently of other prognostic factors, could become a clinical indication.
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Affiliation(s)
- Massimo Martino
- Unit of Stem Cell Transplantation and Cellular Therapies, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Unit of Stem Cell Transplantation and Cellular Therapies, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | | | - Giovanni Martinelli
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Claudio Cerchione
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy -
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23
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Martino M, Naso V, Porto G, Paviglianiti A, Ferreri A, Loteta B, Moscato T, Console G, Gentile M, Rossi M, Provenzano PF, Gori M, Pitino AL, Morabito A, Tripepi G. Granisetron transdermal system and dexamethasone for the prevention of nausea and vomiting in multiple myeloma patients receiving chemo-mobilization: An observational real-world study of effectiveness and safety. Transfus Apher Sci 2020; 59:102911. [PMID: 32859502 DOI: 10.1016/j.transci.2020.102911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Cyclophosphamide (CY) in a dose of 2-4 g/m2 is widely used for hemopoietic progenitor stem cells mobilization. CY administration is associated with several adverse effects, including chemotherapy-induced nausea and vomiting (CINV). This study aimed to evaluate the efficacy and tolerability of granisetron transdermal system (GTDS) plus dexamethasone in the management of CINV in MM patients undergoing chemo-mobilization with CY. METHODS In this single-center, prospective, observational, real world study, GTDS plus dexamethasone was administered to MM patients receiving chemo-mobilization based on CY 2 g/m2 plus G-CSF in an outpatient setting. The rate of complete response was evaluated as the main outcome. Other outcomes were rate of complete control of CINV, incidence of nausea/vomiting of any grade and safety. RESULTS A total of 88 patients were enrolled. A complete response was achieved in 45.5 % of patients; among them, 39.77 % attained complete control of CINV. Nausea and vomiting never occurred in 34.1 % and 45.5 % of patients, respectively. No episodes of grade 3-4 nausea and/or vomiting were documented. GTDS was safe and well tolerated. CONCLUSION In real world, GTDS provided an innovative, effective, and well-tolerated control of CINV in MM patients after chemo-mobilization with CY. The study found out effectiveness of a non-invasive delivery system of antiemetic.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplantation and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
| | - Virginia Naso
- Stem Cell Transplantation and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Gaetana Porto
- Stem Cell Transplantation and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplantation and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Anna Ferreri
- Stem Cell Transplantation and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Barbara Loteta
- Stem Cell Transplantation and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Tiziana Moscato
- Stem Cell Transplantation and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuseppe Console
- Stem Cell Transplantation and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Massimo Gentile
- Hematology Unit, Department of Onco-Hematology, A.O. of Cosenza, Cosenza, Italy
| | - Marco Rossi
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Pasquale Fabio Provenzano
- Stem Cell Transplantation and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | | | - Antonella Morabito
- Pharmacy Unit, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giovanni Tripepi
- CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy
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24
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Genthon A, Brissot E, Malard F, van de Wyngaert Z, Bonnin A, Banet A, Marjanovic Z, Ikhlef S, Lapusan S, Sestili S, Corre E, Paviglianiti A, Adaeva R, 'Hammedi-Bouzina FM, Labopin M, Dulery R, Mohty M, Legrand O. Gemtuzumab Ozogamicin Combined With Intensive Chemotherapy in Patients With Acute Myeloid Leukemia Relapsing After Allogenic Stem Cell Transplantation. Clin Lymphoma Myeloma Leuk 2020; 20:791-796. [PMID: 32741743 DOI: 10.1016/j.clml.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND More than one-third of patients with acute myeloid leukemia (AML) will relapse after allogenic hematopoietic cell transplant (allo-HCT). The main challenge is to overcome disease resistance to achieve a new complete remission while avoiding excessive toxicity. Gemtuzumab ozogamicin (GO), a conjugate of calicheamicin linked to the humanized monoclonal anti-CD33 antibody, has been used for refractory or relapsed AML with promising response rates, but liver toxicity of GO has long been considered a limiting factor. PATIENTS AND METHODS We included 18 consecutive patients with AML relapsing after a first allo-HCT and treated with fractioned GO (fGO) and intensive chemotherapy. The median age was 40 years (range, 18-65). RESULTS The overall response rate was 72% (13/18), including 7 complete remissions. No death was attributed to treatment toxicity. The main liver toxicity was transient and consisted of transaminase level elevation and hyperbilirubinemia. No cases of veno-occlusive disease were observed after the GO treatment. From the time of salvage treatment initiation, 1- and 2-year OS rates were 54% (95% confidence interval, 28%-74%) and 42% (95% confidence interval, 19%-63%), respectively. CONCLUSIONS Our study suggests the feasibility, efficacy, and safety of an fGO-based salvage regimen combined with intensive chemotherapy in patients with CD33+ AML in the case of early relapse after an allo-HCT.
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Affiliation(s)
- Alexis Genthon
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France.
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Florent Malard
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Zoe van de Wyngaert
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Agnès Bonnin
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Anne Banet
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Zora Marjanovic
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Souhila Ikhlef
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Simona Lapusan
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Simona Sestili
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Elise Corre
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Annalisa Paviglianiti
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Rosa Adaeva
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Fella M 'Hammedi-Bouzina
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Myriam Labopin
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Rémy Dulery
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Mohamad Mohty
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Ollivier Legrand
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
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25
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Abstract
In the last decades, adults and pediatric obesity have become a major issue in developed countries. Considerable research has been conducted in patients with acute lymphoblastic (ALL) and myeloid leukemia (AML) with the aim of correlating body mass index (BMI) and outcomes in patients undergoing chemotherapy for hematological diseases. In adults, a high BMI has been associated with increased leukemia-related mortality. Whether a similar effect exists in the pediatric setting remains controversial. Some of the studies detailed in this review have reported no differences in outcomes according to BMI, whilst other reports have described higher treatment-related mortality, increased risk of relapse and death. Although the link between BMI and acute leukemia outcomes is controversial, a large number of studies describe poorer survival rates in children with AML or ALL with higher BMI. On the other hand, being underweight has been associated with higher treatment-related toxicity. Understanding more about the impact of BMI in pediatric leukemia is of utmost importance to provide prompt intervention and improve outcomes.
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Affiliation(s)
- Annalisa Paviglianiti
- Department of Hematology and Stem Cell Transplantation, Saint Antoine Hospital, AP-HP, Paris, France
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26
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Marini C, Brissot E, Bazarbachi A, Duléry R, Sestili S, Battipaglia G, Médiavilla C, Paviglianiti A, Belhocine R, Isnard F, Lapusan S, Adaeva R, Bannet A, van de Wiegert Z, Vekhoff A, Ledraa T, Legrand O, Labopin M, Bonnin A, Ruggeri A, Malard F, Mohty M. Tolerability and Efficacy of Treatment With Azacytidine as Prophylactic or Preemptive Therapy for Myeloid Neoplasms After Allogeneic Stem Cell Transplantation. Clinical Lymphoma Myeloma and Leukemia 2020; 20:377-382. [DOI: 10.1016/j.clml.2019.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/28/2022]
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27
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Sestili S, Eder S, Belhocine R, Dulery R, Battipaglia G, Brissot E, Mediavilla C, Banet A, van de Wyngaert Z, Paviglianiti A, Ledraa T, Bonin A, Mohty M, Malard F. Extracorporeal photopheresis as first-line strategy in the treatment of acute graft-versus-host disease after hematopoietic stem cell transplantation: A single-center experience. Cytotherapy 2020; 22:445-449. [PMID: 32434750 DOI: 10.1016/j.jcyt.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AIMS Corticosteroids are the standard first-line treatment for acute graft-versus-host disease (aGVHD), but they are associated with many complications, and less than half of patients have a sustained response. METHODS To improve outcomes, we performed a retrospective study to analyze the efficacy of the addition of extracorporeal photopheresis (ECP) to low-dose corticosteroids in 37 adult patients (median age, 57 years) with skin-predominant aGVHD (grade I, n = 17; grade II, n = 18; and grade III, n = 2). All patients received ECP in combination with 1 mg/kg prednisone (n = 26) or topical steroids (n = 11). RESULTS Overall response rate was 81% after a median of three ECP procedures (range, 2-8), including 22 complete responses (CR, 59%) and eight very good partial responses (VGPR, 22%). The 11 patients treated with topical corticosteroids achieved CR. Furthermore, 16 (62%) patients reached prednisone withdrawal at a median of 100 days (range, 42-174 days) after its initiation. Eighteen patients developed chronic GVHD (cGVHD); 11 of them (who were in CR of aGVHD) had a new-onset cGVHD, and seven experienced progressive cGVHD (five non-responding and two VGPR patients). A second-line immunosuppressive treatment was initiated in only five (14%) non-responding patients. With a median follow-up of 31 months (range, 6-57 months) 2-year overall survival and non-relapse mortality were 74% and 11%, respectively. CONCLUSIONS Overall, the combination of low-dose corticosteroids and ECP appear to be safe and effective for first-line treatment of skin predominant aGVHD.
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Affiliation(s)
- Simona Sestili
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Sandra Eder
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Ramdane Belhocine
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Remy Dulery
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Giorgia Battipaglia
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Eolia Brissot
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Clemence Mediavilla
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Anne Banet
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Zoe van de Wyngaert
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Annalisa Paviglianiti
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Tounes Ledraa
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Agnes Bonin
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France
| | - Mohamad Mohty
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Florent Malard
- APHP, Hôpital Saint Antoine, Service d'Hématologie Clinique et de Thérapie cellulaire, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
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28
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Paviglianiti A, Labopin M, Blaise D, Socié G, Bulabois CE, Lioure B, Fegueux N, Gerbitz A, Guillermin G, Maertens J, Chevallier P, Huynh A, Turlure P, Deconinck E, Forcade E, Nagler A, Mohty M. Calcineurin Inhibitor Alone or in Combination with Mycophenolate Mofetil for Graft-Versus-Host-Disease Prophylaxis in Patients with Acute Myeloid Leukemia Undergoing Transplantation from Matched Unrelated Donors: A Study from the ALWP of the EBMT. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paviglianiti A. Endocrine and Metabolic Disorders after Hematopoietic Cell Transplantation. Turk J Haematol 2019; 37:111-115. [PMID: 31876135 PMCID: PMC7236409 DOI: 10.4274/tjh.galenos.2019.2019.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Chemotherapy treatment and autologous and allogeneic cell transplantations are often complicated by the onset of metabolic and endocrine disorders. Autoimmune disorders, metabolic diseases, and hormonal dysfunctions are some of the endocrine complications observed during or after treatment with immunotherapy (mostly novel agents) and/or chemotherapy conditioning for transplantation. Although successful treatment of the underlying hematological condition often improves the dysfunction, endocrinopathies can have an impact on prognosis and are associated with poor survival; therefore, it is important to detect and treat them as early as possible. An increased incidence of cardiovascular diseases and metabolic syndrome has been observed after transplantation mostly in long-term survivors. In addition, chemotherapy and radiation along with the prolonged use of corticosteroids can contribute to the onset of thyroid and gonadal dysfunctions. The aim of this article is to describe metabolic dysfunctions occurring in patients who underwent allogeneic cell transplantation.
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Affiliation(s)
- Annalisa Paviglianiti
- Saint Antoine Hospital, Department of Hematology and Cell Therapy, AP-HP, Paris, France
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Stocker N, Duléry R, Battipaglia G, Brissot E, Médiavilla C, Sestili S, Paviglianiti A, Ledraa T, Mohty R, Bazarbachi A, Belhocine R, Vekhoff A, Ruggeri A, Mohty M, Malard F. Impact of cyclosporine A concentration on acute graft‐vs‐host disease incidence after haploidentical hematopoietic cell transplantation. Eur J Haematol 2019; 103:10-17. [DOI: 10.1111/ejh.13233] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Nicolas Stocker
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
| | - Remy Duléry
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | | | - Eolia Brissot
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Clémence Médiavilla
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Simona Sestili
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | | | - Tounes Ledraa
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Razan Mohty
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | | | - Ramdane Belhocine
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Anne Vekhoff
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Annalisa Ruggeri
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Mohamad Mohty
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Florent Malard
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
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31
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Ruggeri A, Paviglianiti A, Volt F, Kenzey C, Rafii H, Rocha V, Gluckman E. Endothelial and Circulating Progenitor Cells in Hematological Diseases and Allogeneic Hematopoietic Stem Cell Transplantation. Curr Med Chem 2019; 25:4535-4544. [PMID: 29022504 DOI: 10.2174/0929867324666171012110244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/23/2017] [Revised: 07/18/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Circulating endothelial cells (CECs), originated form endothelial progenitors (EPCs) are mature cells not associated with vessel walls and detached from the endothelium. Normally, they are present in insignificant amounts in the peripheral blood of healthy individuals. On the other hand, elevated CECs and EPCs levels have been reported in the peripheral blood of patients with different types of cancers and other diseases. OBJECTIVE This review aims to provide an overview on the characterization of CECs and EPCs, to describe isolation methods and to identify the potential role of these cells in hematological diseases and hematopoietic stem cell transplantation. METHODS We performed a detailed search of peer-reviewed literature using keywords related to CECs, EPCs, allogeneic hematopoietic stem cell transplantation, and hematological diseases (hemoglobinopathies, hodgkin and non-hodgkin lymphoma, acute leukemia, myeloproliferative syndromes, chronic lymphocytic leukemia). RESULTS CECs and EPCs are potential biomarkers for several clinical conditions involving endothelial turnover and remodeling, such as in hematological diseases. These cells may be involved in disease progression and in the neoplastic process. Moreover, CECs and EPCs are probably involved in endothelial damage which is a marker of several complications following allogeneic hematopoietic stem cell transplantation. CONCLUSION This review provides information about the role of CECs and EPCs in hematological malignancies and shows their implication in predicting disease activity as well as improving HSCT outcomes.
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Affiliation(s)
- Annalisa Ruggeri
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France
| | - Annalisa Paviglianiti
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Fernanda Volt
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Chantal Kenzey
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Hanadi Rafii
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Vanderson Rocha
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France
| | - Eliane Gluckman
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principality of Monaco
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Furtado-Silva JM, Paviglianiti A, Ruggeri A, Boelens JJ, Veys P, Ahmari AA, Zecca M, Locatelli F, Michel G, Volt F, Kenzey C, Sedlacek P, Rao K, Lankester A, Gluckman E, Rocha V. Risk factors affecting outcome of unrelated cord blood transplantation for children with familial haemophagocytic lymphohistiocytosis. Br J Haematol 2018; 184:397-404. [PMID: 30460979 DOI: 10.1111/bjh.15642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/17/2018] [Accepted: 08/24/2018] [Indexed: 11/27/2022]
Abstract
Allogeneic haematopoietic stem cell transplantation is still the only available curative option for Familial Haemophagocytic Lymphohistiocytosis (FHLH). Most studies report outcomes after bone marrow or peripheral blood stem cell transplantation. We analysed the outcomes of 118 children with FHLH undergoing single-unit umbilical cord blood transplantation performed from 1996 to 2014. Myeloablative conditioning regimen was given to 90% of the patients, and was mostly busulfan-based (n = 81, 76%), including anti-thymocyte globulin or alemtuzumab (n = 102, 86%). The cumulative incidence of Day 60 neutrophil engraftment was 85%; and that of non-relapse mortality and acute graft-versus-host disease (GvHD) was 21% and 33% at 100 days, respectively. The 6-year cumulative incidence of chronic GvHD was 17% and the 6-year probability of overall survival was 55%. In multivariate analysis, children receiving a graft with a total nucleated cell dose greater than 9·9 × 107 /kg had a better overall survival (hazard ratio [HR]: 0·49, 95% CI: 0·27-0·88, P = 0·02). Degree of human leucocyte antigen (HLA) matching was associated with improved disease-free survival (5/6 vs. 6/6 HR: 2·11, 95% confidence interval [CI]: 1·01-4·4, P = 0·05 and ≤4/6 vs. 6/6, HR: 2·82, CI: 1·27-6·23, P = 0·01). Umbilical cord blood transplantation with a high cell dose and good HLA match is a suitable alternative option to haematopoietic stem cell transplantation in children with FHLH who lack a HLA-matched donor.
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Affiliation(s)
| | - Annalisa Paviglianiti
- Eurocord, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Annalisa Ruggeri
- Eurocord, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Department of Paediatric Haematology and Oncology, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Bambino Gesù" Children's Hospital, Rome, Italy.,Department of Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Jaap Jan Boelens
- Paediatric Blood and Marrow Transplantation Programme, Paediatric Blood and Marrow Transplantation Programme University Hospital Utrecht, Utrecht, The Netherlands
| | - Paul Veys
- Bone Marrow Transplant Department, Great Ormond Street Hospital NHS Trust, London, UK
| | - Ali Abdallah Ahmari
- Department of Paediatric Haematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Marco Zecca
- Paediatric Haematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Locatelli
- Department of Paediatric Haematology and Oncology, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Bambino Gesù" Children's Hospital, Rome, Italy.,Department of Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Gerard Michel
- Department of Paediatric Haematology and Oncology, Hopital d'Enfants de la Timone, CHU, Marseille, France
| | - Fernanda Volt
- Eurocord, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Chantal Kenzey
- Eurocord, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Petr Sedlacek
- Department of Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Kanchan Rao
- Bone Marrow Transplant Department, Great Ormond Street Hospital NHS Trust, London, UK
| | - Arjan Lankester
- Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eliane Gluckman
- Eurocord, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Hôpital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Haematology, Transfusion and Cell therapy service, Universidade de São Paulo, São Paulo, Brazil.,Haematology Unit, Churchill Hospital, University of Oxford, Oxford, UK
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33
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Tozatto-Maio K, Giannotti F, Labopin M, Ruggeri A, Volt F, Paviglianiti A, Kenzey C, Hayashi H, Cornelissen J, Michallet M, Karakasis D, Deconinck E, Rohrlich PS, de la Tour RP, Blaise D, Petersen E, D'Aveni M, Sengeloev H, Lamy T, Russell NH, Forcade E, Craddock CF, Nagler A, Gluckman E, Rocha V. Cord Blood Unit Dominance Analysis and Effect of the Winning Unit on Outcomes after Double-Unit Umbilical Cord Blood Transplantation in Adults with Acute Leukemia: A Retrospective Study on Behalf of Eurocord, the Cord Blood Committee of Cellular Therapy, Immunobiology Working Party, and the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2018; 24:1657-1663. [DOI: 10.1016/j.bbmt.2018.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/10/2018] [Indexed: 12/22/2022]
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34
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Paviglianiti A, Tozatto Maio K, Rocha V, Gehlkopf E, Milpied N, Esquirol A, Chevallier P, Blaise D, Gac AC, Leblond V, Cahn JY, Abecasis M, Zuckerman T, Schouten H, Gurman G, Rubio MT, Beguin Y, Corral LL, Nagler A, Snowden JA, Koc Y, Mordini N, Bonifazi F, Volt F, Kenzey C, Robinson SP, Montoto S, Gluckman E, Ruggeri A. Outcomes of Advanced Hodgkin Lymphoma after Umbilical Cord Blood Transplantation: A Eurocord and EBMT Lymphoma and Cellular Therapy & Immunobiology Working Party Study. Biol Blood Marrow Transplant 2018; 24:2265-2270. [PMID: 30031070 DOI: 10.1016/j.bbmt.2018.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/18/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023]
Abstract
Allogeneic stem cell transplantation is an alternative for patients with relapsed or refractory Hodgkin lymphoma (HL), but only limited data on unrelated umbilical cord blood transplantation (UCBT) are available. We analyzed 131 adults with HL who underwent UCBT in European Society for Blood and Marrow Transplantation centers from 2003 to 2015. Disease status at UCBT was complete remission (CR) in 59 patients (47%), and almost all patients had received a previous autologous stem cell transplantation. The 4-year progression-free survival (PFS) and overall survival (OS) were 26% (95% confidence interval [CI], 19% to 34%) and 46% (95% CI, 37% to 55%), respectively. Relapse incidence was 44% (95% CI, 36% to 54%), and nonrelapse mortality (NRM) was 31% (95% CI, 23% to 40%) at 4 years. In multivariate analysis refractory/relapsed disease status at UCBT was associated with increased relapse incidence (hazard ratio [HR], 3.14 [95% CI, 1.41 to 7.00], P = .005) and NRM (HR, 3.61 [95% CI, 1.58 to 8.27], P = .002) and lower PFS (HR, 3.45 [95% CI, 1.95 to 6.10], P < .001) and OS (HR, 3.10 [95% CI, 1.60 to 5.99], P = .001). Conditioning regimen with cyclophosphamide + fludarabine + 2 Gy total body irradiation (Cy+Flu+2GyTBI) was associated with decreased risk of NRM (HR, .26 [95% CI, .10 to .64], P = .004). Moreover, Cy+Flu+2GyTBI conditioning regimen was associated with a better OS (HR, .25 [95% CI, .12 to .50], P < .001) and PFS (HR, .51 [95% CI, .27 to .96], P = .04). UCBT is feasible in heavily pretreated patients with HL. The reduced-intensity conditioning regimen with Cy+Flu+2GyTBI is associated with a better OS and NRM. However, outcomes are poor in patients not in CR at UCBT.
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Affiliation(s)
- Annalisa Paviglianiti
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Karina Tozatto Maio
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco; Department of Haematology, Hospital Sao Paulo, San Paulo, Brazil
| | - Eve Gehlkopf
- Service d'Hématologie, CHU Lapeyronie, Montpellier, France
| | - Noel Milpied
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Haut-leveque, CHU Bordeaux, Pessac, France
| | - Albert Esquirol
- Clinical Hematology Service, Hospital de la Santa Creu i Sant Pau, Jose Carreras Leukaemia Research Institute, Barcelona, Spain
| | | | - Didier Blaise
- Service d'Hématologie et thérapie cellulaire, Institute Paoli Calmettes, Marseille, France
| | | | | | - Jean Yves Cahn
- Hématologie Clinique, CHU Grenoble Alpes, Grenoble, France
| | | | - Tsila Zuckerman
- Department of Hematology and BMT, Rambam Medical Center, Haifa, Israel
| | - Harry Schouten
- Department of Internal Medicine, Hematology and Oncology, University Hospital Maastricht, Maastricht, Netherlands
| | - Gunhan Gurman
- Department of Hematology Adult Stem Cell Transplantation Unit, Ankara University, Ankara, Turkey
| | - Marie Thérèse Rubio
- Service d'Hematologie et Therapie Cellulaire, Hôpitaux des Brabois, Nancy, France
| | - Yves Beguin
- Department of Hematology, CHU of Liège and University of Liege, Liege, Belgium
| | - Lucia Lopez Corral
- Hematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Centro de Investigacion del Cancer-IBMCC, Salamanca, Spain
| | - Arnon Nagler
- Department of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Yener Koc
- Stem Cell Transplant Unit Medical Park Hospitals, Antalya, Turkey
| | - Nicola Mordini
- Division of Hematology, Az. Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Francesca Bonifazi
- Institute of Hematology, "Seragnoli" University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Fernanda Volt
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Chantal Kenzey
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | | | - Silvia Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, EBMT Lymphoma Working Party, London, United Kingdom
| | - Eliane Gluckman
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Annalisa Ruggeri
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco; Hematology Department, Ospedale Pediatrico Bambin Gesù, Dipartimento di Oncoematologia e Terapia Cellulare e Genica, Rome, Italy.
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van den Broek BTA, Page K, Paviglianiti A, Hol J, Allewelt H, Volt F, Michel G, Diaz MA, Bordon V, O'Brien T, Shaw PJ, Kenzey C, Al-Seraihy A, van Hasselt PM, Gennery AR, Gluckman E, Rocha V, Ruggeri A, Kurtzberg J, Boelens JJ. Early and late outcomes after cord blood transplantation for pediatric patients with inherited leukodystrophies. Blood Adv 2018; 2:49-60. [PMID: 29344584 PMCID: PMC5761624 DOI: 10.1182/bloodadvances.2017010645] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022] Open
Abstract
Leukodystrophies (LD) are devastating inherited disorders leading to rapid neurological deterioration and premature death. Hematopoietic stem cell transplantation (HSCT) can halt disease progression for selected LD. Cord blood is a common donor source for transplantation of these patients because it is rapidly available and can be used without full HLA matching. However, precise recommendations allowing care providers to identify patients who benefit from HSCT are lacking. In this study, we define risk factors and describe the early and late outcomes of 169 patients with globoid cell leukodystrophy, X-linked adrenoleukodystrophy, and metachromatic leukodystrophy undergoing cord blood transplantation (CBT) at an European Society for Blood and Marrow Transplantation center or at Duke University Medical Center from 1996 to 2013. Factors associated with higher overall survival (OS) included presymptomatic status (77% vs 49%; P = .006), well-matched (≤1 HLA mismatch) CB units (71% vs 54%; P = .009), and performance status (PS) of >80 vs <60 or 60 to 80 (69% vs 32% and 55%, respectively; P = .003). For patients with PS≤60 (n = 20) or 60 to 80 (n = 24) pre-CBT, only 4 (9%) showed improvement. Of the survivors with PS >80 pre-CBT, 50% remained stable, 20% declined to 60 to 80, and 30% to <60. Overall, an encouraging OS was found for LD patients after CBT, especially for those who are presymptomatic before CBT and received adequately dosed grafts. Early identification and fast referral to a specialized center may lead to earlier treatment and, subsequently, to improved outcomes.
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Affiliation(s)
- Brigitte T A van den Broek
- Blood and Marrow Transplantation Program
- Laboratory for Translational Immunology, and
- Sylvia Toth Center for Multidisciplinary Follow Up After Hematopoietic Cell Transplantation, UMC Utrecht, Utrecht, The Netherlands
| | - Kristin Page
- Pediatric Blood and Marrow Transplantation Program, Duke University Medical Center, Durham, NC
| | | | | | - Heather Allewelt
- Pediatric Blood and Marrow Transplantation Program, Duke University Medical Center, Durham, NC
| | | | | | | | - Victoria Bordon
- Blood and Marrow Transplantation Program, Universiteits Ziekenhuis Gent, Gent, Belgium
| | | | - Peter J Shaw
- Children's Hospital at Westmead, Sydney, Australia
| | | | - Amal Al-Seraihy
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Peter M van Hasselt
- Sylvia Toth Center for Multidisciplinary Follow Up After Hematopoietic Cell Transplantation, UMC Utrecht, Utrecht, The Netherlands
| | - Andrew R Gennery
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; and
| | | | | | | | | | - Jaap Jan Boelens
- Blood and Marrow Transplantation Program
- Laboratory for Translational Immunology, and
- Sylvia Toth Center for Multidisciplinary Follow Up After Hematopoietic Cell Transplantation, UMC Utrecht, Utrecht, The Netherlands
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36
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Paviglianiti A, Dalle JH, Ayas M, Boelens JJ, Volt F, Iori AP, de Souza MP, Diaz MA, Michel G, Locatelli F, Jubert C, Yakoub-Agha I, Bittencourt H, Bertrand Y, Kenzey C, Tozatto Maio K, Hayashi H, Rocha V, Bader P, Gluckman E, Ruggeri A. Low Body Mass Index Is Associated with Increased Risk of Acute GVHD after Umbilical Cord Blood Transplantation in Children and Young Adults with Acute Leukemia: A Study on Behalf of Eurocord and the EBMT Pediatric Disease Working Party. Biol Blood Marrow Transplant 2017; 24:799-805. [PMID: 29288817 DOI: 10.1016/j.bbmt.2017.12.790] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/19/2017] [Indexed: 01/19/2023]
Abstract
Body mass index (BMI) may influence outcomes after allogeneic hematopoietic stem cell transplantation (HSCT). However, the impact of BMI on survival in children undergoing HSCT is not well defined, with conflicting results being reported on this issue. We analyzed 855 patients age 2 to 20 years with diagnosis of acute leukemia who underwent umbilical cord blood transplantation (UCBT) from 1990 to 2015. Patients were classified according to BMI as normal (fifth to 85th percentile), underweight (less than fifth percentile), overweight (85th to 95th percentile), and obese (>95th percentile) using growth charts for age and sex. All patients received single-unit UCBT after a myeloablative conditioning regimen. Diagnosis was acute lymphoblastic leukemia in 68% of the patients. Sixty-one percent of patients (n = 523) were in the normal BMI category, 11% (n = 96) were underweight, 16% (n = 137) overweight, and 12% (n = 99) obese. The cumulative incidence of grade II to IV acute graft-versus-host disease (aGVHD) was 35% (32% to 38%). According to pretransplantation BMI, aGVHD was 46% (33% to 59%) for underweight, 34% (31% to 42%) for normal, 36% (18% to 38%) for overweight, and 27% (15% to 37%) for obese (P = .04). In multivariate analysis, a BMI less than the fifth percentile was associated with higher incidence of acute grade II to IV GVHD compared with normal-BMI patients (hazard ratio, 1.61; 95% confidence interval, 1.15 to 2.26; P = .006). Our results show that being underweight at the time of transplantation is associated with an increased risk of aGVHD, highlighting the importance of nutritional status before UCBT.
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Affiliation(s)
- Annalisa Paviglianiti
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco.
| | - Jean Hugues Dalle
- Pediatric Hematology Department, Hospital Robert Debré, Paris, Paris 7-Paris Diderot University, Paris, France
| | - Mouhab Ayas
- Pediatric Stem Cell Transplant, Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jan Jaap Boelens
- Department of Pediatrics, Pediatric Blood and Marrow Transplantation Program, University Medical Center, Utrecht, the Netherlands
| | - Fernanda Volt
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Anna Paola Iori
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Miguel Angel Diaz
- Stem Cell Transplant Unit, Hospital Universitario Niño Jesus, Madrid, Spain
| | - Gerard Michel
- Department of Pediatric Hematology and Oncology, Timone Enfants Hospital, APHM and Aix Marseille Université, Marseille, France
| | - Franco Locatelli
- Department of Paediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Bambino Gesù" Children's Hospital, Rome, Italy; Department of Pediatric Sciences, University of Pavia, Rome, Italy
| | - Charlotte Jubert
- Pediatric Hematology Department, Bordeaux-Hospital, Bordeaux University, Lille, France
| | | | - Henrique Bittencourt
- Department of Pediatrics, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Yves Bertrand
- Department of Child Hematology and Oncology, IHOP University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Chantal Kenzey
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Karina Tozatto Maio
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Hiromi Hayashi
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco; Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Eliane Gluckman
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Annalisa Ruggeri
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco; Hopital Saint Antoine, Service d'Hématologie et thérapie cellulaire, Paris, France
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Paviglianiti A, Ruggeri A, Volt F, Sanz G, Milpied N, Furst S, Esquirol A, Arcese W, Picardi A, Ferra C, Ifrah N, Bourhis JH, Raj K, von dem Borne PA, Sica S, Menard AL, Bloor A, Kenzey C, Gluckman E, Rocha V. Evaluation of a disease risk index for adult patients undergoing umbilical cord blood transplantation for haematological malignancies. Br J Haematol 2017; 179:790-801. [DOI: 10.1111/bjh.14962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Annalisa Paviglianiti
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
| | - Annalisa Ruggeri
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
- Service d'Hématologie et thérapie cellulaire; Hopital Saint Antoine; Paris France
| | - Fernanda Volt
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
| | - Guillermo Sanz
- Department of Haematology; Hospital Universitario La Fe; Valencia Spain
| | - Noel Milpied
- Service d'Hématologie et thérapie cellulaire; Bordeaux France
| | - Sabine Furst
- Service d'Hématologie et thérapie cellulaire; Institute Paoli Calmettes Marseille; Marseille France
| | - Albert Esquirol
- Clinical Haematology Service; Hospital de la Santa Creu i Sant Pau; Jose Carreras Leukaemia Research Institute; Barcelona Spain
| | - William Arcese
- Stem Cell Transplant Unit; Rome Transplant Network; Tor Vergata University; Rome Italy
| | - Alessandra Picardi
- Stem Cell Transplant Unit; Rome Transplant Network; Tor Vergata University; Rome Italy
| | | | - Norbert Ifrah
- Departement of Haematology; CHU Angers; Angers France
| | - Jean H. Bourhis
- Departement of Haematology; Institute Gustave Roussy; Paris France
| | - Kavita Raj
- Departement of Haematology; Kings Hospital & Guy Hospital; London UK
| | | | - Simona Sica
- Department of Haematology; Università Cattolica Sacro Cuore; Roma Italy
| | | | - Adrian Bloor
- Departement of Haematology; Christie NHS Trust Hospital; Manchester UK
| | - Chantal Kenzey
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
| | - Eliane Gluckman
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
| | - Vanderson Rocha
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
- Serviço de Hematologia; Hemoterapia e TerapiaCelular; Hospital das Clinicas; Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
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Eapen M, Wang T, Veys PA, Boelens JJ, St Martin A, Spellman S, Bonfim CS, Brady C, Cant AJ, Dalle JH, Davies SM, Freeman J, Hsu KC, Fleischhauer K, Kenzey C, Kurtzberg J, Michel G, Orchard PJ, Paviglianiti A, Rocha V, Veneris MR, Volt F, Wynn R, Lee SJ, Horowitz MM, Gluckman E, Ruggeri A. Allele-level HLA matching for umbilical cord blood transplantation for non-malignant diseases in children: a retrospective analysis. Lancet Haematol 2017. [PMID: 28623181 DOI: 10.1016/s2352-3026(17)30104-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The standard for selecting unrelated umbilical cord blood units for transplantation for non-malignant diseases relies on antigen-level (lower resolution) HLA typing for HLA-A and HLA-B, and allele-level for HLA-DRB1. We aimed to study the effects of allele-level matching at a higher resolution-HLA-A, HLA-B, HLA-C, and HLA-DRB1, which is the standard used for adult unrelated volunteer donor transplantation for non-malignant diseases-for umbilical cord blood transplantation. METHODS We retrospectively studied 1199 paediatric donor-recipient pairs with allele-level HLA matching who received a single unit umbilical cord blood transplantation for non-malignant diseases reported to the Center for International Blood and Marrow Transplant Research or Eurocord and European Group for Blood and Marrow Transplant. Transplantations occurred between Jan 1, 2000, and Dec 31, 2012. The primary outcome was overall survival. The effect of HLA matching on survival was studied using a Cox regression model. FINDINGS Compared with HLA-matched transplantations, mortality was higher with transplantations mismatched at two (hazard ratio [HR] 1·55, 95% CI 1·08-2·21, p=0·018), three (2·04, 1·44-2·89, p=0·0001), and four or more alleles (3·15, 2·16-4·58, p<0·0001). There were no significant differences in mortality between transplantations that were matched and mismatched at one allele (HR 1·18, 95% CI 0·80-1·72, p=0·39). Other factors associated with higher mortality included recipient cytomegalovirus seropositivity (HR 1·40, 95% CI 1·13-1·74, p=0·0020), reduced intensity compared with myeloablative conditioning regimens (HR 1·36, 1·10-1·68, p=0·0041), transplantation of units with total nucleated cell dose of more than 21 × 107 cells per kg compared with 21 × 107 cells per kg or less (HR 1·47, 1·11-1·95, p=0·0076), and transplantations done in 2000-05 compared with those done in 2006-12 (HR 1·64, 1·31-2·04, p<0·0001). The 5-year overall survival adjusted for recipient cytomegalovirus serostatus, conditioning regimen intensity, total nucleated cell dose, and transplantation period was 79% (95% CI 74-85) after HLA matched, 76% (71-81) after one allele mismatched, 70% (65-75) after two alleles mismatched, 62% (57-68) after three alleles mismatched, and 49% (41-57) after four or more alleles mismatched transplantations. Graft failure was the predominant cause of mortality. INTERPRETATION These data support a change from current practice in that selection of unrelated umbilical cord blood units for transplantation for non-malignant diseases should consider allele-level HLA matching at HLA-A, HLA-B, HLA-C, and HLA-DRB1. FUNDING National Cancer Institute; National Heart, Lung, and Blood Institute; National Institute for Allergy and Infectious Diseases; US Department of Health and Human Services-Health Resources and Services Administration; and US Department of Navy.
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Affiliation(s)
- Mary Eapen
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Tao Wang
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul A Veys
- Bone Marrow Transplantation Department, Great Ormond Street Hospital, London, UK
| | - Jaap J Boelens
- Paediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands
| | - Andrew St Martin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Andrew J Cant
- Paediatric Immunology and Infection, Newcastle General Hospital, Newcastle-upon-Tyne, UK
| | - Jean-Hugues Dalle
- Paediatric Haematology Department, Hôpital Robert Debre, Paris, France
| | - Stella M Davies
- Department of Paediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - John Freeman
- National Marrow Donor Program, Minneapolis, MN, USA
| | - Katherine C Hsu
- Department of Medicine, Memorial Sloane Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Gerard Michel
- Department of Paediatrics and Paediatric Haematology, University Hospital of Marseille, Marseille, France
| | - Paul J Orchard
- Department of Paediatrics, University of Minnesota, Minneapolis, MN, USA
| | | | - Vanderson Rocha
- Oxford Cancer and Haematology Center, Churchill Hospital, Oxford, UK
| | | | | | - Robert Wynn
- Pediatric Haematology, Central Manchester University Hospitals, Manchester, UK
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mary M Horowitz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Annalisa Ruggeri
- Service d'Haematologie et Therapie Cellulaire, Hôpital Saint Antoine, Paris, France
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Rafii H, Bernaudin F, Rouard H, Vanneaux V, Ruggeri A, Cavazzana M, Gauthereau V, Stanislas A, Benkerrou M, De Montalembert M, Ferry C, Girot R, Arnaud C, Kamdem A, Gour J, Touboul C, Cras A, Kuentz M, Rieux C, Volt F, Cappelli B, Maio KT, Paviglianiti A, Kenzey C, Larghero J, Gluckman E. Family cord blood banking for sickle cell disease: a twenty-year experience in two dedicated public cord blood banks. Haematologica 2017; 102:976-983. [PMID: 28302713 PMCID: PMC5451329 DOI: 10.3324/haematol.2016.163055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/10/2017] [Indexed: 11/16/2022] Open
Abstract
Efforts to implement family cord blood banking have been developed in the past decades for siblings requiring stem cell transplantation for conditions such as sickle cell disease. However, public banks are faced with challenging decisions about the units to be stored, discarded, or used for other endeavors. We report here 20 years of experience in family cord blood banking for sickle cell disease in two dedicated public banks. Participants were pregnant women who had a previous child diagnosed with homozygous sickle cell disease. Participation was voluntary and free of charge. All mothers underwent mandatory serological screening. Cord blood units were collected in different hospitals, but processed and stored in two public banks. A total of 338 units were stored for 302 families. Median recipient age was six years (11 months-15 years). Median collected volume and total nucleated cell count were 91 mL (range 23-230) and 8.6×108 (range 0.7-75×108), respectively. Microbial contamination was observed in 3.5% (n=12), positive hepatitis B serology in 25% (n=84), and homozygous sickle cell disease in 11% (n=37) of the collections. Forty-four units were HLA-identical to the intended recipient, and 28 units were released for transplantation either alone (n=23) or in combination with the bone marrow from the same donor (n=5), reflecting a utilization rate of 8%. Engraftment rate was 96% with 100% survival. Family cord blood banking yields good quality units for sibling transplantation. More comprehensive banking based on close collaboration among banks, clinical and transplant teams is recommended to optimize the use of these units.
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Affiliation(s)
- Hanadi Rafii
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Françoise Bernaudin
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Paris XII University, Créteil, France
| | - Helene Rouard
- Cell Therapy Facility, EFS Ile de France, Créteil, France
| | - Valérie Vanneaux
- Cell Therapy Facility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Paris-Diderot University, Sorbonne Paris Cité, INSERM, F-75010, France
| | - Annalisa Ruggeri
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Marina Cavazzana
- Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, France
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, France
| | - Valerie Gauthereau
- Fédération Parisienne Pour le Dépistage et la Prévention des Handicaps de l'Enfant (FPDPHE), Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Aurélie Stanislas
- Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, France
| | - Malika Benkerrou
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Mariane De Montalembert
- Department of Pediatrics, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Christele Ferry
- Department of Stem Cell Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Robert Girot
- Department of Hemato-Biology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Cecile Arnaud
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Paris XII University, Créteil, France
| | - Annie Kamdem
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Paris XII University, Créteil, France
| | - Joelle Gour
- Department of Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Claudine Touboul
- Department of Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Audrey Cras
- Cell Therapy Facility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Paris-Diderot University, Sorbonne Paris Cité, INSERM, F-75010, France
| | - Mathieu Kuentz
- Department of Hematology, Groupe Hospitalier Universitaire Henri-Mondor, Créteil, France
| | - Claire Rieux
- Unité d'Hémovigilance, Groupe Hospitalier Universitaire Henri-Mondor, Créteil, France
| | - Fernanda Volt
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Barbara Cappelli
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Karina T Maio
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Annalisa Paviglianiti
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Chantal Kenzey
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Jerome Larghero
- Cell Therapy Facility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Paris-Diderot University, Sorbonne Paris Cité, INSERM, F-75010, France
| | - Eliane Gluckman
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
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40
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Chiesa R, Ruggeri A, Paviglianiti A, Zecca M, Gónzalez-Vicent M, Bordon V, Stein J, Lawson S, Dupont S, Lanino E, Abecasis M, Al-Seraihy A, Kenzey C, Bierings M, Locatelli F, Gluckman E, Schulz A, Gennery A, Page K, Kurtzberg J, Rocha V. Outcomes after Unrelated Umbilical Cord Blood Transplantation for Children with Osteopetrosis. Biol Blood Marrow Transplant 2016; 22:1997-2002. [DOI: 10.1016/j.bbmt.2016.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/21/2016] [Indexed: 11/17/2022]
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41
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Paviglianiti A, Xavier E, Ruggeri A, Ceballos P, Deconinck E, Cornelissen JJ, Nguyen-Quoc S, Maillard N, Sanz G, Rohrlich PS, Garderet L, Volt F, Rocha V, Kroeger N, Gluckman E, Fegueux N, Mohty M. Outcomes of unrelated cord blood transplantation in patients with multiple myeloma: a survey on behalf of Eurocord, the Cord Blood Committee of Cellular Therapy and Immunobiology Working Party, and the Chronic Leukemia Working Party of the EBMT. Haematologica 2016; 101:1120-7. [PMID: 27229716 DOI: 10.3324/haematol.2015.138917] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/24/2016] [Indexed: 12/11/2022] Open
Abstract
Although allogeneic stem cell transplantation is not a standard therapy for multiple myeloma, some patients can benefit from this intense therapy. There are few reports on outcomes after umbilical cord blood transplantation in multiple myeloma, and investigation of this procedure is warranted. We retrospectively analyzed 95 patients, 85 with multiple myeloma and 10 with plasma cell leukemia, receiving single or double umbilical cord blood transplantation from 2001 to 2013. Median follow up was 41 months. The majority of patients received a reduced intensity conditioning. The cumulative incidence of neutrophil engraftment was 97%±3% at 60 days, and that of 100-day acute graft-versus-host disease grade II-IV was 41%±5%. Chronic graft-versus-host disease at two years was 22%±4%. Relapse and non-relapse mortality was 47%±5% and 29%±5% at three years, respectively. Three-year progression-free survival and overall survival were 24%±5% and 40%±5%, respectively. Anti-thymocyte globulin was associated with decreased incidence of acute graft-versus-host disease, higher non-relapse mortality, decreased overall and progression-free survival. Patients with high cytogenetic risk had higher relapse, and worse overall and progression-free survival. In conclusion, umbilical cord blood transplantation is feasible for multiple myeloma patients.
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Affiliation(s)
- Annalisa Paviglianiti
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France Monacord, Centre Scientifique de Monaco, France
| | - Erick Xavier
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France Monacord, Centre Scientifique de Monaco, France
| | - Annalisa Ruggeri
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France Monacord, Centre Scientifique de Monaco, France Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Patrice Ceballos
- Département d'Hématologie Clinique, CHU Lapeyronie, Montpellier, France
| | | | - Jan J Cornelissen
- Department of Hematology, Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, the Netherlands
| | - Stephanie Nguyen-Quoc
- Department Hematology, University Paris IV, Hôpital la Pitié-Salpêtrière, Paris, France
| | - Natacha Maillard
- Bone Marrow Transplant Unit Clinical Hematology, Hôpital La Miletrie, Poitiers, France
| | - Guillermo Sanz
- Servicio de Hematologia, Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | | | - Laurent Garderet
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Fernanda Volt
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France Monacord, Centre Scientifique de Monaco, France
| | - Vanderson Rocha
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France Monacord, Centre Scientifique de Monaco, France Department Hematology, Churchill Hospital, Oxford, UK
| | - Nicolaus Kroeger
- Dept. Stem Cell Transplantation, University Hospital of Hamburg, Germany
| | - Eliane Gluckman
- Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France Monacord, Centre Scientifique de Monaco, France
| | - Nathalie Fegueux
- Département d'Hématologie Clinique, CHU Lapeyronie, Montpellier, France
| | - Mohamad Mohty
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France INSERM, UMRs 938, Paris, France
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42
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Ruggeri A, Paviglianiti A, Gluckman E, Rocha V. Impact of HLA in cord blood transplantation outcomes. HLA 2016; 87:413-21. [PMID: 27060588 DOI: 10.1111/tan.12792] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 12/31/2022]
Abstract
Umbilical cord blood (UCB) emerged in the last 20 years as a valid alternative source of hematopoietic stem cell (HSC) in allogeneic transplantation setting, mainly in the absence of a fully human leucocyte antigen (HLA)-matched sibling. The probability of finding a matched unrelated donor through the registries varies from 20 to 70%, depending on the ethnicity of the patients. Therefore, patients in need may benefit of an HLA-mismatched hematopoietic stem cell transplantation from haploidentical donors or from UCB. One of the advantages of using UCB is the lower incidence of acute graft-versus-host-disease and allowance of greater HLA mismatch. Conversely, the low number of HSCs and lymphocytes and specific immunological features of T cells are associated with delayed engraftment and immune reconstitution and consequently, increased opportunistic infections. Nevertheless, retrospective studies showed similar results comparing UCB with other stem cell sources, both in pediatric and adult setting. The ability to use partially HLA-matched UCB units allows expanding the donor pool. Many UCB banks have strategies to increase their inventory including UCB grafts that have rare haplotypes. HLA and cell dose are very important factors associated with outcomes after umbilical cord blood transplantation (UCBT) that interact with each other. Increasing cell dose counterbalances the number of HLA disparities. Understanding those interactions, the role of HLA mismatches and other immunogenic factors, are important to allow clinicians to choose the best cord blood graft for patients. This review will describe the role of HLA in UCBT setting.
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Affiliation(s)
- A Ruggeri
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France.,Eurocord, Hôpital Saint Louis AP-HP, University Paris VII IUH, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principauté de Monaco
| | - A Paviglianiti
- Eurocord, Hôpital Saint Louis AP-HP, University Paris VII IUH, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principauté de Monaco
| | - E Gluckman
- Eurocord, Hôpital Saint Louis AP-HP, University Paris VII IUH, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principauté de Monaco
| | - V Rocha
- Eurocord, Hôpital Saint Louis AP-HP, University Paris VII IUH, Paris, France.,Department of Haematology, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK.,NHS Blood and Transplant, Oxford Centre, John Radcliffe Hospital, Oxford, UK
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43
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Girardi K, Paviglianiti A, Cirillo M, Bianchi A, Gherardi G, Annibali O, Cerchiara E, Marchesi F, Tomarchio V, Miglio C, Tirindelli M, Onetti Muda A, Avvisati G. Tuberculous meningoencephalitis in a patient with hairy cell leukemia in complete remission. J Clin Exp Hematop 2012; 52:31-4. [PMID: 22706528 DOI: 10.3960/jslrt.52.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Tuberculous meningoencephalitis is a rare disease associated with high morbidity and mortality. We report a patient with hairy cell leukemia in complete remission who, after a single cycle of chemotherapy with cladribine, presented fever and neurological deficits. Laboratory diagnosis of tuberculous meningoencephalitis was made by polymerase chain reaction testing for Mycobacterium tuberculosis in cerebrospinal fluid. Despite the prompt institution of antitubercular-therapy, patient's general condition did not improve and he died. Mycobacterial infection should be considered in patients with intra-cranial lesions, affected by hematological malignancies and persistent immunosuppression.
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Affiliation(s)
- K Girardi
- Department of Hematology, Transfusion Medicine and Cellular Therapy, University Campus Biomedico, Rome, Italy.
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D'Andrea M, Nosotti L, Pimpinelli F, Dessanti ML, Paviglianiti A, Miglioresi L, Morrone A, Petti MC. The controversial role of lamivudine prophylaxis in occult HBV carriers treated with chemo-immune therapy. Dig Liver Dis 2009; 41:839-40. [PMID: 19464241 DOI: 10.1016/j.dld.2009.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/28/2009] [Accepted: 03/11/2009] [Indexed: 12/11/2022]
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45
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Tambone V, De Virgilio A, Paolini A, Paviglianiti A, Picconi F, Pietrapertosa G, Rega D, Ricciardi R, Spada A. [Some behavioral characteristics of physicians desired by ambulatory patients. A pilot survey]. Clin Ter 2007; 158:497-503. [PMID: 18265714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIMS We must pay attention to character formation of Medical Doctors because it could build a good or bad relationship with colleagues and patients: it is not a merely "humanistic" goal but a necessary component of professional excellence. The first endpoint of this study is to identify how to improve the quality of the outpatient visit. MATERIALS AND METHODS We tested a user-friendly questionnaire, distributed to 100 patients. RESULTS AND CONCLUSIONS The most important behavioral characteristics desired by patients from physicians are: 1. to have the physician's attention without feeling hurried (such as without the physician answering a phone call during the office visit); 2. to have continuity of care even in the ambulatory setting; 3. to find a relationship of empathy, participation and sharing; 4. to have a peaceful relationship of collaboration with the nurses and other health care personnel; 5. to find the physician appropriately groomed and dressed; 6. to receive the full diagnosis with clarity and at the most appropriate moment of communication.
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Affiliation(s)
- V Tambone
- Dipartimento di Antropologia ed Etica Applicata, Università Campus Biomedico di Roma, Italia.
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