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Martens MJ, Logan BR. Statistical rules for safety monitoring in clinical trials. Clin Trials 2024; 21:152-161. [PMID: 37877375 PMCID: PMC11003847 DOI: 10.1177/17407745231203391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND/AIMS Protecting patient safety is an essential component of the conduct of clinical trials. Rigorous safety monitoring schemes are implemented for these studies to guard against excess toxicity risk from study therapies. They often include protocol-specified stopping rules dictating that an excessive number of safety events will trigger a halt of the study. Statistical methods are useful for constructing rules that protect patients from exposure to excessive toxicity while also maintaining the chance of a false safety signal at a low level. Several statistical techniques have been proposed for this purpose, but the current literature lacks a rigorous comparison to determine which method may be best suitable for a given trial design. The aims of this article are (1) to describe a general framework for repeated monitoring of safety events in clinical trials; (2) to survey common statistical techniques for creating safety stopping criteria; and (3) to provide investigators with a software tool for constructing and assessing these stopping rules. METHODS The properties and operating characteristics of stopping rules produced by Pocock and O'Brien-Fleming tests, Bayesian Beta-Binomial models, and sequential probability ratio tests (SPRTs) are studied and compared for common scenarios that may arise in phase II and III trials. We developed the R package "stoppingrule" for constructing and evaluating stopping rules from these methods. Its usage is demonstrated through a redesign of a stopping rule for BMT CTN 0601 (registered at Clinicaltrials.gov as NCT00745420), a phase II, single-arm clinical trial that evaluated outcomes in pediatric sickle cell disease patients treated by bone marrow transplant. RESULTS Methods with aggressive stopping criteria early in the trial, such as the Pocock test and Bayesian Beta-Binomial models with weak priors, have permissive stopping criteria at late stages. This results in a trade-off where rules with aggressive early monitoring generally will have a smaller number of expected toxicities but also lower power than rules with more conservative early stopping, such as the O-Brien-Fleming test and Beta-Binomial models with strong priors. The modified SPRT method is sensitive to the choice of alternative toxicity rate. The maximized SPRT generally has a higher number of expected toxicities and/or worse power than other methods. CONCLUSIONS Because the goal is to minimize the number of patients exposed to and experiencing toxicities from an unsafe therapy, we recommend using the Pocock or Beta-Binomial, weak prior methods for constructing safety stopping rules. At the design stage, the operating characteristics of candidate rules should be evaluated under various possible toxicity rates in order to guide the choice of rule(s) for a given trial; our R package facilitates this evaluation.
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Affiliation(s)
- Michael J. Martens
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI USA
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI USA
| | - Brent R. Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI USA
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI USA
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Eissa H, Thakar MS, Shah AJ, Logan BR, Griffith LM, Dong H, Parrott RE, O'Reilly RJ, Dara J, Kapoor N, Forbes Satter L, Chandra S, Kapadia M, Chandrakasan S, Knutsen A, Jyonouchi SC, Molinari L, Rayes A, Ebens CL, Teira P, Dávila Saldaña BJ, Burroughs LM, Chaudhury S, Chellapandian D, Gillio AP, Goldman F, Malech HL, DeSantes K, Cuvelier GDE, Rozmus J, Quinones R, Yu LC, Broglie L, Aquino V, Shereck E, Moore TB, Vander Lugt MT, Mousallem TI, Oved JH, Dorsey M, Abdel-Azim H, Martinez C, Bleesing JH, Prockop S, Kohn DB, Bednarski JJ, Leiding J, Marsh RA, Torgerson T, Notarangelo LD, Pai SY, Pulsipher MA, Puck JM, Dvorak CC, Haddad E, Buckley RH, Cowan MJ, Heimall J. Posttransplantation late complications increase over time for patients with SCID: A Primary Immune Deficiency Treatment Consortium (PIDTC) landmark study. J Allergy Clin Immunol 2024; 153:287-296. [PMID: 37793572 DOI: 10.1016/j.jaci.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The Primary Immune Deficiency Treatment Consortium (PIDTC) enrolled children in the United States and Canada onto a retrospective multicenter natural history study of hematopoietic cell transplantation (HCT). OBJECTIVE We investigated outcomes of HCT for severe combined immunodeficiency (SCID). METHODS We evaluated the chronic and late effects (CLE) after HCT for SCID in 399 patients transplanted from 1982 to 2012 at 32 PIDTC centers. Eligibility criteria included survival to at least 2 years after HCT without need for subsequent cellular therapy. CLE were defined as either conditions present at any time before 2 years from HCT that remained unresolved (chronic), or new conditions that developed beyond 2 years after HCT (late). RESULTS The cumulative incidence of CLE was 25% in those alive at 2 years, increasing to 41% at 15 years after HCT. CLE were most prevalent in the neurologic (9%), neurodevelopmental (8%), and dental (8%) categories. Chemotherapy-based conditioning was associated with decreased-height z score at 2 to 5 years after HCT (P < .001), and with endocrine (P < .001) and dental (P = .05) CLE. CD4 count of ≤500 cells/μL and/or continued need for immunoglobulin replacement therapy >2 years after transplantation were associated with lower-height z scores. Continued survival from 2 to 15 years after HCT was 90%. The presence of any CLE was associated with increased risk of late death (hazard ratio, 7.21; 95% confidence interval, 2.71-19.18; P < .001). CONCLUSION Late morbidity after HCT for SCID was substantial, with an adverse impact on overall survival. This study provides evidence for development of survivorship guidelines based on disease characteristics and treatment exposure for patients after HCT for SCID.
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Affiliation(s)
- Hesham Eissa
- Division of Pediatric Hematology-Oncology-BMT, University of Colorado, Aurora, Wash.
| | - Monica S Thakar
- Fred Hutchinson Cancer Center, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash
| | - Ami J Shah
- Pediatrics [Hematology/Oncology/Stem Cell Transplantation and Regenerative Medicine], Stanford University/Lucille Packard Children's Hospital, Palo Alto, Calif
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wis
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Huaying Dong
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wis
| | | | - Richard J O'Reilly
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jasmeen Dara
- Division of Allergy, Immunology and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Neena Kapoor
- Division of Hematology, Oncology and Blood and Marrow Transplant, Children's Hospital Los Angeles, Los Angeles, Calif
| | - Lisa Forbes Satter
- Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Malika Kapadia
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Mass
| | | | - Alan Knutsen
- St Louis University, Cardinal Glennon Children's Hospital, St Louis, Mo
| | - Soma C Jyonouchi
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | | | - Ahmad Rayes
- Division of Hematology, Oncology, Transplantation, and Immunology, Primary Children's Hospital, Huntsman Cancer Institute, Spense Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
| | - Christen L Ebens
- Division of Pediatric Blood and Marrow Transplant and Cellular Therapy, University of Minnesota Masonic Children's Hospital, Minneapolis, Minn
| | - Pierre Teira
- Paediatric Haematology Oncology, Ste-Justine Hospital, Montreal, Canada
| | | | - Lauri M Burroughs
- Fred Hutchinson Cancer Center, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash
| | - Sonali Chaudhury
- Hematology, Oncology, Neuro-oncology & Stem Cell Transplantation Division, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Deepak Chellapandian
- Center for Cell and Gene Therapy for Non-malignant Conditions, Johns Hopkins All Children's Hospital, St Petersburg, Fla
| | - Alfred P Gillio
- Children's Cancer Institute, Hackensack University Medical Center, Hackensack, NJ
| | - Fredrick Goldman
- Division of Pediatric Hematology and Oncology and Bone Marrow Transplant, University of Alabama at Birmingham, Birmingham, Ala
| | | | - Kenneth DeSantes
- Division of Pediatric Hematology-Oncology & Bone Marrow Transplant, University of Wisconsin, American Family Children's Hospital, Madison, Wis
| | - Geoff D E Cuvelier
- Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, Winnipeg, Canada
| | - Jacob Rozmus
- Children's & Women's Health Centre of British Columbia, Vancouver, Canada
| | - Ralph Quinones
- Division of Pediatric Hematology-Oncology-BMT, University of Colorado, Aurora, Wash
| | - Lolie C Yu
- Division of Heme-Onc/HSCT, Children's Hospital/LSUHSC, New Orleans, La
| | - Larisa Broglie
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, Wis
| | - Victor Aquino
- Division of Pediatric Hematology and Oncology, The University of Texas Southwestern Medical Center, Dallas, Tex
| | - Evan Shereck
- Division of Pediatric Hematology/Oncology, Oregon Health and Science University, Portland, Ore
| | - Theodore B Moore
- Department of Pediatric Hematology-Oncology, Mattel Children's Hospital, University of California, Los Angeles, Calif
| | - Mark T Vander Lugt
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Mich
| | | | - Joeseph H Oved
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Morna Dorsey
- Division of Allergy, Immunology and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood and Marrow Transplant, Children's Hospital Los Angeles, Los Angeles, Calif; Loma Linda University School of Medicine, Cancer Center, Children Hospital and Medical Center, Loma Linda, Calif
| | - Caridad Martinez
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex
| | - Jacob H Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Susan Prockop
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Mass
| | | | - Jeffrey J Bednarski
- Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | - Jennifer Leiding
- Orlando Health Arnold Palmer Hospital for Children, Orlando, Fla
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, Md
| | - Sung-Yun Pai
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Md
| | - Michael A Pulsipher
- Division of Hematology, Oncology, Transplantation, and Immunology, Primary Children's Hospital, Huntsman Cancer Institute, Spense Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah
| | - Jennifer M Puck
- Division of Allergy, Immunology and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Christopher C Dvorak
- Division of Allergy, Immunology and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Elie Haddad
- Department of Pediatrics and the Department of Microbiology, Immunology, and Infectious Diseases, University of Montreal, CHU Sainte-Justine, Montreal, Canada
| | | | - Morton J Cowan
- Division of Allergy, Immunology and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
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Li X, Logan BR, Hossain SMF, Moodie EEM. Dynamic Treatment Regimes Using Bayesian Additive Regression Trees for Censored Outcomes. Lifetime Data Anal 2024; 30:181-212. [PMID: 37659991 PMCID: PMC10764602 DOI: 10.1007/s10985-023-09605-8] [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] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/16/2023] [Indexed: 09/04/2023]
Abstract
To achieve the goal of providing the best possible care to each individual under their care, physicians need to customize treatments for individuals with the same health state, especially when treating diseases that can progress further and require additional treatments, such as cancer. Making decisions at multiple stages as a disease progresses can be formalized as a dynamic treatment regime (DTR). Most of the existing optimization approaches for estimating dynamic treatment regimes including the popular method of Q-learning were developed in a frequentist context. Recently, a general Bayesian machine learning framework that facilitates using Bayesian regression modeling to optimize DTRs has been proposed. In this article, we adapt this approach to censored outcomes using Bayesian additive regression trees (BART) for each stage under the accelerated failure time modeling framework, along with simulation studies and a real data example that compare the proposed approach with Q-learning. We also develop an R wrapper function that utilizes a standard BART survival model to optimize DTRs for censored outcomes. The wrapper function can easily be extended to accommodate any type of Bayesian machine learning model.
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Affiliation(s)
- Xiao Li
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
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Chandrasekaran P, Han Y, Zerbe CS, Heller T, DeRavin SS, Kreuzberg SA, Marciano BE, Siu Y, Jones DR, Abraham RS, Stephens MC, Tsou AM, Snapper S, Conlan S, Subramanian P, Quinones M, Grou C, Calderon V, Deming C, Leiding JW, Arnold DE, Logan BR, Griffith LM, Petrovic A, Mousallem TI, Kapoor N, Heimall JR, Barnum JL, Kapadia M, Wright N, Rayes A, Chandra S, Broglie LA, Chellapandian D, Deal CL, Grunebaum E, Lim SS, Mallhi K, Marsh RA, Murguia-Favela L, Parikh S, Touzot F, Cowan MJ, Dvorak CC, Haddad E, Kohn DB, Notarangelo LD, Pai SY, Puck JM, Pulsipher MA, Torgerson TR, Kang EM, Malech HL, Segre JA, Bryant CE, Holland SM, Falcone EL. Intestinal microbiome and metabolome signatures in patients with chronic granulomatous disease. J Allergy Clin Immunol 2023; 152:1619-1633.e11. [PMID: 37659505 DOI: 10.1016/j.jaci.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Chronic granulomatous disease (CGD) is caused by defects in any 1 of the 6 subunits forming the nicotinamide adenine dinucleotide phosphate oxidase complex 2 (NOX2), leading to severely reduced or absent phagocyte-derived reactive oxygen species production. Almost 50% of patients with CGD have inflammatory bowel disease (CGD-IBD). While conventional IBD therapies can treat CGD-IBD, their benefits must be weighed against the risk of infection. Understanding the impact of NOX2 defects on the intestinal microbiota may lead to the identification of novel CGD-IBD treatments. OBJECTIVE We sought to identify microbiome and metabolome signatures that can distinguish individuals with CGD and CGD-IBD. METHODS We conducted a cross-sectional observational study of 79 patients with CGD, 8 pathogenic variant carriers, and 19 healthy controls followed at the National Institutes of Health Clinical Center. We profiled the intestinal microbiome (amplicon sequencing) and stool metabolome, and validated our findings in a second cohort of 36 patients with CGD recruited through the Primary Immune Deficiency Treatment Consortium. RESULTS We identified distinct intestinal microbiome and metabolome profiles in patients with CGD compared to healthy individuals. We observed enrichment for Erysipelatoclostridium spp, Sellimonas spp, and Lachnoclostridium spp in CGD stool samples. Despite differences in bacterial alpha and beta diversity between the 2 cohorts, several taxa correlated significantly between both cohorts. We further demonstrated that patients with CGD-IBD have a distinct microbiome and metabolome profile compared to patients without CGD-IBD. CONCLUSION Intestinal microbiome and metabolome signatures distinguished patients with CGD and CGD-IBD, and identified potential biomarkers and therapeutic targets.
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Affiliation(s)
| | - Yu Han
- Division of Molecular Genetics and Pathology, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Md; Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Christa S Zerbe
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Theo Heller
- Translational Hepatology Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, Md
| | - Suk See DeRavin
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Samantha A Kreuzberg
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Beatriz E Marciano
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Yik Siu
- Department of Biochemistry and Molecular Pharmacology, New York University Langone Health, New York, NY
| | - Drew R Jones
- Department of Biochemistry and Molecular Pharmacology, New York University Langone Health, New York, NY
| | - Roshini S Abraham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn; Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Amy M Tsou
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass; Jill Roberts Institute for Research in Inflammatory Bowel Disease, Weill Cornell Medical College, New York, NY
| | - Scott Snapper
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Sean Conlan
- National Human Genome Research Institute (NHGRI), NIH, Bethesda, Md
| | - Poorani Subramanian
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, Md
| | - Mariam Quinones
- Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, NIAID, NIH, Bethesda, Md
| | - Caroline Grou
- Bioinformatics Core, Montreal Clinical Research Institute (IRCM), Montreal, Quebec, Canada
| | - Virginie Calderon
- Bioinformatics Core, Montreal Clinical Research Institute (IRCM), Montreal, Quebec, Canada
| | - Clayton Deming
- National Human Genome Research Institute (NHGRI), NIH, Bethesda, Md
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University, Baltimore, Md
| | - Danielle E Arnold
- Immune Deficiency-Cellular Therapy Program, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Md
| | - Brent R Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wis
| | - Linda M Griffith
- Division of Allergy, Immunology, and Transplantation, NIAID, NIH, Bethesda, Md
| | - Aleksandra Petrovic
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital and Research Center, Seattle, Wash
| | - Talal I Mousallem
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Neena Kapoor
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, Calif
| | - Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Jessie L Barnum
- Division of Blood and Marrow Transplantation and Cellular Therapies, University of Pittsburgh Medical Center (UPMC) and Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Malika Kapadia
- Department of Pediatrics, Harvard University Medical School, Boston, Mass
| | - Nicola Wright
- Section of Hematology/Immunology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Ahmad Rayes
- Intermountain Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Larisa A Broglie
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Deepak Chellapandian
- Center for Cell and Gene Therapy for Non-Malignant Conditions, Johns Hopkins All Children's Hospital, St Petersburg, Fla
| | - Christin L Deal
- Division of Allergy and Immunology, UPMC, Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Eyal Grunebaum
- Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Si Lim
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii; University of Hawai'i Cancer Center, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | | | - Rebecca A Marsh
- Cincinnati Children's Hospital Medical Center, and University of Cincinnati, Cincinnati, Ohio
| | - Luis Murguia-Favela
- Section of Hematology/Immunology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Suhag Parikh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Fabien Touzot
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada; Department of Microbiology, Infectious Diseases, and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Morton J Cowan
- University of California San Francisco Benioff Children's Hospital, San Francisco, Calif
| | - Christopher C Dvorak
- University of California San Francisco Benioff Children's Hospital, San Francisco, Calif
| | - Elie Haddad
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada; Department of Microbiology, Infectious Diseases, and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Donald B Kohn
- Microbiology, Immunology, & Molecular Genetics, University of California, Los Angeles, Calif
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Sung-Yun Pai
- Immune Deficiency-Cellular Therapy Program, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, Md
| | - Jennifer M Puck
- University of California San Francisco Benioff Children's Hospital, San Francisco, Calif
| | - Michael A Pulsipher
- Division of Pediatric Hematology and Oncology, Intermountain Primary Children's Hospital, Huntsman Cancer Institute at the University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | | | - Elizabeth M Kang
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Harry L Malech
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Julia A Segre
- National Human Genome Research Institute (NHGRI), NIH, Bethesda, Md
| | - Clare E Bryant
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Steven M Holland
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Emilia Liana Falcone
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md; Department of Microbiology, Infectious Diseases, and Immunology, Université de Montréal, Montreal, Quebec, Canada; Center for Immunity, Inflammation and Infectious Diseases, IRCM, Montreal, Quebec, Canada; Department of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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5
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Devine SM, Bo-Subait S, Kuxhausen M, Spellman SR, Bupp C, Ahn KW, Stefanski HE, Auletta JJ, Logan BR, Shaw BE. Clinical impact of cryopreservation of allogeneic hematopoietic cell grafts during the onset of the COVID-19 pandemic. Blood Adv 2023; 7:5982-5993. [PMID: 37036959 PMCID: PMC10580174 DOI: 10.1182/bloodadvances.2023009786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/12/2023] Open
Abstract
At the onset of the COVID-19 pandemic, the National Marrow Donor Program mandated the cryopreservation of hematopoietic cell grafts from volunteer unrelated donors because of numerous patient and donor safety concerns and logistical hurdles. Using the Center for International Blood and Marrow Transplant Research outcomes database, we report the impact of cryopreservation on overall survival (OS) and other outcomes within 1 year after hematopoietic cell transplantation (HCT). We analyzed 1543 recipients of cryopreserved allografts receiving HCT at US centers during the first 6 months of the pandemic and compared them with 2499 recipients of fresh allografts during a 6-month period in 2019. On multivariable regression analysis, we observed no difference in the OS (P = .09), nonrelapse mortality (P = .89), graft-versus-host disease (GVHD), or GVHD- and relapse-free survival (P = .58) in recipients of cryopreserved vs fresh allografts. Disease-free survival (DFS) was lower in the cryopreserved allograft recipients (P = .006) because of a higher risk of relapse (P = .01) compared with the fresh allograft recipients. Primary graft failure was higher (P = .01), and the risk of chronic GVHD was lower (P = .001) with cryopreservation compared with fresh grafts. In conclusion, although there was no negative impact of cryopreservation on OS, relapse was higher, and DFS was lower than that with no cryopreservation. Fresh grafts are recommended as the pandemic-related logistical hurdles resolve. Cryopreservation should be considered an option for patients when fresh grafts are not feasible.
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Affiliation(s)
- Steven M. Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Stephanie Bo-Subait
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Michelle Kuxhausen
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Stephen R. Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Caitrin Bupp
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Kwang Woo Ahn
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Heather E. Stefanski
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Jeffery J. Auletta
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Brent R. Logan
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Bronwen E. Shaw
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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Logan BR, Fu D, Howard A, Fei M, Kou J, Little MR, Adom D, Mohamed FA, Blazar BR, Gafken PR, Paczesny S. Validated graft-specific biomarkers identify patients at risk for chronic graft-versus-host disease and death. J Clin Invest 2023; 133:e168575. [PMID: 37526081 PMCID: PMC10378149 DOI: 10.1172/jci168575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/16/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUNDChronic graft-versus-host disease (cGVHD) is a serious complication of allogeneic hematopoietic cell transplantation (HCT). More accurate information regarding the risk of developing cGVHD is required. Bone marrow (BM) grafts contribute to lower cGVHD, which creates a dispute over whether risk biomarker scores should be used for peripheral blood (PB) and BM.METHODSDay 90 plasma proteomics from PB and BM recipients developing cGVHD revealed 5 risk markers that were added to 8 previous cGVHD markers to screen 982 HCT samples of 2 multicenter Blood and Marrow Transplant Clinical Trials Network (BMTCTN) cohorts. Each marker was tested for its association with cause-specific hazard ratios (HRs) of cGVHD using Cox-proportional-hazards models. We paired these clinical studies with biomarker measurements in a mouse model of cGVHD.RESULTSSpearman correlations between DKK3 and MMP3 were significant in both cohorts. In BMTCTN 0201 multivariate analyses, PB recipients with 1-log increase in CXCL9 and DKK3 were 1.3 times (95% CI: 1.1-1.4, P = 0.001) and 1.9 times (95%CI: 1.1-3.2, P = 0.019) and BM recipients with 1-log increase in CXCL10 and MMP3 were 1.3 times (95%CI: 1.0-1.6, P = 0.018 and P = 0.023) more likely to develop cGVHD. In BMTCTN 1202, PB patients with high CXCL9 and MMP3 were 1.1 times (95%CI: 1.0-1.2, P = 0.037) and 1.2 times (95%CI: 1.0-1.3, P = 0.009) more likely to develop cGVHD. PB patients with high biomarkers had increased likelihood to develop cGVHD in both cohorts (22%-32% versus 8%-12%, P = 0.002 and P < 0.001, respectively). Mice showed elevated circulating biomarkers before the signs of cGVHD.CONCLUSIONBiomarker levels at 3 months after HCT identify patients at risk for cGVHD occurrence.FUNDINGNIH grants R01CA168814, R21HL139934, P01CA158505, T32AI007313, and R01CA264921.
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Affiliation(s)
- Brent R. Logan
- Division of Biostatistics and Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Denggang Fu
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alan Howard
- Be The Match and Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | - Mingwei Fei
- Be The Match and Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | - Jianqun Kou
- Division of Biostatistics and Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Morgan R. Little
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Djamilatou Adom
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Fathima A. Mohamed
- Department of Pediatrics, Division of Blood & Marrow Transplant & Cellular Therapy, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Bruce R. Blazar
- Department of Pediatrics, Division of Blood & Marrow Transplant & Cellular Therapy, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Philip R. Gafken
- Proteomics & Metabolomics shared resource, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Sophie Paczesny
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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7
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Thakar MS, Logan BR, Puck JM, Dunn EA, Buckley RH, Cowan MJ, O'Reilly RJ, Kapoor N, Satter LF, Pai SY, Heimall J, Chandra S, Ebens CL, Chellapandian D, Williams O, Burroughs LM, Saldana BD, Rayes A, Madden LM, Chandrakasan S, Bednarski JJ, DeSantes KB, Cuvelier GDE, Teira P, Gillio AP, Eissa H, Knutsen AP, Goldman FD, Aquino VM, Shereck EB, Moore TB, Caywood EH, Lugt MTV, Rozmus J, Broglie L, Yu LC, Shah AJ, Andolina JR, Liu X, Parrott RE, Dara J, Prockop S, Martinez CA, Kapadia M, Jyonouchi SC, Sullivan KE, Bleesing JJ, Chaudhury S, Petrovic A, Keller MD, Quigg TC, Parikh S, Shenoy S, Seroogy C, Rubin T, Decaluwe H, Routes JM, Torgerson TR, Leiding JW, Pulsipher MA, Kohn DB, Griffith LM, Haddad E, Dvorak CC, Notarangelo LD. Measuring the effect of newborn screening on survival after haematopoietic cell transplantation for severe combined immunodeficiency: a 36-year longitudinal study from the Primary Immune Deficiency Treatment Consortium. Lancet 2023; 402:129-140. [PMID: 37352885 PMCID: PMC10386791 DOI: 10.1016/s0140-6736(23)00731-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/25/2023] [Accepted: 04/03/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Severe combined immunodeficiency (SCID) is fatal unless durable adaptive immunity is established, most commonly through allogeneic haematopoietic cell transplantation (HCT). The Primary Immune Deficiency Treatment Consortium (PIDTC) explored factors affecting the survival of individuals with SCID over almost four decades, focusing on the effects of population-based newborn screening for SCID that was initiated in 2008 and expanded during 2010-18. METHODS We analysed transplantation-related data from children with SCID treated at 34 PIDTC sites in the USA and Canada, using the calendar time intervals 1982-89, 1990-99, 2000-09, and 2010-18. Categorical variables were compared by χ2 test and continuous outcomes by the Kruskal-Wallis test. Overall survival was estimated by the Kaplan-Meier method. A multivariable analysis using Cox proportional hazards regression models examined risk factors for HCT outcomes, including the variables of time interval of HCT, infection status and age at HCT, trigger for diagnosis, SCID type and genotype, race and ethnicity of the patient, non-HLA-matched sibling donor type, graft type, GVHD prophylaxis, and conditioning intensity. FINDINGS For 902 children with confirmed SCID, 5-year overall survival remained unchanged at 72%-73% for 28 years until 2010-18, when it increased to 87% (95% CI 82·1-90·6; n=268; p=0·0005). For children identified as having SCID by newborn screening since 2010, 5-year overall survival was 92·5% (95% CI 85·8-96·1), better than that of children identified by clinical illness or family history in the same interval (79·9% [69·5-87·0] and 85·4% [71·8-92·8], respectively [p=0·043]). Multivariable analysis demonstrated that the factors of active infection (hazard ratio [HR] 2·41, 95% CI 1·56-3·72; p<0·0001), age 3·5 months or older at HCT (2·12, 1·38-3·24; p=0·001), Black or African-American race (2·33, 1·56-3·46; p<0·0001), and certain SCID genotypes to be associated with lower overall survival during all time intervals. Moreover, after adjusting for several factors in this multivariable analysis, HCT after 2010 no longer conveyed a survival advantage over earlier time intervals studied (HR 0·73, 95% CI 0·43-1·26; p=0·097). This indicated that younger age and freedom from infections at HCT, both directly driven by newborn screening, were the main drivers for recent improvement in overall survival. INTERPRETATION Population-based newborn screening has facilitated the identification of infants with SCID early in life, in turn leading to prompt HCT while avoiding infections. Public health programmes worldwide can benefit from this definitive demonstration of the value of newborn screening for SCID. FUNDING National Institute of Allergy and Infectious Diseases, Office of Rare Diseases Research, and National Center for Advancing Translational Sciences.
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Affiliation(s)
- Monica S Thakar
- Fred Hutchinson Cancer Center, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, WI, USA; Center for International Blood and Marrow Transplant Research, Milwaukee, WI, USA
| | - Jennifer M Puck
- Division of Pediatric Allergy, Immunology, and Blood and Marrow Transplantation, University of California San Francisco, CA, USA; UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Elizabeth A Dunn
- Division of Pediatric Allergy, Immunology, and Blood and Marrow Transplantation, University of California San Francisco, CA, USA
| | - Rebecca H Buckley
- Department of Allergy and Immunology, Department of Pediatrics and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Morton J Cowan
- Division of Pediatric Allergy, Immunology, and Blood and Marrow Transplantation, University of California San Francisco, CA, USA; UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Richard J O'Reilly
- Stem Cell Transplantation and Cellular Therapy, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neena Kapoor
- Transplant and Cell Therapy Program and Laboratory, Department of Pediatrics, Keck School of Medicine, University of Southern California, CA, USA; Hematology, Oncology and TCT, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lisa Forbes Satter
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Immunology Allergy and Retrovirology, Center for Human Immunobiology, Texas Children's Hospital Infusion Center, Houston, TX, USA
| | - Sung-Yun Pai
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute (NCI)/NIH, Bethesda, MD, USA
| | - Jennifer Heimall
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, PA, USA; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sharat Chandra
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christen L Ebens
- Department of Pediatrics, Division of Blood and Marrow Transplantation & Cellular Therapy, University of Minnesota, Minneapolis, MN, USA
| | - Deepak Chellapandian
- Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Cell and Gene Therapy for Nonmalignant Conditions, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Olatundun Williams
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA; Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Lauri M Burroughs
- Fred Hutchinson Cancer Center, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Blachy Davila Saldana
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC, USA; Division of Blood and Marrow Transplantation and Center for Cancer and Immunology Research, Children's National Hospital, Washington DC, USA
| | - Ahmad Rayes
- Pediatric Immunology and Blood and Marrow Transplant Program, University of Utah, Salt Lake City, UT, USA; Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - Lisa M Madden
- Pediatric Bone Marrow Transplant Program, Texas Transplant Institute, San Antonio, TX, USA
| | - Shanmuganathan Chandrakasan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jeffrey J Bednarski
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | | | - Geoffrey D E Cuvelier
- University of Manitoba, Winnipeg, MB, Canada; Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Pierre Teira
- Department of Pediatrics and Department of Microbiology, Immunology and Infectious Diseases, University of Montreal, Montreal, QC, Canada; Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Alfred P Gillio
- Pediatric Stem Cell and Cellular Therapy Division, Joseph M Sanzari Children's Hospital at HMH Hackensack University Medical Center, Hackensack, NJ, USA
| | - Hesham Eissa
- Department of Pediatrics, University of Colorado, Aurora, CO, USA; Bone Marrow Transplant and Cellular Therapeutics, Children's Hospital of Colorado, Aurora, CO, USA
| | - Alan P Knutsen
- Pediatric Allergy and Immunology, St Louis University, St Louis, MO, USA; Jeffrey Modell Diagnostic & Research Center for Primary Immunodeficiencies, Cardinal Glennon Children's Hospital, St Louis, MO, USA
| | - Frederick D Goldman
- Division of Hematology/Oncology/BMT, Department of Pediatrics, University of Alabama, Birmingham, AL, USA
| | - Victor M Aquino
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Evan B Shereck
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Theodore B Moore
- Pediatric Blood and Marrow Transplant Program, Division of Pediatric Hematology/Oncology in the Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Emi H Caywood
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Nemours Children's Health, Delaware, Wilmington, DE, USA
| | | | - Jacob Rozmus
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Larisa Broglie
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lolie C Yu
- Louisiana State University Health New Orleans School of Medicine, New Orleans, LA, USA; Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Ami J Shah
- Division of Hematology/Oncology/Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA
| | - Jeffrey R Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Xuerong Liu
- Division of Biostatistics, Medical College of Wisconsin, WI, USA
| | - Roberta E Parrott
- Department of Allergy and Immunology, Department of Pediatrics and Immunology, Duke University Medical Center, Durham, NC, USA
| | - Jasmeen Dara
- Division of Pediatric Allergy, Immunology, and Blood and Marrow Transplantation, University of California San Francisco, CA, USA; UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Susan Prockop
- Department of Pediatrics, Harvard University Medical School, Boston, MA, USA; Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Caridad A Martinez
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Immunology Allergy and Retrovirology, Center for Human Immunobiology, Texas Children's Hospital Infusion Center, Houston, TX, USA
| | - Malika Kapadia
- Department of Pediatrics, Harvard University Medical School, Boston, MA, USA; Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Soma C Jyonouchi
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, PA, USA; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathleen E Sullivan
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, PA, USA; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack J Bleesing
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sonali Chaudhury
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Aleksandra Petrovic
- Fred Hutchinson Cancer Center, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Michael D Keller
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC, USA; Division of Blood and Marrow Transplantation and Center for Cancer and Immunology Research, Children's National Hospital, Washington DC, USA; Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - Troy C Quigg
- Pediatrics, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Pediatric Blood and Marrow Transplant and Cellular Therapy Program, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Suhag Parikh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Shalini Shenoy
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Christine Seroogy
- Division of Allergy, Immunology, and Rheumatology, University of Wisconsin, Madison, WI, USA
| | - Tamar Rubin
- Division of Pediatric Allergy and Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Hélène Decaluwe
- Department of Pediatrics and Department of Microbiology, Immunology and Infectious Diseases, University of Montreal, Montreal, QC, Canada; Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - John M Routes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Troy R Torgerson
- Experimental Immunology, Allen Institute for Immunology, Seattle, WA, USA
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Michael A Pulsipher
- Pediatric Immunology and Blood and Marrow Transplant Program, University of Utah, Salt Lake City, UT, USA; Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - Donald B Kohn
- Pediatric Blood and Marrow Transplant Program, Division of Pediatric Hematology/Oncology in the Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, (NIAID)/NIH, Bethesda, MD, USA
| | - Elie Haddad
- Department of Pediatrics and Department of Microbiology, Immunology and Infectious Diseases, University of Montreal, Montreal, QC, Canada; Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, and Blood and Marrow Transplantation, University of California San Francisco, CA, USA; UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID)/NIH, Bethesda, MD, USA
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Page KM, Spellman SR, Logan BR. Worldwide sources of data in haematology: Importance of clinician-biostatistician collaboration. Best Pract Res Clin Haematol 2023; 36:101450. [PMID: 37353283 DOI: 10.1016/j.beha.2023.101450] [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: 01/06/2023] [Revised: 01/19/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
The field of haematology has benefitted greatly from registry-based observational research. Medical and technical advances, changes in regulations and events such as the global pandemic is changing the landscape for registries. This review describes features of high-quality registries, statistical approaches and study design needed, an overview of worldwide hematologic registries, and how registries are evolving and expanding. The importance of collaborations between biostatisticians and haematologists in designing and conducting registry-related research is highlighted.
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Affiliation(s)
- Kristin M Page
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA.
| | | | - Brent R Logan
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin (MCW), Milwaukee, WI, USA.
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9
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Guru Murthy GS, Logan BR, Bo-Subait S, Beitinjaneh A, Devine S, Farhadfar N, Gowda L, Hashmi S, Lazarus H, Nathan S, Sharma A, Yared JA, Stefanski HE, Pulsipher MA, Hsu JW, Switzer GE, Panch SR, Shaw BE. Association of ABO mismatch with the outcomes of allogeneic hematopoietic cell transplantation for acute leukemia. Am J Hematol 2023; 98:608-619. [PMID: 36606713 PMCID: PMC10290878 DOI: 10.1002/ajh.26834] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/20/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). While many factors influence the outcomes of allo-HCT, the independent impact of donor-recipient ABO mismatching remains unclear. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified patients aged ≥18 years with AML or ALL who underwent allo-HCT between 2008 and 2018. Our objectives were to analyze the outcomes of allo-HCT based on the donor-recipient ABO status (match, minor mismatch, major mismatch, bidirectional mismatch). Among 4946 eligible patients, 2741 patients (55.4%) were ABO matched, 1030 patients (20.8%) had a minor ABO mismatch, 899 patients (18.1%) had a major ABO mismatch, and 276 patients (5.6%) had a bidirectional ABO mismatch. In multivariable analyses, compared to ABO matched allo-HCT, the presence of a major ABO mismatch was associated with worse overall survival (HR 1.16, 95% CI 1.05-1.29; p = 0.005), inferior platelet engraftment (HR 0.83, 95% CI 0.77-0.90; p < 0.001), and higher primary graft failure (HR 1.60, 95% CI 1.12-2.30, p = 0.01). Relapse, acute graft versus host disease (GVHD) grades III-IV and chronic GVHD were not significantly associated with ABO status. While donor age was not significantly associated with outcomes, older recipient age was associated with worse survival and non-relapse mortality. Our study demonstrates that donor-recipient ABO status is independently associated with survival and other post-transplantation outcomes in acute leukemia. This underscores the importance of considering the ABO status in donor selection algorithms and its impact in acute leukemia.
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Affiliation(s)
- Guru Subramanian Guru Murthy
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brent R Logan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephanie Bo-Subait
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota, USA
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Steven Devine
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota, USA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Lohith Gowda
- Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut, USA
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Hillard Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jean A Yared
- Transplantation & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Heather E Stefanski
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota, USA
| | - Michael A Pulsipher
- Division of Hematology and Oncology, Intermountain Primary Children's Hospital, Huntsman Cancer Institute, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - Jack W Hsu
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Galen E Switzer
- Departments of Medicine, Psychiatry, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sandhya R Panch
- Fred Hutchinson Cancer Center/University of Washington, School of Medicine, Seattle, Washington, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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10
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Shaw BE, Jimenez-Jimenez AM, Burns LJ, Logan BR, Khimani F, Shaffer BC, Shah NN, Mussetter A, Tang XY, McCarty JM, Alavi A, Farhadfar N, Jamieson K, Hardy NM, Choe H, Ambinder RF, Anasetti C, Perales MA, Spellman SR, Howard A, Komanduri KV, Luznik L, Norkin M, Pidala JA, Ratanatharathorn V, Confer DL, Devine SM, Horowitz MM, Bolaños-Meade J. Three-Year Outcomes in Recipients of Mismatched Unrelated Bone Marrow Donor Transplants Using Post-Transplantation Cyclophosphamide: Follow-Up from a National Marrow Donor Program-Sponsored Prospective Clinical Trial. Transplant Cell Ther 2023; 29:208.e1-208.e6. [PMID: 36584941 PMCID: PMC9992261 DOI: 10.1016/j.jtct.2022.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
The use of post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis has resulted in reductions in GVHD and improved outcomes in allogeneic hematopoietic cell transplantation (HCT) using HLA-mismatched related donors. We report the 3-year outcomes of the first multicenter prospective clinical trial using PTCy in the setting of mismatched unrelated donor (MMUD) bone marrow HCT. The study enrolled 80 patients, treated with either myeloablative conditioning (MAC; n = 40) or reduced-intensity conditioning (RIC; n = 40), with the primary endpoint of 1-year overall survival (OS). The median follow-up for this study was 34 months (range, 12 to 46 months) in the RIC group and 36 months (range, 18 to 49 months) in the MAC group. Three-year OS and nonrelapse mortality were 70% and 15%, respectively, in the RIC group and 62% and 10% in the MAC group. No GVHD was reported after 1 year. The incidence of relapse was 29% in the RIC group and 51% in the MAC group. OS did not differ based on HLA match grade (63% in the 7/8 strata and 71% in the 4 to 6/8 strata). These encouraging outcomes, which were sustained for 3 years post-HCT, support the continued exploration of MMUD HCT using a PTCy platform. Important future areas to address include relapse reduction and furthering our understanding of optimal donor selection based on HLA and non-HLA factors.
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Affiliation(s)
- Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | | | - Linda J Burns
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Farhad Khimani
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Brian C Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nirav N Shah
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alisha Mussetter
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Xiao-Ying Tang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John M McCarty
- Cellular Immunotherapies and Transplant Program, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Asif Alavi
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Katarzyna Jamieson
- University of North Carolina Hospitals-Chapel Hill, Chapel Hill, North Carolina
| | - Nancy M Hardy
- Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Hannah Choe
- Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Richard F Ambinder
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Claudio Anasetti
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Alan Howard
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Krishna V Komanduri
- Division of Hematology and Oncology, UCSF Health and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Leo Luznik
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Maxim Norkin
- Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Joseph A Pidala
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Steven M Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
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11
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Cusatis R, Martens MJ, Nakamura R, Cutler CS, Saber W, Lee SJ, Logan BR, Shaw BE, Gregory A, D’Souza A, Hamilton BK, Horowitz MM, Flynn KE. Health-related quality of life in reduced-intensity hematopoietic cell transplantation based on donor availability in patients aged 50-75 with advanced myelodysplastic syndrome: BMT CTN 1102. Am J Hematol 2023; 98:229-250. [PMID: 36251401 PMCID: PMC9839494 DOI: 10.1002/ajh.26768] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/19/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 01/17/2023]
Abstract
For myelodysplastic syndrome (MDS), allogeneic hematopoietic cell transplantation (alloHCT) is the only available curative therapy. The Blood and Marrow Transplant Clinical Trials Network study 1102 (BMT CTN 1102, NCT02016781) was a multicenter, biologic assignment trial based on matched donor availability in adults aged 50-75 with higher risk de novo MDS who were candidates for reduced-intensity conditioning (RIC) alloHCT. The primary analysis showed that those who received alloHCT had a survival benefit, but whether this is at the cost of worse quality of life (QOL) has not been described in detail. English- and Spanish-speaking trial participants completed the Functional Assessment of Cancer Therapy-General (FACT-G), the SF-36, and the EQ-5D, at enrollment, every 6 months until 24 months, and 36 months. We compared patient-reported outcome (PRO) scores between study arms using an inverse probability weighted-independent estimating equation (IPW-IEE) model. Between January 2014 and November 2018, 384 subjects (median age 66.7 years, range: 50.1-75.3) enrolled at 34 centers. PRO completion rates were generally high at 65%-78%. The PRO trajectories for both arms were similar, with most decreasing or stable from baseline to 6 months and improving thereafter. Baseline PRO scores were the most consistent independent predictors of subsequent QOL outcomes and survival, even after controlling for clinical and patient-level factors. For older adults with MDS, the survival advantage associated with donor availability and alloHCT did not come at the cost of worse QOL. These results should reassure older patients and clinicians who prefer a curative approach to treating MDS.
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Affiliation(s)
- Rachel Cusatis
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Michael J. Martens
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Corey S. Cutler
- Stem Cell Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA
| | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Stephanie J. Lee
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Brent R. Logan
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Bronwen E. Shaw
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Anita D’Souza
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Betty K. Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Mary M. Horowitz
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Kathryn E. Flynn
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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12
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Broglie L, Friend BD, Chhabra S, Logan BR, Bupp C, Schiller G, Savani BN, Stadtmauer E, Abraham AA, Aljurf M, Badawy SM, Perez MAD, Guinan EC, Hashem H, Krem MM, Lazarus HM, Rotz SJ, Wirk B, Yared JA, Pasquini M, Thakar MS, Sorror ML. Expanded HCT-CI Definitions Capture Comorbidity Better for Younger Patients of Allogeneic HCT for Nonmalignant Diseases. Transplant Cell Ther 2023; 29:125.e1-125.e9. [PMID: 36442768 PMCID: PMC9911359 DOI: 10.1016/j.jtct.2022.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) can cure many nonmalignant conditions, but concern for morbidity and mortality remains. To help physicians estimate patient-specific transplant mortality risk, the HCT comorbidity index (HCT-CI) is used. However, pediatric physicians use the HCT-CI less frequently than adult counterparts. We used the Center for International Blood and Marrow Transplant Research database to expand the HCT-CI comorbidity definitions to be more inclusive of children and adolescent and young adult (AYA) patients, adding history of mechanical ventilation, history of invasive fungal infection, assessment of chronic kidney disease (CKD) by estimated glomerular filtration rate, expanding the definition of obesity, and adding an underweight category. A total of 2815 children and AYAs (<40 years old) who received first allogeneic HCT for nonmalignant diseases from 2008 to 2017 were included to create an expanded youth nonmalignant HCT-CI (expanded ynHCT-CI) and a simplified non-malignant (simplified ynHCT-CI) HCT-CI. The expanded comorbidities occurred frequently-history of mechanical ventilation (9.6%), history of invasive fungal infection (5.9%), mild CKD (12.2%), moderate/severe CKD (2.1%), obesity (10.9%), and underweight (14.5%). Thirty-nine percent of patients had an increase in their comorbidity score using the expanded ynHCT-CI, leading to a redistribution of scores: ynHCT-CI score 0 (35%), 1-2 (36.4%), and ≥3 (28.6%). Patients with an increase in their comorbidity score had an increased hazard of mortality compared to those whose score remained the same (hazard ratio = 1.41; 95% confidence interval, 1.01-1.98). Modifications to the HCT-CI can benefit children and AYA patients with nonmalignant diseases, creating a risk assessment tool that is clinically relevant and better captures comorbidity in this younger population.
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Affiliation(s)
- Larisa Broglie
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian D Friend
- Baylor College of Medicine, Center for Cell and Gene Therapy, Houston, Texas
| | - Saurabh Chhabra
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Brent R Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Caitrin Bupp
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Gary Schiller
- Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward Stadtmauer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Allistair A Abraham
- Center for Cancer and Immunology Research, Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, District of Columbia
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Miguel Angel Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Eva C Guinan
- Departments of Pediatric and Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hasan Hashem
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | | | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Jean A Yared
- Transplantation & Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Marcelo Pasquini
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Monica S Thakar
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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13
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Friend BD, Broglie L, Logan BR, Chhabra S, Bupp C, Schiller G, Beitinjaneh A, Perez MAD, Guilcher GMT, Hashem H, Hildebrandt GC, Krem MM, Lazarus HM, Nishihori T, Nusrat R, Rotz SJ, Wirk B, Wieduwilt M, Pasquini M, Savani BN, Stadtmauer EA, Sorror ML, Thakar MS. Adapting the HCT-CI Definitions for Children, Adolescents, and Young Adults with Hematologic Malignancies Undergoing Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2023; 29:123.e1-123.e10. [PMID: 36442769 PMCID: PMC9911376 DOI: 10.1016/j.jtct.2022.11.019] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Allogeneic hematopoietic cell transplantation is a curative procedure for hematologic malignancies but is associated with a significant risk of non-relapse mortality (NRM). The Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) is a prognostic tool that discriminates this risk in all age groups. A recent survey of transplant physicians demonstrated that 79% of pediatric providers used the HCT-CI infrequently, and most reported concerns about its applicability in the younger population. We conducted a retrospective study using the Center for International Blood and Marrow Transplant Research database to examine the impact of expanded HCT-CI definitions on NRM in pediatric and young adult patients with hematologic malignancies. We included 5790 patients <40 years old receiving allogeneic transplants between 2008 and 2017 to examine broader definitions of comorbidities in the HCT-CI, including history of mechanical ventilation and fungal infection, estimated glomerular filtration rate, and body mass index (BMI) percentiles. Multivariable Fine-Gray models were created to determine the effect of each HCT-CI defining comorbidity and its modification on NRM and were used to develop 2 novel risk scores. We next developed the expanded HCT-CI for children and young adults (youth with malignancies; expanded ymHCT-CI), where 23% patients had an increased comorbidity score, compared to the HCT-CI. Comorbidities with hazard ratio < 1.2 were then removed to create the simplified HCT-CI for children and young adults (youth with malignancies; simplified ymHCT-CI), which demonstrated higher scores corresponded to a greater risk of NRM (P < .001). These novel comorbidity indexes with broader definitions are more relevant to pediatric and young adult patients, and prospective studies are needed to validate these in the younger patient population. It remains to be seen whether the development of these pediatric-specific and practical risk indexes increases their use by the pediatric transplant community.
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Affiliation(s)
- Brian D Friend
- Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas
| | - Larisa Broglie
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brent R Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saurabh Chhabra
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Caitrin Bupp
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Gary Schiller
- Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Miguel Angel Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Gregory M T Guilcher
- Section of Pediatric Oncology/Cellular Therapy, Alberta Children's Hospital, Departments of Oncology and Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Hasan Hashem
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, Florida
| | | | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Matthew Wieduwilt
- Department of Medicine, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Marcelo Pasquini
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward A Stadtmauer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Monica S Thakar
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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14
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Labrosse R, Boufaied I, Bourdin B, Gona S, Randolph HE, Logan BR, Bourbonnais S, Berthe C, Chan W, Buckley RH, Parrott RE, Cuvelier GDE, Kapoor N, Chandra S, Dávila Saldaña BJ, Eissa H, Goldman FD, Heimall J, O'Reilly R, Chaudhury S, Kolb EA, Shenoy S, Griffith LM, Pulsipher M, Kohn DB, Notarangelo LD, Pai SY, Cowan MJ, Dvorak CC, Haddad É, Puck JM, Barreiro LB, Decaluwe H. Aberrant T-cell exhaustion in severe combined immunodeficiency survivors with poor T-cell reconstitution after transplantation. J Allergy Clin Immunol 2023; 151:260-271. [PMID: 35987350 PMCID: PMC9924130 DOI: 10.1016/j.jaci.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Severe combined immunodeficiency (SCID) comprises rare inherited disorders of immunity that require definitive treatment through hematopoietic cell transplantation (HCT) or gene therapy for survival. Despite successes of allogeneic HCT, many SCID patients experience incomplete immune reconstitution, persistent T-cell lymphopenia, and poor long-term outcomes. OBJECTIVE We hypothesized that CD4+ T-cell lymphopenia could be associated with a state of T-cell exhaustion in previously transplanted SCID patients. METHODS We analyzed markers of exhaustion in blood samples from 61 SCID patients at a median of 10.4 years after HCT. RESULTS Compared to post-HCT SCID patients with normal CD4+ T-cell counts, those with poor T-cell reconstitution showed lower frequency of naive CD45RA+/CCR7+ T cells, recent thymic emigrants, and TCR excision circles. They also had a restricted TCR repertoire, increased expression of inhibitory receptors (PD-1, 2B4, CD160, BTLA, CTLA-4), and increased activation markers (HLA-DR, perforin) on their total and naive CD8+ T cells, suggesting T-cell exhaustion and aberrant activation, respectively. The exhaustion score of CD8+ T cells was inversely correlated with CD4+ T-cell count, recent thymic emigrants, TCR excision circles, and TCR diversity. Exhaustion scores were higher among recipients of unconditioned HCT, especially when further in time from HCT. Patients with fewer CD4+ T cells showed a transcriptional signature of exhaustion. CONCLUSIONS Recipients of unconditioned HCT for SCID may develop late post-HCT T-cell exhaustion as a result of diminished production of T-lineage cells. Elevated expression of inhibitory receptors on their T cells may be a biomarker of poor long-term T-cell reconstitution.
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Affiliation(s)
- Roxane Labrosse
- Pediatric Immunology and Rheumatology Division, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Ines Boufaied
- Cytokines and Adaptive Immunity Laboratory, Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
| | - Benoîte Bourdin
- Cytokines and Adaptive Immunity Laboratory, Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
| | - Saideep Gona
- Genetics, Genomics, and Systems Biology, Department of Medicine, Section of Genetic Medicine, University of Chicago, Chicago, Ill
| | - Haley E Randolph
- Genetics, Genomics, and Systems Biology, Department of Medicine, Section of Genetic Medicine, University of Chicago, Chicago, Ill
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wis
| | - Sara Bourbonnais
- Cytokines and Adaptive Immunity Laboratory, Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
| | - Chloé Berthe
- Cytokines and Adaptive Immunity Laboratory, Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
| | - Wendy Chan
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California, San Francisco, and UCSF Benioff Children's Hospital, San Francisco, Calif
| | | | | | - Geoffrey D E Cuvelier
- Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Neena Kapoor
- Blood and Marrow Transplant Program, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Blachy J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Hesham Eissa
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Fred D Goldman
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Ala
| | - Jennifer Heimall
- Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Richard O'Reilly
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sonali Chaudhury
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Edward A Kolb
- Nemours Children's Health, Center for Cancer and Blood Disorders, Wilmington, Del
| | - Shalini Shenoy
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | - Linda M Griffith
- Division of Allergy, Immunology, and Transplantation, National Institutes of Health, Bethesda, Md
| | - Michael Pulsipher
- Blood and Marrow Transplant Program, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Donald B Kohn
- Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Calif
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Health, Bethesda, Md
| | - Sung-Yun Pai
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md
| | - Morton J Cowan
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California, San Francisco, and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Christopher C Dvorak
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California, San Francisco, and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Élie Haddad
- Pediatric Immunology and Rheumatology Division, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Jennifer M Puck
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California, San Francisco, and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Luis B Barreiro
- Genetics, Genomics, and Systems Biology, Department of Medicine, Section of Genetic Medicine, University of Chicago, Chicago, Ill
| | - Hélène Decaluwe
- Pediatric Immunology and Rheumatology Division, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada; Cytokines and Adaptive Immunity Laboratory, Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada.
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15
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DeZern AE, Eapen M, Wu J, Talano JA, Solh M, Dávila Saldaña BJ, Karanes C, Horwitz ME, Mallhi K, Arai S, Farhadfar N, Hexner E, Westervelt P, Antin JH, Deeg HJ, Leifer E, Brodsky RA, Logan BR, Horowitz MM, Jones RJ, Pulsipher MA. Haploidentical bone marrow transplantation in patients with relapsed or refractory severe aplastic anaemia in the USA (BMT CTN 1502): a multicentre, single-arm, phase 2 trial. Lancet Haematol 2022; 9:e660-e669. [PMID: 35907408 PMCID: PMC9444987 DOI: 10.1016/s2352-3026(22)00206-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Relapsed severe aplastic anaemia is a marrow failure disorder with high morbidity and mortality. It is often treated with bone marrow transplantation at relapse post-immunosuppressive therapy, but under-represented minorities often cannot find a suitably matched donor. This study aimed to understand the 1-year overall survival in patients with relapsed or refractory severe aplastic anaemia after haploidentical bone marrow transplantation. METHODS We report the outcomes of BMT CTN 1502, a single-arm, phase 2 clinical trial done at academic bone marrow transplantation centres in the USA. Included patients were children and adults (75 years or younger) with severe aplastic anaemia that was refractory (fulfilment of severe aplastic anaemia disease criteria at least 3 months after initial immunosuppressive therapy) or relapsed (initial improvement of cytopenias after first-line immunosuppressive therapy but then a later return to fulfilment of severe aplastic anaemia disease criteria), adequate performance status (Eastern Cooperative Oncology Group score 0 or 1, Karnofsky or Lansky score ≥60%), and the presence of an eligible related haploidentical donor. The regimen used reduced-intensity conditioning (rabbit anti-thymocyte globulin 4·5 mg/kg in total, cyclophosphamide 14·5 mg/kg daily for 2 days, fludarabine 30 mg/m2 daily for 5 days, total body irradiation 200 cGy in a single fraction), related HLA-haploidentical donors, and post-transplantation cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis. Additionally, for GVHD prophylaxis, mycophenolate mofetil was given orally at a dose of 15 mg/kg three times a day up to 1 g three times a day (maximum dose 3000 mg per day) from day 5 to day 35, and tacrolimus was given orally or intravenously from day 5 to day 180 as per institutional standards to maintain a serum concentration of 10-15 ng/mL. The primary endpoint was overall survival 1 year after bone marrow transplantation. All patients treated per protocol were analysed. This study is complete and is registered with ClinicalTrials.gov, NCT02918292. FINDINGS Between May 1, 2017, and Aug 30, 2020, 32 patients with relapsed or refractory severe aplastic anaemia were enrolled from 14 centres, and 31 underwent bone marrow transplantation. The median age was 24·9 years (IQR 10·4-51·3), and median follow-up was 24·3 months (IQR 12·1-29·2). Of the 31 patients who received a transplant, 19 (61%) were male and 12 (39%) female. 13 (42%) patients were site-reported as non-White, and 19 (61%) were from under-represented racial and ethnic groups; there were four (13%) patients who were Asian, seven (23%) Black, one (3%) Hawaiian/Pacific Islander, and one (3%) more than one race, with seven (23%) patients reporting Hispanic ethnicity. 24 (77%) of 31 patients were alive with engraftment at 1 year, and one (3%) patient alive with autologous recovery. The 1-year overall survival was 81% (95% CI 62-91). The most common grade 3-5 adverse events (seen in seven or more patients) included seven (23%) patients with abnormal liver tests, 15 (48%) patients with cardiovascular changes (including sinus tachycardia, heart failure, pericarditis), ten (32%) patients with gastrointestinal issues, seven (23%) patients with nutritional disorders, and eight (26%) patients with respiratory disorders. Six (19%) deaths, due to disease and unsuccessful bone marrow transplantation, were reported after transplantation. INTERPRETATION Haploidentical bone marrow transplantation using this approach results in excellent overall survival with minimal GVHD in patients who have not responded to immunosuppressive therapy, and can expand access to bone marrow transplantation across all populations. In clinical practice, this could now be considered a standard approach for salvage treatment of severe aplastic anaemia. Attention to obtaining high cell doses (>2·5 × 108 nucleated marrow cells per kg of recipient ideal bodyweight) from bone marrow harvests is crucial to the success of this approach. FUNDING US National Heart, Lung, and Blood Institute and US National Cancer Institute.
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Affiliation(s)
- Amy E DeZern
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
| | - Mary Eapen
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Juan Wu
- The EMMES Company, Rockville, MD, USA
| | - Julie-An Talano
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | | | | | | | - Sally Arai
- Blood and Marrow Transplantation and Cellular Therapy Division, Stanford University, Stanford, CA, USA
| | - Nosha Farhadfar
- UF Health Bone Marrow Transplant, University of Florida, Gainesville, FL, USA
| | - Elizabeth Hexner
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | | | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eric Leifer
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Robert A Brodsky
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Brent R Logan
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mary M Horowitz
- Division of Hematologic Malignancies, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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16
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Cuvelier GDE, Logan BR, Prockop SE, Buckley RH, Kuo CY, Griffith LM, Liu X, Yip A, Hershfield MS, Ayoub PG, Moore TB, Dorsey MJ, O'Reilly RJ, Kapoor N, Pai SY, Kapadia M, Ebens CL, Forbes Satter LR, Burroughs LM, Petrovic A, Chellapandian D, Heimall J, Shyr DC, Rayes A, Bednarski JJ, Chandra S, Chandrakasan S, Gillio AP, Madden L, Quigg TC, Caywood EH, Dávila Saldaña BJ, DeSantes K, Eissa H, Goldman FD, Rozmus J, Shah AJ, Vander Lugt MT, Thakar MS, Parrott RE, Martinez C, Leiding JW, Torgerson TR, Pulsipher MA, Notarangelo LD, Cowan MJ, Dvorak CC, Haddad E, Puck JM, Kohn DB. Outcomes following treatment for ADA-deficient severe combined immunodeficiency: a report from the PIDTC. Blood 2022; 140:685-705. [PMID: 35671392 PMCID: PMC9389638 DOI: 10.1182/blood.2022016196] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/04/2022] [Accepted: 05/21/2022] [Indexed: 11/20/2022] Open
Abstract
Adenosine deaminase (ADA) deficiency causes ∼13% of cases of severe combined immune deficiency (SCID). Treatments include enzyme replacement therapy (ERT), hematopoietic cell transplant (HCT), and gene therapy (GT). We evaluated 131 patients with ADA-SCID diagnosed between 1982 and 2017 who were enrolled in the Primary Immune Deficiency Treatment Consortium SCID studies. Baseline clinical, immunologic, genetic characteristics, and treatment outcomes were analyzed. First definitive cellular therapy (FDCT) included 56 receiving HCT without preceding ERT (HCT); 31 HCT preceded by ERT (ERT-HCT); and 33 GT preceded by ERT (ERT-GT). Five-year event-free survival (EFS, alive, no need for further ERT or cellular therapy) was 49.5% (HCT), 73% (ERT-HCT), and 75.3% (ERT-GT; P < .01). Overall survival (OS) at 5 years after FDCT was 72.5% (HCT), 79.6% (ERT-HCT), and 100% (ERT-GT; P = .01). Five-year OS was superior for patients undergoing HCT at <3.5 months of age (91.6% vs 68% if ≥3.5 months, P = .02). Active infection at the time of HCT (regardless of ERT) decreased 5-year EFS (33.1% vs 68.2%, P < .01) and OS (64.7% vs 82.3%, P = .02). Five-year EFS (90.5%) and OS (100%) were best for matched sibling and matched family donors (MSD/MFD). For patients treated after the year 2000 and without active infection at the time of FDCT, no difference in 5-year EFS or OS was found between HCT using a variety of transplant approaches and ERT-GT. This suggests alternative donor HCT may be considered when MSD/MFD HCT and GT are not available, particularly when newborn screening identifies patients with ADA-SCID soon after birth and before the onset of infections. This trial was registered at www.clinicaltrials.gov as #NCT01186913 and #NCT01346150.
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Affiliation(s)
- Geoffrey D E Cuvelier
- Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Susan E Prockop
- Stem Cell Transplant Service, Dana Farber Cancer Institute/Boston Children's Hospital, Boston, MA
| | | | - Caroline Y Kuo
- Division of Allergy, Immunology, Rheumatology, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, National Institutes of Allergy, National Institutes of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD
| | - Xuerong Liu
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Alison Yip
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | | | - Paul G Ayoub
- Microbiology, Immunology & Molecular Genetics, University of California, Los Angeles, CA
| | - Theodore B Moore
- Department of Pediatric Hematology-Oncology, Mattel Children's Hospital, University of California, Los Angeles, CA
| | - Morna J Dorsey
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Richard J O'Reilly
- Stem Cell Transplantation and Cellular Therapy, MSK Kids, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Neena Kapoor
- Division of Hematology, Oncology and Blood and Marrow Transplant, Children's Hospital, Los Angeles, CA
| | - Sung-Yun Pai
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Malika Kapadia
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Christen L Ebens
- Division of Pediatric Blood and Marrow Transplant and Cellular Therapy, MHealth Fairview Masonic Children's Hospital, Minneapolis, MN
| | - Lisa R Forbes Satter
- Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Lauri M Burroughs
- Fred Hutchinson Cancer Research Center, University of Washington, Department of Pediatrics and Seattle Children's Hospital, Seattle, WA
| | - Aleksandra Petrovic
- Fred Hutchinson Cancer Research Center, University of Washington, Department of Pediatrics and Seattle Children's Hospital, Seattle, WA
| | - Deepak Chellapandian
- Center for Cell and Gene Therapy for Non-Malignant Conditions, Johns Hopkins All Children's Hospital, St Petersburg, FL
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - David C Shyr
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA
| | - Ahmad Rayes
- Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | | | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Alfred P Gillio
- Children's Cancer Institute, Hackensack University Medical Center, Hackensack, NJ
| | - Lisa Madden
- Methodist Children's Hospital of South Texas, San Antonio, TX
| | - Troy C Quigg
- Pediatric Blood and Marrow Transplant and Cellular Therapy Program, Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Emi H Caywood
- Nemours Children's Health, Thomas Jefferson University, Wilmington, DE
| | | | - Kenneth DeSantes
- Division of Pediatric Hematology-Oncology & Bone Marrow Transplant, University of Wisconsin, American Family Children's Hospital, Madison, WI
| | - Hesham Eissa
- Division of Pediatric Hematology-Oncology-BMT, Aurora, CO
| | - Frederick D Goldman
- Division of Pediatric Hematology and Oncology and Bone Marrow Transplant, University of Alabama at Birmingham, Birmingham, AL
| | - Jacob Rozmus
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Ami J Shah
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA
| | - Mark T Vander Lugt
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI
| | - Monica S Thakar
- Fred Hutchinson Cancer Research Center, University of Washington, Department of Pediatrics and Seattle Children's Hospital, Seattle, WA
| | | | - Caridad Martinez
- Hematology/Oncology/BMT, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Johns Hopkins University, St Petersburg, FL
| | | | - Michael A Pulsipher
- Division of Pediatric Hematology and Oncology, Intermountain Primary Children's Hospital, Huntsman Cancer Institute at the University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD; and
| | - Morton J Cowan
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Christopher C Dvorak
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Elie Haddad
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Jennifer M Puck
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Donald B Kohn
- Microbiology, Immunology & Molecular Genetics, University of California, Los Angeles, CA
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17
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Wingard JR, Alexander BD, Baden LR, Chen M, Sugrue MW, Leather HL, Caliendo AM, Clancy CJ, Denning DW, Marty FM, Nguyen MH, Wheat LJ, Logan BR, Horowitz MM, Marr KA. Impact of Changes of the 2020 Consensus Definitions of Invasive Aspergillosis on Clinical Trial Design: Unintended Consequences for Prevention Trials? Open Forum Infect Dis 2021; 8:ofab441. [PMID: 34631917 PMCID: PMC8496761 DOI: 10.1093/ofid/ofab441] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022] Open
Abstract
Background Consensus definitions for the diagnosis of invasive fungal diseases (IFDs) were updated in 2020 to increase the certainty of IFD for inclusion in clinical trials, for instance by increasing biomarker cutoff limits to define positivity. To date, there is a paucity of data as to the impact of the revised definitions on clinical trials. Methods In this study, we sought to determine the impact of the new definitions on classifying invasive aspergillosis (IA), the most common invasive mold disease in immunocompromised patients. We reclassified 226 proven and probable IA cases plus 139 possible IFD cases in the Aspergillus Technology Consortium (AsTeC) and in an antifungal prophylaxis trial (BMT CTN 0101) using the new criteria. Results Fewer cases met the more stringent diagnostic 2020 criteria after applying the reclassification criteria to define probable IA. Of 188 evaluable probable cases, 41 (22%) were reclassified to 40 possible IA and 1 probable IFD. Reclassification to possible IFD occurred in 22% of hematologic malignancy (HM) patients, 29% of hematopoietic cell transplant (HCT) patients, and in no lung transplant (LT) patients. Date of diagnosis was established a median (range) of 3 (1–105) days later in 15% of probable IA cases using the new criteria. Applying the new definitions to the BMT CTN 0101 trial, the power to detect the same odds ratio decreased substantially. Conclusions The updated IA consensus definitions may impact future trial designs, especially for antifungal prophylaxis studies.
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Affiliation(s)
- John R Wingard
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Barbara D Alexander
- Departments of Medicine and Pathology, Duke University, Durham, North Carolina, USA
| | - Lindsey R Baden
- Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Min Chen
- CIBMTR Milwaukee, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michele W Sugrue
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Helen L Leather
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Angela M Caliendo
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Cornelius J Clancy
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Francisco M Marty
- Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Brent R Logan
- CIBMTR Milwaukee, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary M Horowitz
- CIBMTR Milwaukee, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kieren A Marr
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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18
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Logan BR, Maiers MJ, Sparapani RA, Laud PW, Spellman SR, McCulloch RE, Shaw BE. Optimal Donor Selection for Hematopoietic Cell Transplantation Using Bayesian Machine Learning. JCO Clin Cancer Inform 2021; 5:494-507. [PMID: 33950708 DOI: 10.1200/cci.20.00185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Donor selection practices for matched unrelated donor (MUD) hematopoietic cell transplantation (HCT) vary, and the impact of optimizing donor selection in a patient-specific way using modern machine learning (ML) models has not been studied. METHODS We trained a Bayesian ML model in 10,318 patients who underwent MUD HCT from 1999 to 2014 to provide patient- and donor-specific predictions of clinically severe (grade 3 or 4) acute graft-versus-host disease or death by day 180. The model was validated in 3,501 patients from 2015 to 2016 with archived records of potential donors at search. Donor selection optimizing predicted outcomes was implemented over either an unlimited donor pool or the donors in the search archives. Posterior mean differences in outcomes from optimal donor selection versus actual practice were summarized per patient and across the population with 95% intervals. RESULTS Event rates were 33% (training) and 37% (validation). Among donor features, only age affected outcomes, with the effect consistent regardless of patient features. The median (interquartile range) difference in age between the youngest donor at search and the selected donor was 6 (1-10) years, whereas the number of donors per patient younger than the selected donor was 6 (1-36). Fourteen percent of the validation data set had an approximate 5% absolute reduction in event rates from selecting the youngest donor at search versus the actual donor used, leading to an absolute population reduction of 1% (95% interval, 0 to 3). CONCLUSION We confirmed the singular importance of selecting the youngest available MUD, irrespective of patient features, identified potential for improved HCT outcomes by selecting a younger MUD, and demonstrated use of novel ML models transferable to optimize other complex treatment decisions in a patient-specific way.
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Affiliation(s)
- Brent R Logan
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin (MCW), Milwaukee, WI.,Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI
| | - Martin J Maiers
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Rodney A Sparapani
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin (MCW), Milwaukee, WI
| | - Purushottam W Laud
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin (MCW), Milwaukee, WI
| | - Stephen R Spellman
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Robert E McCulloch
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI
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19
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Shaw BE, Jimenez-Jimenez AM, Burns LJ, Logan BR, Khimani F, Shaffer BC, Shah NN, Mussetter A, Tang XY, McCarty JM, Alavi A, Farhadfar N, Jamieson K, Hardy NM, Choe H, Ambinder RF, Anasetti C, Perales MA, Spellman SR, Howard A, Komanduri KV, Luznik L, Norkin M, Pidala JA, Ratanatharathorn V, Confer DL, Devine SM, Horowitz MM, Bolaños-Meade J. National Marrow Donor Program-Sponsored Multicenter, Phase II Trial of HLA-Mismatched Unrelated Donor Bone Marrow Transplantation Using Post-Transplant Cyclophosphamide. J Clin Oncol 2021; 39:1971-1982. [PMID: 33905264 PMCID: PMC8260905 DOI: 10.1200/jco.20.03502] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [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: 12/03/2020] [Revised: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Hematopoietic cell transplantation (HCT) is curative for hematologic disorders, but outcomes are historically inferior when using HLA-mismatched donors. Despite unrelated donor registries listing > 38 million volunteers, 25%-80% of US patients lack an HLA-matched unrelated donor, with significant disparity across ethnic groups. We hypothesized that HCT with a mismatched unrelated donor (MMUD) using post-transplant cyclophosphamide (PTCy), a novel strategy successful in overcoming genetic disparity using mismatched related donors, would be feasible and increase access to HCT. PATIENTS AND METHODS We performed a prospective phase II study of MMUD bone marrow HCT with PTCy for patients with hematologic malignancies. The primary end point was 1-year overall survival (OS), hypothesized to be 65% or better. 80 patients enrolled at 11 US transplant centers (December 2016-March 2019). Following myeloablative or reduced-intensity conditioning-based HCT, patients received PTCy on days +3, +4, with sirolimus and mycophenolate mofetil starting on day +5. We compared outcomes to Center for International Blood and Marrow Transplant Research contemporary controls receiving PTCy. RESULTS Notably, 48% of patients enrolled were ethnic minorities. 39% of pairs were matched for 4-6 out of 8 HLA alleles. The primary end point was met, with 1-year OS of 76% (90% CI, 67.3 to 83.3) in the entire cohort, and 72% and 79% in the myeloablative and reduced-intensity conditioning strata, respectively. Secondary end points related to engraftment and graft-versus-host-disease were reached. Multivariate analysis comparing the study group with other mismatched HCT controls found no significant differences in OS. CONCLUSION Our prospective study demonstrates the feasibility and effectiveness of HCT with an MMUD in the setting of PTCy. Remarkably, nearly half of the study participants belonged to an ethnic minority population, suggesting this approach may significantly expand access to HCT.
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Affiliation(s)
- Bronwen E. Shaw
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
| | | | - Linda J. Burns
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
| | - Brent R. Logan
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
| | - Farhad Khimani
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Brian C. Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nirav N. Shah
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Alisha Mussetter
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | - Xiao-Ying Tang
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
| | - John M. McCarty
- Massey Cancer Center Bone Marrow Transplant Program, Virginia Commonwealth University, Richmond, VA
| | - Asif Alavi
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL
| | | | - Nancy M. Hardy
- Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Hannah Choe
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Richard F. Ambinder
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen R. Spellman
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | - Alan Howard
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | | | - Leo Luznik
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Maxim Norkin
- LifeSouth Community Blood Centers, Baptist MD Anderson Cancer Center, Jacksonville, FL
| | | | - Voravit Ratanatharathorn
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Dennis L. Confer
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | - Steven M. Devine
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | - Mary M. Horowitz
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
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20
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Seftel MD, Chitphakdithai P, Miller JP, Kobusingye H, Logan BR, Linenberger M, Artz AS, Haight AE, Jacobsohn DA, Litzow MR, Magalhaes-Silverman M, Selby GB, Vusirikala M, Horowitz MM, Switzer GE, Confer DL, Shaw BE, Pulsipher MA. Serious Adverse Events in Related Donors: A Report from the Related Donor Safe Study. Transplant Cell Ther 2021; 27:352.e1-352.e5. [PMID: 33836890 PMCID: PMC8036235 DOI: 10.1016/j.jtct.2021.01.009] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
The incidence and risk factors for severe adverse events (SAEs) in related donors (RD) of hematopoietic cell transplants is unknown. The Related Donor Safe study is a prospective observational cohort of 1680 RDs and represents an opportunity to examine characteristics of SAEs in RDs. In this cohort, we found that SAEs were reported in a total 12 (0.71%) RDs. Of these, 5 SAEs occurred in bone marrow donors (5/404, 1.24%), and 7 (7/1276, 0.55%) were in donors of peripheral blood stem cells. All of the SAEs were considered to be related (definite, probable, or possible) to the donation process. There were no donor fatalities. Of the 12 RDs who experienced an SAE, 10 were either overweight or obese. Five of the 12 RDs had predonation medical conditions that would have resulted in either possible or definite ineligibility for donation were they being assessed as unrelated donors. These SAE data will be useful in the counseling of prospective RDs before planned donation and may be helpful in identifying donors who should be considered medically unsuitable for donation.
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Affiliation(s)
- Matthew D Seftel
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - David A Jacobsohn
- Children's National Medical Center, Washington, District of Columbia
| | | | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, Oklahoma
| | | | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Michael A Pulsipher
- Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, California
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21
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Hsu JW, Farhadfar N, Murthy H, Logan BR, Bo-Subait S, Frey N, Goldstein SC, Horowitz MM, Lazarus H, Schwanke JD, Shah NN, Spellman SR, Switzer GE, Devine SM, Shaw BE, Wingard JR. The Effect of Donor Graft Cryopreservation on Allogeneic Hematopoietic Cell Transplantation Outcomes: A Center for International Blood and Marrow Transplant Research Analysis. Implications during the COVID-19 Pandemic. Transplant Cell Ther 2021; 27:507-516. [PMID: 33865804 DOI: 10.1016/j.jtct.2021.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/26/2020] [Revised: 03/05/2021] [Accepted: 03/14/2021] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic has resulted in the increased use of cryopreserved grafts for allogeneic hematopoietic cell transplantation (HCT). However, information about the effect of cryopreservation on outcomes for patients receiving allogeneic donor grafts is limited. We evaluated outcomes of HCT recipients who received either fresh or cryopreserved allogeneic bone marrow (BM) or peripheral blood stem cell (PBSC) grafts reported to the Center for International Blood and Marrow Transplant Research. A total of 7397 patients were included in the analysis. Recipients of cryopreserved graft were divided into 3 cohorts based on graft source: HLA-matched related PBSC donors (n = 1051), matched unrelated PBSC donors (n = 678), and matched related or unrelated BM donors (n = 154). These patients were propensity score matched with 5514 patients who received fresh allografts. The primary endpoint was engraftment. Multivariate analyses showed no significant increased risk of delayed engraftment, relapse, nonrelapse mortality (NRM), or survival with cryopreservation of BM grafts. In contrast, cryopreservation of related donor PBSC grafts was associated with decreased platelet recovery (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.68 to 0.78; P < .001) and an increased risk of grade II-IV (HR, 1.27; 95% CI, 1.09 to 1.48; P = .002) and grade III-IV (HR, 1.48; 95% CI, 1.19 to 1.84; P < .001) acute graft-versus-host disease. Cryopreservation of unrelated PBSC grafts was associated with delayed engraftment of neutrophils (HR, 0.77; 95% CI, 0.71 to 0.84; P < .001) and platelets (HR, 0.61; 95% CI, 0.56 to 0.66; P < .001) as well as an increased risk of NRM (HR, 1.4; 95% CI, 1.18 to 1.66; P < .001) and relapse (HR, 1.32; 95% CI, 1.11 to 1.58; P = .002) and decreased progression-free survival (HR, 1.36; 95% CI, 1.20 to 1.55; P < .001) and overall survival (OS) (HR, 1.38; 95% CI, 1.22 to 1.58; P < .001). Reasons for cryopreservation were not routinely collected; however, in a subset of unrelated donor HCT recipients, the reason was typically a change in patient condition. Products cryopreserved for patient reasons were significantly associated with inferior OS in multivariate analysis (HR, 0.65; 95% CI, 0.44 to 0.96; P = .029). We conclude that cryopreservation is associated with slower engraftment of PBSC grafts, which may be associated with inferior transplantation outcomes in some patient populations. However, the small numbers in the cryopreserved BM cohort and the lack of information on the reason for cryopreservation in all patients suggests that these data should be interpreted with caution, particularly in the context of the risks associated with unexpected loss of a graft during the pandemic. Future analyses addressing outcomes when cryopreservation is universally applied are urgently required.
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Affiliation(s)
- Jack W Hsu
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida.
| | - Nosha Farhadfar
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida.
| | - Hemant Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Stephanie Bo-Subait
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
| | - Noelle Frey
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania.
| | - Steven C Goldstein
- AdventHealth Medical Group Blood & Marrow Transplant at Orlando, Orlando, Florida.
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Hillard Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - Joshua D Schwanke
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland.
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
| | - Galen E Switzer
- Professor of Medicine at University of Pittsburgh Medical Center-Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Steven M Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida.
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22
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Dillon LW, Gui G, Logan BR, Fei M, Ghannam J, Li Y, Licon A, Alyea EP, Bashey A, Devine SM, Fernandez HF, Giralt S, Hamadani M, Howard A, Maziarz RT, Porter DL, Warlick ED, Pasquini MC, Scott BL, Horwitz ME, Deeg HJ, Hourigan CS. Impact of Conditioning Intensity and Genomics on Relapse After Allogeneic Transplantation for Patients With Myelodysplastic Syndrome. JCO Precis Oncol 2021; 5:PO.20.00355. [PMID: 34036237 PMCID: PMC8140814 DOI: 10.1200/po.20.00355] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2020] [Accepted: 12/14/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Patients with myelodysplastic syndrome (MDS) are at risk of relapse after allogeneic hematopoietic cell transplantation. The utility of ultra-deep genomic testing to predict and the impact of conditioning intensity to prevent MDS relapse are unknown. METHODS Targeted error-corrected DNA sequencing was performed on preconditioning blood samples from patients with MDS (n = 48) from the Blood and Marrow Transplant Clinical Trials Network 0901 phase III randomized clinical trial, which compared outcomes by allogeneic hematopoietic cell transplantation conditioning intensity in adult patients with < 5% marrow myeloblasts and no leukemic myeloblasts in blood on morphological analysis at the time of pretransplant assessment. Clinical end points (53-month median follow-up) included transplant-related mortality (TRM), relapse, relapse-free survival (RFS), and overall survival (OS). Of the 48 patients examined, 14 experienced TRM, 23 are relapse-free, and 11 relapsed, of which 7 died. RESULTS Using a previously described set of 10 gene regions, 42% of patients (n = 20) had mutations detectable before random assignment to reduced intensity conditioning (RIC) or myeloablative conditioning (MAC). Testing positive was associated with increased rates of relapse (3-year relapse, 40% v 11%; P = .022) and decreased OS (3-year OS, 55% v 79%, P = .045). In those testing positive, relapse rates were higher (3-year relapse, 75% v 17%; P = .003) and RFS was lower (3-year RFS, 13% v 49%; P = .003) in RIC versus MAC arms. Testing additional genes, including those associated with MDS, did not improve prognostication. CONCLUSION This study provides evidence that targeted DNA sequencing in patients with MDS before transplant can identify those with highest post-transplant relapse rates. In those testing positive, random assignment to MAC lowered but did not eliminate relapse risk.
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Affiliation(s)
- Laura W. Dillon
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Gege Gui
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Jack Ghannam
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Yuesheng Li
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | - Steven M. Devine
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alan Howard
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Richard T. Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | - Christopher S. Hourigan
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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23
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Martens MJ, Logan BR. A unified approach to sample size and power determination for testing parameters in generalized linear and time-to-event regression models. Stat Med 2020; 40:1121-1132. [PMID: 33210321 DOI: 10.1002/sim.8823] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 11/09/2022]
Abstract
To ensure that a study can properly address its research aims, the sample size and power must be determined appropriately. Covariate adjustment via regression modeling permits more precise estimation of the effect of a primary variable of interest at the expense of increased complexity in sample size/power calculation. The presence of correlation between the main variable and other covariates, commonly seen in observational studies and non-randomized clinical trials, further complicates this process. Though sample size and power specification methods have been obtained to accommodate specific covariate distributions and models, most existing approaches rely on either simple approximations lacking theoretical support or complex procedures that are difficult to apply at the design stage. The current literature lacks a general, coherent theory applicable to a broader class of regression models and covariate distributions. We introduce succinct formulas for sample size and power determination with the generalized linear, Cox, and Fine-Gray models that account for correlation between a main effect and other covariates. Extensive simulations demonstrate that this method produces studies that are appropriately sized to meet their type I error rate and power specifications, particularly offering accurate sample size/power estimation in the presence of correlated covariates.
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Affiliation(s)
- Michael J Martens
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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24
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Martens MJ, Logan BR. Group sequential tests for treatment effect on survival and cumulative incidence at a fixed time point. Lifetime Data Anal 2020; 26:603-623. [PMID: 31729633 PMCID: PMC7365590 DOI: 10.1007/s10985-019-09491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
Medical research frequently involves comparing an event time of interest between treatment groups. Rather than comparing the entire survival or cumulative incidence curves, it is sometimes preferable to evaluate these probabilities at a fixed point in time. Performing a covariate adjusted analysis can improve efficiency, even in randomized clinical trials, but no currently available group sequential test for fixed point analysis provides this adjustment. This paper introduces covariate adjusted group sequential pointwise comparisons of survival and cumulative incidence probabilities. Their test statistics have an asymptotic distribution with independent increments, permitting use of common stopping boundary specification methods. These tests are demonstrated through a redesign of BMT CTN 0402, a clinical trial that evaluated a prophylactic treatment for adverse outcomes following blood and marrow transplantation. A simulation study demonstrates that these tests maintain the type I error rate and power at nominal levels under a variety of settings involving influential covariates.
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Affiliation(s)
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
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25
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Farhadfar N, Murthy HS, Logan BR, Sees JA, Ayas M, Battiwalla M, Beitinjaneh AM, Chhabra S, Diaz MA, Engles K, Frangoul H, Ganguly S, Gergis U, Kamani NR, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Norkin M, O' Donnell PV, Olsson RF, Rossmann S, Savani BN, Schears R, Seo S, Solh MM, Spitzer T, Sugrue M, Yared JA, Linenberger M, Schwartz J, Pulsipher MA, Shah NN, Switzer GE, Confer DL, Shaw BE, Wingard JR. Correction: Impact of autologous blood transfusion after bone marrow harvest on unrelated donor's health and outcome: a CIBMTR analysis. Bone Marrow Transplant 2020; 56:522. [PMID: 32514157 DOI: 10.1038/s41409-020-0963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nosha Farhadfar
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Brent R Logan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Sees
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Katie Engles
- CW Bill Young Marrow Donor Program, Kensington, MD, USA
| | - Haydar Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
| | | | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | | | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jane L Liesveld
- Strong Memorial Hospital-University of Rochester Medical Center, Rochester, NY, USA
| | - Maxim Norkin
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | | | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raquel Schears
- Department of Emergency Medicine, Mayo Medical School, Rochester, MN, USA
| | | | - Melhem M Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | | | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | | | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Dennis L Confer
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.,National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
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26
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Burroughs LM, Petrovic A, Brazauskas R, Liu X, Griffith LM, Ochs HD, Bleesing JJ, Edwards S, Dvorak CC, Chaudhury S, Prockop SE, Quinones R, Goldman FD, Quigg TC, Chandrakasan S, Smith AR, Parikh S, Dávila Saldaña BJ, Thakar MS, Phelan R, Shenoy S, Forbes LR, Martinez C, Chellapandian D, Shereck E, Miller HK, Kapoor N, Barnum JL, Chong H, Shyr DC, Chen K, Abu-Arja R, Shah AJ, Weinacht KG, Moore TB, Joshi A, DeSantes KB, Gillio AP, Cuvelier GDE, Keller MD, Rozmus J, Torgerson T, Pulsipher MA, Haddad E, Sullivan KE, Logan BR, Kohn DB, Puck JM, Notarangelo LD, Pai SY, Rawlings DJ, Cowan MJ. Excellent outcomes following hematopoietic cell transplantation for Wiskott-Aldrich syndrome: a PIDTC report. Blood 2020; 135:2094-2105. [PMID: 32268350 PMCID: PMC7273831 DOI: 10.1182/blood.2019002939] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/20/2020] [Indexed: 01/14/2023] Open
Abstract
Wiskott-Aldrich syndrome (WAS) is an X-linked disease caused by mutations in the WAS gene, leading to thrombocytopenia, eczema, recurrent infections, autoimmune disease, and malignancy. Hematopoietic cell transplantation (HCT) is the primary curative approach, with the goal of correcting the underlying immunodeficiency and thrombocytopenia. HCT outcomes have improved over time, particularly for patients with HLA-matched sibling and unrelated donors. We report the outcomes of 129 patients with WAS who underwent HCT at 29 Primary Immune Deficiency Treatment Consortium centers from 2005 through 2015. Median age at HCT was 1.2 years. Most patients (65%) received myeloablative busulfan-based conditioning. With a median follow-up of 4.5 years, the 5-year overall survival (OS) was 91%. Superior 5-year OS was observed in patients <5 vs ≥5 years of age at the time of HCT (94% vs 66%; overall P = .0008). OS was excellent regardless of donor type, even in cord blood recipients (90%). Conditioning intensity did not affect OS, but was associated with donor T-cell and myeloid engraftment after HCT. Specifically, patients who received fludarabine/melphalan-based reduced-intensity regimens were more likely to have donor myeloid chimerism <50% early after HCT. In addition, higher platelet counts were observed among recipients who achieved full (>95%) vs low-level (5%-49%) donor myeloid engraftment. In summary, HCT outcomes for WAS have improved since 2005, compared with prior reports. HCT at a younger age continues to be associated with superior outcomes supporting the recommendation for early HCT. High-level donor myeloid engraftment is important for platelet reconstitution after either myeloablative or busulfan-containing reduced intensity conditioning. (This trial was registered at www.clinicaltrials.gov as #NCT02064933.).
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Affiliation(s)
- Lauri M Burroughs
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Pediatrics, University of Washington-Seattle Children's Hospital, Seattle, WA
| | - Aleksandra Petrovic
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Pediatrics, University of Washington-Seattle Children's Hospital, Seattle, WA
| | - Ruta Brazauskas
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Xuerong Liu
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Linda M Griffith
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Hans D Ochs
- Department of Pediatrics, University of Washington-Seattle Children's Hospital, Seattle, WA
| | - Jack J Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Stephanie Edwards
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Christopher C Dvorak
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Sonali Chaudhury
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago-Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Susan E Prockop
- Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ralph Quinones
- Pediatric Bone Marrow Transplant (BMT) and Cellular Therapy Section, Department of Pediatrics, The University of Colorado School of Medicine, Aurora, CO
| | - Frederick D Goldman
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
| | - Troy C Quigg
- Texas Transplant Institute, Methodist Children's Hospital, San Antonio, TX
| | | | - Angela R Smith
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN
| | | | - Blachy J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Hospital-George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Monica S Thakar
- Center for Blood and Marrow Transplant Research-Division of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Rachel Phelan
- Center for Blood and Marrow Transplant Research-Division of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Shalini Shenoy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Lisa R Forbes
- Department of Pediatrics, Baylor College of Medicine Section of Immunology, Allergy, and Retrovirology, Texas Children's Hospital, Baylor, TX
| | - Caridad Martinez
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital Cancer Center, Baylor, TX
| | - Deepak Chellapandian
- Blood and Marrow Transplant, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Evan Shereck
- Division of Pediatric Hematology/Oncology, Oregon Health and Science University, Portland, OR
| | | | - Neena Kapoor
- Transplantation and Cellular Therapy Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Hey Chong
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - David C Shyr
- Division of Pediatric Hematology/Oncology, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, UT
| | - Karin Chen
- Division of Allergy and Immunology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine Pediatric Stem Cell Transplantation, Stanford University, Stanford, CA
| | - Katja G Weinacht
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine Pediatric Stem Cell Transplantation, Stanford University, Stanford, CA
| | - Theodore B Moore
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Avni Joshi
- Mayo Clinic Children's Center, Rochester, MN
| | - Kenneth B DeSantes
- American Family Children's Hospital, University of Wisconsin, Madison, WI
| | - Alfred P Gillio
- Institute for Pediatric Cancer and Blood Disorders, Hackensack University Medical Center, Hackensack, NJ
| | | | - Michael D Keller
- Division of Allergy & Immunology, Children's National Hospital, Washington, DC
- GW Cancer Center, George Washington University, Washington, DC
| | - Jacob Rozmus
- Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada
| | - Troy Torgerson
- Department of Pediatrics, University of Washington-Seattle Children's Hospital, Seattle, WA
| | - Michael A Pulsipher
- Transplantation and Cellular Therapy Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Elie Haddad
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Kathleen E Sullivan
- Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Donald B Kohn
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Jennifer M Puck
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, MA; and
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - David J Rawlings
- Department of Pediatrics, University of Washington-Seattle Children's Hospital, Seattle, WA
| | - Morton J Cowan
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
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27
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Farhadfar N, Murthy HS, Logan BR, Sees JA, Ayas M, Battiwalla M, Beitinjaneh AM, Chhabra S, Diaz MA, Engles K, Frangoul H, Ganguly S, Gergis U, Kamani NR, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Norkin M, O' Donnell PV, Olsson RF, Rossmann S, Savani BN, Schears R, Seo S, Solh MM, Spitzer T, Sugrue M, Yared JA, Linenberger M, Schwartz J, Pulsipher MA, Shah NN, Switzer GE, Confer DL, Shaw BE, Wingard JR. Impact of autologous blood transfusion after bone marrow harvest on unrelated donor's health and outcome: a CIBMTR analysis. Bone Marrow Transplant 2020; 55:2121-2131. [PMID: 32355289 DOI: 10.1038/s41409-020-0911-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 01/28/2023]
Abstract
Pre-harvest autologous blood collection from bone marrow (BM) donors is performed to meet potential post-operative transfusion needs. This study examines the impact of autologous blood transfusion on BM donor's health and safety. The study included first-time unrelated BM donors from the United States whose BM harvest was facilitated by the National Marrow Donor Program (NMDP) centers between 2006 and 2017. Examination of 7024 BM donors revealed that 60% received at least one unit of autologous blood. The donors who received autologous blood were older, had lower hemoglobin pre-harvest, underwent longer duration of anesthesia, and higher volume BM harvest. Only donors who underwent high-volume BM harvest, defined as a BM harvest volume >27% of donor's blood volume, benefited from autologous transfusion. After a high-volume BM harvest, autologous blood transfusion was shown to decrease grade 2 to 4 collection-associated toxicities within 48 h of BM donation (p = 0.010) and shorten the time to donor-reported "complete" recovery from donation-associated symptoms (p < 0.001). Therefore, autologous transfusion could be avoided as support of marrow donation in the majority of unrelated BM donors and should be limited to cases where the planned BM harvest volume is expected to exceed 27% of donor's blood volume.
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Affiliation(s)
- Nosha Farhadfar
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Brent R Logan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Sees
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Katie Engles
- CW Bill Young Marrow Donor Program, Kensington, MD, USA
| | - Haydar Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
| | | | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | | | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jane L Liesveld
- Strong Memorial Hospital-University of Rochester Medical Center, Rochester, NY, USA
| | - Maxim Norkin
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | | | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raquel Schears
- Department of Emergency Medicine, Mayo Medical School, Rochester, MN, USA
| | | | - Melhem M Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | | | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | | | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Dennis L Confer
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.,National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
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28
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Hourigan CS, Dillon LW, Gui G, Logan BR, Fei M, Ghannam J, Li Y, Licon A, Alyea EP, Bashey A, Deeg HJ, Devine SM, Fernandez HF, Giralt S, Hamadani M, Howard A, Maziarz RT, Porter DL, Scott BL, Warlick ED, Pasquini MC, Horwitz ME. Impact of Conditioning Intensity of Allogeneic Transplantation for Acute Myeloid Leukemia With Genomic Evidence of Residual Disease. J Clin Oncol 2020; 38:1273-1283. [PMID: 31860405 PMCID: PMC7164487 DOI: 10.1200/jco.19.03011] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [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] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Patients with acute myeloid leukemia (AML) in remission remain at risk for relapse even after allogeneic hematopoietic cell transplantation (alloHCT). AML measurable residual disease (MRD) status before alloHCT has been shown to be prognostic. Whether modulation of the intensity of the alloHCT conditioning regimen in patients with AML who test positive for MRD can prevent relapse and improve survival is unknown. METHODS Ultra-deep, error-corrected sequencing for 13 commonly mutated genes in AML was performed on preconditioning blood from patients treated in a phase III clinical trial that randomly assigned adult patients with myeloid malignancy in morphologic complete remission to myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC). RESULTS No mutations were detected in 32% of MAC and 37% of RIC recipients; these groups had similar survival (3-year overall survival [OS], 56% v 63%; P = .96). In patients with a detectable mutation (next-generation sequencing [NGS] positive), relapse (3-year cumulative incidence, 19% v 67%; P < .001) and survival (3-year OS, 61% v 43%; P = .02) was significantly different between the MAC and RIC arms, respectively. In multivariable analysis for NGS-positive patients, adjusting for disease risk and donor group, RIC was significantly associated with increased relapse (hazard ratio [HR], 6.38; 95% CI, 3.37 to 12.10; P < .001), decreased relapse-free survival (HR, 2.94; 95% CI, 1.84 to 4.69; P < .001), and decreased OS (HR, 1.97; 95% CI, 1.17 to 3.30; P = .01) compared with MAC. Models of AML MRD also showed benefit for MAC over RIC for those who tested positive. CONCLUSION This study provides evidence that MAC rather than RIC in patients with AML with genomic evidence of MRD before alloHCT can result in improved survival.
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MESH Headings
- Adult
- Aged
- Circulating Tumor DNA/blood
- Circulating Tumor DNA/genetics
- Clinical Trials, Phase III as Topic
- Female
- Hematopoietic Stem Cell Transplantation/methods
- High-Throughput Nucleotide Sequencing
- Humans
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Mutation
- Neoplasm, Residual
- Prognosis
- Randomized Controlled Trials as Topic
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Young Adult
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Affiliation(s)
| | - Laura W. Dillon
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Gege Gui
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Jack Ghannam
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Yuesheng Li
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | | | - Steven M. Devine
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alan Howard
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Richard T. Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
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29
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Chan AY, Leiding JW, Liu X, Logan BR, Burroughs LM, Allenspach EJ, Skoda-Smith S, Uzel G, Notarangelo LD, Slatter M, Gennery AR, Smith AR, Pai SY, Jordan MB, Marsh RA, Cowan MJ, Dvorak CC, Craddock JA, Prockop SE, Chandrakasan S, Kapoor N, Buckley RH, Parikh S, Chellapandian D, Oshrine BR, Bednarski JJ, Cooper MA, Shenoy S, Davila Saldana BJ, Forbes LR, Martinez C, Haddad E, Shyr DC, Chen K, Sullivan KE, Heimall J, Wright N, Bhatia M, Cuvelier GDE, Goldman FD, Meyts I, Miller HK, Seidel MG, Vander Lugt MT, Bacchetta R, Weinacht KG, Andolina JR, Caywood E, Chong H, de la Morena MT, Aquino VM, Shereck E, Walter JE, Dorsey MJ, Seroogy CM, Griffith LM, Kohn DB, Puck JM, Pulsipher MA, Torgerson TR. Hematopoietic Cell Transplantation in Patients With Primary Immune Regulatory Disorders (PIRD): A Primary Immune Deficiency Treatment Consortium (PIDTC) Survey. Front Immunol 2020; 11:239. [PMID: 32153572 PMCID: PMC7046837 DOI: 10.3389/fimmu.2020.00239] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 12/25/2019] [Accepted: 01/29/2020] [Indexed: 12/20/2022] Open
Abstract
Primary Immune Regulatory Disorders (PIRD) are an expanding group of diseases caused by gene defects in several different immune pathways, such as regulatory T cell function. Patients with PIRD develop clinical manifestations associated with diminished and exaggerated immune responses. Management of these patients is complicated; oftentimes immunosuppressive therapies are insufficient, and patients may require hematopoietic cell transplant (HCT) for treatment. Analysis of HCT data in PIRD patients have previously focused on a single gene defect. This study surveyed transplanted patients with a phenotypic clinical picture consistent with PIRD treated in 33 Primary Immune Deficiency Treatment Consortium centers and European centers. Our data showed that PIRD patients often had immunodeficient and autoimmune features affecting multiple organ systems. Transplantation resulted in resolution of disease manifestations in more than half of the patients with an overall 5-years survival of 67%. This study, the first to encompass disorders across the PIRD spectrum, highlights the need for further research in PIRD management.
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Affiliation(s)
- Alice Y Chan
- Division of Pediatric Allergy, Immunology, BMT, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer W Leiding
- Department of Pediatrics, Johns Hopkins All Children's Hospital, University of South Florida, St. Petersburg, FL, United States
| | - Xuerong Liu
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Lauri M Burroughs
- Department of Pediatrics, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States
| | - Eric J Allenspach
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States
| | - Suzanne Skoda-Smith
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States
| | - Gulbu Uzel
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Luigi D Notarangelo
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Mary Slatter
- Primary Immunodeficiency Group, Paediatric Immunology and Haematopoietic Stem Cell Transplantation, Translational and Clinical Research Institute, Great North Childrens' Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew R Gennery
- Primary Immunodeficiency Group, Paediatric Immunology and Haematopoietic Stem Cell Transplantation, Translational and Clinical Research Institute, Great North Childrens' Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Angela R Smith
- Pediatric Blood and Marrow Transplant, University of Minnesota, Minneapolis, MN, United States
| | - Sung-Yun Pai
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Michael B Jordan
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Morton J Cowan
- Division of Pediatric Allergy, Immunology, BMT, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, BMT, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - John A Craddock
- Texas Children's Cancer Center, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, United States
| | - Susan E Prockop
- Stem Cell Transplant and Cellular Therapy Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Shanmuganathan Chandrakasan
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States
| | - Neena Kapoor
- Section of Transplantation and Cellular Therapy, Cancer and Blood Disease Institute, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Rebecca H Buckley
- Departments of Pediatrics and Immunology, Duke University School of Medicine, Durham, NC, United States
| | - Suhag Parikh
- Departments of Pediatrics and Immunology, Duke University School of Medicine, Durham, NC, United States
| | - Deepak Chellapandian
- Cancer and Blood Disorders Institute, Blood and Marrow Transplant Program, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Benjamin R Oshrine
- Cancer and Blood Disorders Institute, Blood and Marrow Transplant Program, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Jeffrey J Bednarski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Megan A Cooper
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Shalini Shenoy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Blachy J Davila Saldana
- Division of Blood and Marrow Transplantation, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Lisa R Forbes
- Department of Pediatrics, Immunology, Allergy, and Retrovirology Baylor College of Medicine, Texas Children's Hospital William T. Shearer Center for Human Immunobiology, Houston, TX, United States
| | - Caridad Martinez
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital Cancer Center, Houston, TX, United States
| | - Elie Haddad
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - David C Shyr
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Karin Chen
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kathleen E Sullivan
- Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer Heimall
- Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Nicola Wright
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Monica Bhatia
- Pediatric Stem Cell Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Geoffrey D E Cuvelier
- Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick D Goldman
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Isabelle Meyts
- Laboratory of Inborn Errors of Immunity, Department of Immunology, Microbiology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | | | - Markus G Seidel
- Research Unit for Pediatric Hematology and Immunology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Mark T Vander Lugt
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Rosa Bacchetta
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Katja G Weinacht
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Jeffrey R Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, United States
| | - Emi Caywood
- Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, United States
| | - Hey Chong
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Maria Teresa de la Morena
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States
| | - Victor M Aquino
- Department of Pediatrics, University of Texas Southwestern Medical Center Dallas, Dallas, TX, United States
| | - Evan Shereck
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States
| | - Jolan E Walter
- Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, St. Petersburg, FL, United States.,Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Division of Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Morna J Dorsey
- Division of Pediatric Allergy, Immunology, BMT, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Christine M Seroogy
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Donald B Kohn
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | - Jennifer M Puck
- Division of Pediatric Allergy, Immunology, BMT, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Michael A Pulsipher
- Section of Transplantation and Cellular Therapy, Cancer and Blood Disease Institute, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Troy R Torgerson
- Allen Institute for Immunology and Department of Pediatrics, University of Washington, Seattle, WA, United States
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30
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Hsu JW, Shaw BE, Kim S, Logan BR, Sees JA, Confer DL, Pulsipher MA, Shah N, Switzer GE, Abidi MH, Ahmed IA, Anderlini PN, Bredeson C, Chhabra S, Dandoy CE, Diaz MA, Farhadfar N, Ganguly S, Gergis U, Hale GA, Hematti P, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Murthy HS, Olsson RF, Savani BN, Schears R, Seo S, Solh M, Spitzer T, Steinberg A, Sugrue M, Warkentin P, Wingard JR. Collection of Peripheral Blood Progenitor Cells in 1 Day Is Associated with Decreased Donor Toxicity Compared to 2 Days in Unrelated Donors. Biol Blood Marrow Transplant 2020; 26:1210-1217. [PMID: 32088366 DOI: 10.1016/j.bbmt.2020.02.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/29/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Abstract
Peripheral blood stem cells (PBSCs) have been increasingly used for allogeneic hematopoietic cell transplantation instead of bone marrow stem cells. Current National Marrow Donor Program policy recommends 5 days of daily filgrastim, followed by either 1 or 2 days of apheresis for unrelated donors, depending on collection center choice. To date, there are no published studies comparing the differences in donor experience between 1 day and 2 days of apheresis. We examined 22,348 adult unrelated donor collections in 184 centers between 2006 and 2016. Of these 22,348 donors, 20,004 (89.5%) had collection on 1 day, and the other 2344 (9.5%) had collection over 2 days. Information on why donors underwent apheresis in 1 day or 2 days was not available. Donors who underwent apheresis in 1 day were more likely to be male (67% versus 46%; P < .001), younger (age <30 years, 48% versus 36%; P < .001), and have a higher body weight (83.0 kg versus 75.9 kg; P< .001) and body mass index (BMI; >30, 30% versus 22%; P < .001). Successful collection of the requested CD34+ cell count was achieved on the first day in 82% of 1-day collections and in 16% of 2-day collections. Despite not administering filgrastim the evening after the first day of collection in patients who underwent 2 days of apheresis, the median concentration of CD34+ cells/L in the product was higher on the second day of apheresis compared with the first day (23.8 × 106 CD34+/L on day 1 versus 28.7 × 106 CD34+/L on day 2; P< .001). Donors who underwent collection in 1 day were less likely to experience citrate toxicity (36% versus 52%; P< .001), hospitalization (1% versus 6%; P< .001), and other side effects related to apheresis (Modified Toxicity Criteria incidence: 20% versus 26%; P < .001). Female sex, older age, collection via central lines, and higher BMI were factors associated with greater likelihood for the development of toxicity, whereas less toxicity was noted in those with higher CD34+ counts and more blood processed on the first day of collection. We conclude that although unrelated donors can be successfully collected in 1 day or 2 days, 1-day apheresis procedures were associated with less overall toxicity, and thus we recommend single-day collections, especially if the requested number of cells have been collected in 1 day.
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Affiliation(s)
- Jack W Hsu
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida.
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Soyoung Kim
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer A Sees
- Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | - Nirali Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Galen E Switzer
- University of Pittsburgh Medical Center- Cancer Center University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Muneer H Abidi
- Hematology and Oncology, Spectrum Health Hospital Group, Grand Rapids, Michigan
| | - Ibrahim A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Paulo N Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Nosha Farhadfar
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Gregory A Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Kimberly A Kasow
- Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jane L Liesveld
- Department of Medicine, Strong Memorial Hospital-University of Rochester Medical Center, Rochester, New York
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Raquel Schears
- Department of Emergency Medicine, Mayo Medical School, Rochester, Minnesota
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Melhern Solh
- Northside Hospital Blood and Marrow Transplant and Leukemia Program, The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Thomas Spitzer
- Cellular Therapy and Transplantation Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - John R Wingard
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida
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31
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Abstract
Many time-to-event studies are complicated by the presence of competing risks. Such data are often analyzed using Cox models for the cause-specific hazard function or Fine and Gray models for the subdistribution hazard. In practice, regression relationships in competing risks data are often complex and may include nonlinear functions of covariates, interactions, high-dimensional parameter spaces and nonproportional cause-specific, or subdistribution, hazards. Model misspecification can lead to poor predictive performance. To address these issues, we propose a novel approach: flexible prediction modeling of competing risks data using Bayesian Additive Regression Trees (BART). We study the simulation performance in two-sample scenarios as well as a complex regression setting, and benchmark its performance against standard regression techniques as well as random survival forests. We illustrate the use of the proposed method on a recently published study of patients undergoing hematopoietic stem cell transplantation.
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Affiliation(s)
- Rodney Sparapani
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert E McCulloch
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ, USA
| | - Purushottam W Laud
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
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Knight JM, Rizzo JD, Wang T, He N, Logan BR, Spellman SR, Lee SJ, Verneris MR, Arevalo JMG, Cole SW. Molecular Correlates of Socioeconomic Status and Clinical Outcomes Following Hematopoietic Cell Transplantation for Leukemia. JNCI Cancer Spectr 2019; 3:pkz073. [PMID: 31763620 PMCID: PMC6859844 DOI: 10.1093/jncics/pkz073] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/24/2019] [Accepted: 09/09/2019] [Indexed: 01/08/2023] Open
Abstract
Background Clinical outcomes among allogeneic hematopoietic cell transplant (HCT) recipients are negatively affected by low socioeconomic status (SES), yet the biological mechanisms accounting for this health disparity remain to be elucidated. Among unrelated donor HCT recipients with acute myelogenous leukemia, one recent pilot study linked low SES to increased expression of a stress-related gene expression profile known as the conserved transcriptional response to adversity (CTRA) in peripheral blood mononuclear cells, which involves up-regulation of pro-inflammatory genes and down-regulation of genes involved in type I interferon response and antibody synthesis. Methods This study examined these relationships using additional measures in a larger archival sample of 261 adults who received an unrelated donor HCT for acute myelogenous leukemia to 1) identify cellular and molecular mechanisms involved in SES-related differences in pre-transplant leukocyte transcriptome profiles, and 2) evaluate pre-transplant CTRA biology associations with clinical outcomes through multivariable analysis controlling for demographic-, disease-, and transplant-related covariates. Results Low SES individuals showed increases in classic monocyte activation and pro-inflammatory transcription control pathways as well as decreases in activation of nonclassic monocytes, all consistent with the CTRA biological pattern. Transplant recipients in the highest or lowest quartiles of the CTRA pro-inflammatory gene component had a more than 2-fold elevated hazard of relapse (hazard ratio [HR] = 2.47, 95% confidence interval [CI] = 1.44 to 4.24), P = .001; HR = 2.52, 95% CI = 1.46 to 4.34, P = .001) and more than 20% reduction in leukemia-free survival (HR = 1.57, 95% CI = 1.08 to 2.28, P = .012; HR = 1.49, 95% CI = 1.04 to 2.15, P = .03) compared with the middle quartiles. Conclusions These findings identify SES- and CTRA-associated myeloid- and inflammation-related transcriptome signatures in recipient pre-transplant blood samples as a potential novel predictive biomarker of HCT-related clinical outcomes.
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Affiliation(s)
| | - J Douglas Rizzo
- See the Notes section for the full list of authors' affiliations
| | - Tao Wang
- See the Notes section for the full list of authors' affiliations
| | - Naya He
- See the Notes section for the full list of authors' affiliations
| | - Brent R Logan
- See the Notes section for the full list of authors' affiliations
| | | | - Stephanie J Lee
- See the Notes section for the full list of authors' affiliations
| | | | | | - Steve W Cole
- See the Notes section for the full list of authors' affiliations
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Pulsipher MA, Logan BR, Kiefer DM, Chitphakdithai P, Riches ML, Rizzo JD, Anderlini P, Leitman SF, Varni JW, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Ball ED, Bolwell BJ, Bunin NJ, Cheerva A, Delgado DC, Dvorak CC, Gillio AP, Hahn TE, Hale GA, Haight AE, Hayes-Lattin BM, Kasow KA, Linenberger M, Magalhaes-Silverman M, Mori S, Prasad VK, Quigg TC, Sahdev I, Schriber JR, Shenoy S, Tse WT, Yanik GA, Navarro WH, Horowitz MM, Confer DL, Shaw BE, Switzer GE. Higher Risks of Toxicity and Incomplete Recovery in 13- to 17-Year-Old Females after Marrow Donation: RDSafe Peds Results. Biol Blood Marrow Transplant 2019; 25:955-964. [PMID: 30605731 PMCID: PMC6511296 DOI: 10.1016/j.bbmt.2018.12.765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
Although donation of bone marrow (BM) or peripheral blood stem cells (PBSCs) from children to family members undergoing allogeneic transplantation are well-established procedures, studies detailing levels of pain, symptoms, and long-term recovery are lacking. To address this lack, we prospectively enrolled 294 donors age <18 years at 25 pediatric transplantation centers in North America, assessing them predonation, peridonation, and at 1 month, 6 months, and 1 year postdonation. We noted that 71% of children reported pain and 59% reported other symptoms peridonation, with resolution to 14% and 12% at 1 month postdonation. Both older age (age 13 to 17 years versus younger) and female sex were associated with higher levels of pain peridonation, with the highest rates in older females (57% with grade 2-4 pain and 17% with grade 3-4 pain). Multivariate analyses showed a 4-fold increase in risk for older females compared with males age <13 years (P <.001). At 1 year, 11% of 13- to 17-year-old females reported grade 2-4 pain, compared with 3% of males age 13 to 17 years, 0% of females age <13 years, and 1% of males age <13 years (P = .01). Males and females age 13 to 17 years failed to return to predonation pain levels at 1 year 22% and 23% of the time, respectively, compared with 3% and 10% in males and females age <13 years (P = .002). Our data show that females age 13 to 17 years are at increased risk of grade 2-4 pain at 1 year and >20% of females and males age 13 to 17 years do not return to baseline pain levels by 1 year after BM donation. Studies aimed at decreasing symptoms and improving recovery in older children are warranted.
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Affiliation(s)
- Michael A Pulsipher
- Children's Hospital Los Angeles, Center for Children's Cancer and Blood Diseases, USC Keck School of Medicine, Los Angeles, California.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Marcie L Riches
- University of North Carolina Hospitals, Chapel Hill, North Carolina, Division of Hematology and Oncology
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cell Transplantation and Cellular Therapy, Division of Cancer Medicine. M.D. Anderson Cancer Center, Houston, Texas
| | - Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - James W Varni
- Department of Landscape Architecture & Urban Planning, Center for Health Systems & Design, Texas A&M University, College Station, Texas
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Aly Abdel-Mageed
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Ibrahim A Ahmed
- Department of Hematology and Oncology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, California
| | - Brian J Bolwell
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nancy J Bunin
- Blood and Marrow Transplant Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexandra Cheerva
- Blood and Marrow Transplant Program, Kosair Children's Hospital, Louisville, Kentucky
| | - David C Delgado
- Indiana University Hospital/Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher C Dvorak
- Division of Pediatric Blood and Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | - Alfred P Gillio
- Pediatric Hematology-Oncology, Hackensack Meridian University Medical Center, Hackensack, New Jersey
| | - Theresa E Hahn
- Department of Medicine. Cancer Prevention and Population Sciences CCSG Program. Roswell Park Cancer Institute, Buffalo, New York
| | - Gregory A Hale
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Division of Hematology/Oncology-Bone Marrow Pediatric Hematology & Medical Oncology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | | | - Kimberly A Kasow
- Pediatric Hematology Oncology Program, Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Healthcare, Chapel Hill, North Carolina
| | - Michael Linenberger
- Division of Hematology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, Florida
| | - Vinod K Prasad
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - Shalini Shenoy
- Hematology and Oncology, St. Louis Children's Hospital, St. Louis, Missouri
| | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Galen E Switzer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Pulsipher MA, Logan BR, Kiefer DM, Chitphakdithai P, Riches ML, Rizzo JD, Anderlini P, Leitman OF, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Parameswaran V, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Confer DL, Shaw BE. Related peripheral blood stem cell donors experience more severe symptoms and less complete recovery at one year compared to unrelated donors. Haematologica 2019; 104:844-854. [PMID: 30381298 PMCID: PMC6442962 DOI: 10.3324/haematol.2018.200121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022] Open
Abstract
Unlike unrelated donor registries, transplant centers lack uniform approaches to related donor assessment and deferral. To test whether related donors are at increased risk for donation-related toxicities, we conducted a prospective observational trial of 11,942 related and unrelated donors aged 18-60 years. Bone marrow (BM) was collected at 37 transplant and 78 National Marrow Donor Program centers, and peripheral blood stem cells (PBSC) were collected at 42 transplant and 87 unrelated donor centers in North America. Possible presence of medical comorbidities was verified prior to donation, and standardized pain and toxicity measures were assessed pre-donation, peri-donation, and one year following. Multivariate analyses showed similar experiences for BM collection in related and unrelated donors; however, related stem cell donors had increased risk of moderate [odds ratios (ORs) 1.42; P<0.001] and severe (OR 8.91; P<0.001) pain and toxicities (OR 1.84; P<0.001) with collection. Related stem cell donors were at increased risk of persistent toxicities (OR 1.56; P=0.021) and non-recovery from pain (OR 1.42; P=0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors reporting grade ≥2 pain had significant decreases in Health-Related Quality of Life (HR-QoL) scores at one month and one year post donation (P=0.004). In conclusion, related PBSC donors with comorbidities are at increased risk for pain, toxicity, and non-recovery at one year after donation. Risk profiles described in this study should be used for donor education, planning studies to improve the related donor experience, and decisions regarding donor deferral. Registered at clinicaltrials.gov identifier:00948636.
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Affiliation(s)
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Marcie L Riches
- University of North Carolina Hospitals, Division of Hematology and Oncology Chapel Hill, NC
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - O'Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Aly Abdel-Mageed
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Ibrahim A Ahmed
- Department of Hematology and Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, IN
| | | | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, CA
| | | | | | | | | | | | | | - Christopher C Dvorak
- Division of Pediatric Blood and Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, CA
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Division of Hematology/Oncology-Bone Marrow Pediatric Hematology & Medical Oncology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | - Kimberly A Kasow
- Pediatric Hematology Oncology Program, Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Healthcare, Chapel Hill, NC
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, OH
| | - Jane L Liesveld
- Strong Memorial Hospital - University of Rochester Medical Center, NY
| | | | | | - Walter Longo
- University of Wisconsin Hospital and Clinics, Madison, WI
| | | | - John M McCarty
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, VA
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, FL
| | | | - Vinod K Prasad
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | | | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, NY
| | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK
| | | | - Shalini Shenoy
- Division of Hematology/Oncology, St. Louis Children's Hospital, MO
| | | | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL
| | | | - Madhuri Vusirikala
- Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Galen E Switzer
- Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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Wang Y, Logan BR. Testing for center effects on survival and competing risks outcomes using pseudo-value regression. Lifetime Data Anal 2019; 25:206-228. [PMID: 29978275 PMCID: PMC6320737 DOI: 10.1007/s10985-018-9443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
In multi-center studies, the presence of a cluster effect leads to correlation among outcomes within a center and requires different techniques to handle such correlation. Testing for a cluster effect can serve as a pre-screening step to help guide the researcher towards the appropriate analysis. With time to event data, score tests have been proposed which test for the presence of a center effect on the hazard function. However, sometimes researchers are interested in directly modeling other quantities such as survival probabilities or cumulative incidence at a fixed time. We propose a test for the presence of a center effect acting directly on the quantity of interest using pseudo-value regression, and derive the asymptotic properties of our proposed test statistic. We examine the performance of our proposed test through simulation studies in both survival and competing risks settings. The proposed test may be more powerful than tests based on the hazard function in settings where the center effect is time-varying. We illustrate the test using a multicenter registry study of survival and competing risks outcomes after hematopoietic cell transplantation.
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Affiliation(s)
- Yanzhi Wang
- Division of Research Services/Department of Medicine, University of Illinois College of Medicine at Peoria, 1 Illini Dr., Peoria, IL, 61605, USA.
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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Pulsipher MA, Logan BR, Chitphakdithai P, Kiefer DM, Riches ML, Rizzo JD, Anderlini P, Leitman SF, Varni JW, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Bunin NJ, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Shaw BE, Confer DL. Effect of Aging and Predonation Comorbidities on the Related Peripheral Blood Stem Cell Donor Experience: Report from the Related Donor Safety Study. Biol Blood Marrow Transplant 2019; 25:699-711. [PMID: 30423480 PMCID: PMC6453753 DOI: 10.1016/j.bbmt.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
The development of reduced-intensity approaches for allogeneic hematopoietic cell transplantation has resulted in growing numbers of older related donors (RDs) of peripheral blood stem cells (PBSCs). The effects of age on donation efficacy, toxicity, and long-term recovery in RDs are poorly understood. To address this we analyzed hematologic variables, pain, donation-related symptoms, and recovery in 1211 PBSC RDs aged 18 to 79 enrolled in the Related Donor Safety Study. RDs aged > 60 had a lower median CD34+ level before apheresis compared with younger RDs (age > 60, 59 × 106/L; age 41 to 60, 81 × 106/L; age 18 to 40, 121 × 106/L; P < .001). This resulted in older donors undergoing more apheresis procedures (49% versus 30% ≥ 2 collections, P < .001) and higher collection volumes (52% versus 32% > 24 L, P < .001), leading to high percentages of donors aged > 60 with postcollection thrombocytopenia <50 × 109/L (26% and 57% after 2 and 3days of collection, respectively). RDs aged 18 to 40 had a higher risk of grades 2 to 4 pain and symptoms pericollection, but donors over age 40 had more persistent pain at 1, 6, and 12 months (odds ratio [OR], 1.7; P = 0.02) and a higher rate of nonrecovery to predonation levels (OR, 1.7; P = .01). Donors reporting comorbidities increased significantly with age, and those with comorbidities that would have led to deferral by National Marrow Donor Program unrelated donor standards had an increased risk for persistent grades 2 to 4 pain (OR, 2.41; P < .001) and failure to recover to predonation baseline for other symptoms (OR, 2.34; P = .004). This information should be used in counseling RDs regarding risk and can assist in developing practice approaches aimed at improving the RD experience for high-risk individuals.
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Affiliation(s)
- Michael A Pulsipher
- Children's Hospital Los Angeles, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Los Angeles, California.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Marcie L Riches
- University of North Carolina Hospitals, Division of Hematology and Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paolo Anderlini
- M.D. Anderson Cancer Center, Department of Stem Cell Transplantation and Cellular Therapy, Houston, Texas
| | - Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - James W Varni
- Texas A & M University, Department of Pediatrics, College Station, Texas
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - Ibrahim A Ahmed
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, Indiana
| | | | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, California
| | | | - Carolyn Bigelow
- University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | - Nancy J Bunin
- Children's Hospital of Philadelphia, Division of Oncology, Philadelphia, Pennsylvania
| | - David C Delgado
- Indiana University Hospital/Riley Hospital for Children, Indianapolis, Indiana
| | - Katharine Duckworth
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Christopher C Dvorak
- University of California San Francisco Benioff Children's Hospital, Division of Pediatric Blood and Marrow Transplantation San Francisco, California
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Ann A Jakubowski
- Memorial Sloan Kettering Cancer Center-Adult, New York, New York
| | - Kimberly A Kasow
- University of North Carolina Healthcare, Chapel Hill, North Carolina
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jane L Liesveld
- Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | | | | | - Walter Longo
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | - John M McCarty
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, Virginia
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, Florida
| | | | | | - Witold B Rybka
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK
| | | | | | | | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | - Daniel J Weisdorf
- University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
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Hsu JW, Kim S, Logan BR, Sees JA, Chitphakdithai P, Confer DL, Pulsipher MA, Shah NN, Switzer GE, Shaw BE, Wingard JR. Peripheral Blood Stem Cell Collection in One Day Is Preferable to Two Days in Unrelated Donors. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.334] [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: 10/27/2022]
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Bolaños-Meade J, Reshef R, Fraser R, Fei M, Abhyankar S, Al-Kadhimi Z, Alousi AM, Antin JH, Arai S, Bickett K, Chen YB, Damon LE, Efebera YA, Geller NL, Giralt SA, Hari P, Holtan SG, Horowitz MM, Jacobsohn DA, Jones RJ, Liesveld JL, Logan BR, MacMillan ML, Mielcarek M, Noel P, Pidala J, Porter DL, Pusic I, Sobecks R, Solomon SR, Weisdorf DJ, Wu J, Pasquini MC, Koreth J. Three prophylaxis regimens (tacrolimus, mycophenolate mofetil, and cyclophosphamide; tacrolimus, methotrexate, and bortezomib; or tacrolimus, methotrexate, and maraviroc) versus tacrolimus and methotrexate for prevention of graft-versus-host disease with haemopoietic cell transplantation with reduced-intensity conditioning: a randomised phase 2 trial with a non-randomised contemporaneous control group (BMT CTN 1203). Lancet Haematol 2019; 6:e132-e143. [PMID: 30824040 PMCID: PMC6503965 DOI: 10.1016/s2352-3026(18)30221-7] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prevention of graft-versus-host disease (GvHD) without malignant relapse is the overall goal of allogeneic haemopoietic cell transplantation (HCT). We aimed to evaluate regimens using either maraviroc, bortezomib, or post-transplantation cyclophosphamide for GvHD prophylaxis compared with controls receiving the combination of tacrolimus and methotrexate using a novel composite primary endpoint to identify the most promising intervention to be further tested in a phase 3 trial. METHODS In this prospective multicentre phase 2 trial, adult patients aged 18-75 years who received reduced-intensity conditioning HCT were randomly assigned (1:1:1) by random block sizes to tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide (cyclophosphamide 50 mg/kg on days 3 and 4, followed by tacrolimus starting on day 5 and mycophenolate mofetil starting on day 5 at 15 mg/kg three times daily not to exceed 1 g from day 5 to day 35); tacrolimus, methotrexate, and bortezomib (bortezomib 1·3 mg/m2 intravenously on days 1, 4, and 7 after HCT); or tacrolimus, methotrexate, and maraviroc (maraviroc 300 mg orally twice daily from day -3 to day 30 after HCT). Methotrexate was administered as a 15 mg/m2 intravenous bolus on day 1 and 10 mg/m2 intravenous bolus on days 3, 6, and 11 after HCT; tacrolimus was given intravenously at a dose of 0·05 mg/kg twice daily (or oral equivalent) starting on day -3 (except the post-transplantation cyclophosphamide, as indicated), with a target level of 5-15 ng/mL. Tacrolimus was continued at least until day 90 and was tapered off by day 180. Each study group was compared separately to a contemporary non-randomised prospective cohort of patients (control group) who fulfilled the same eligibility criteria as the trial, but who were treated with tacrolimus and methotrexate at centres not participating in the trial. The primary endpoint (GvHD-free, relapse-free survival [GRFS]) was defined as the time from HCT to onset of grade 3-4 acute GvHD, chronic GvHD requiring systemic immunosuppression, disease relapse, or death. The study was analysed by modified intention to treat. The study is closed to accrual and this is the planned analysis. This trial is registered with ClinicalTrials.gov, number NCT02208037. FINDINGS Between Nov 17, 2014, and May 18, 2016, 273 patients from 31 US centres were randomly assigned to the three study arms: 89 to tacrolimus, methotrexate, and bortezomib; 92 to tacrolimus, methotrexate, and maraviroc; 92 to tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; and six were excluded. Between Aug 1, 2014, and Sept 14, 2016, 224 controls received tacrolimus and methotrexate. Controls were generally well matched except for more frequent comorbidities than the intervention groups and a different distribution of types of conditioning regimens used. Compared with controls, the hazard ratio for GRFS was 0·72 (90% CI 0·54-0·94; p=0·044) for tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide, 0·98 (0·76-1·27; p=0·92) for tacrolimus, methotrexate, and bortezomib, and 1·10 (0·86-1·41; p=0·49) for tacrolimus, methotrexate, and maraviroc. 238 patients experienced grade 3 or 4 toxicities: 12 (13%) had grade 3 and 67 (73%) grade 4 events with tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; ten (11%) had grade 3 and 68 (76%) had grade 4 events with tacrolimus, methotrexate, and bortezomib; and 18 (20%) had grade 3 and 63 (68%) had grade 4 events with tacrolimus, methotrexate, and maraviroc. The most common toxicities were haematological (77 [84%] for tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; 73 [82%] for tacrolimus, methotrexate, and bortezomib; and 78 [85%] for tacrolimus, methotrexate, and maraviroc) and cardiac (43 [47%], 44 [49%], and 43 [47%], respectively). INTERPRETATION Tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide was the most promising intervention, yielding the best GRFS; this regimen is thus being prospectively compared with tacrolimus and methotrexate in a phase 3 randomised trial. FUNDING US National Health, Lung, and Blood Institute; National Cancer Institute; National Institute of Allergy and Infectious Disease; and Millennium Pharmaceuticals.
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Affiliation(s)
- Javier Bolaños-Meade
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
| | - Ran Reshef
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Raphael Fraser
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mingwei Fei
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sunil Abhyankar
- Department of Internal Medicine, University of Kansas Medical Center, Westwood, KS, USA
| | - Zaid Al-Kadhimi
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Amin M Alousi
- Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph H Antin
- Department of Medicial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sally Arai
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | | | - Yi-Bin Chen
- Department of Medicine, Massachusetts General, Hospital, Boston, MA, USA
| | - Lloyd E Damon
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yvonne A Efebera
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Nancy L Geller
- Office of Biostatistics Research, National Institutes of Health, Bethesda, MD, USA
| | - Sergio A Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Parameswaran Hari
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shernan G Holtan
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Mary M Horowitz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David A Jacobsohn
- Department of Pediatrics at George Washington University, Children's National Medical Center, Washington, DC, USA
| | - Richard J Jones
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Jane L Liesveld
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Brent R Logan
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Marco Mielcarek
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Pierre Noel
- Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Joseph Pidala
- Blood and Marrow Transplantation and Cellular Immunotherapy, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David L Porter
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Iskra Pusic
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ronald Sobecks
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Solomon
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Daniel J Weisdorf
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Juan Wu
- The Emmes Corporation, Rockville, MD, USA
| | - Marcelo C Pasquini
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Koreth
- Department of Medicial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Farhadfar N, Murthy H, Khanal M, Ahn KW, Logan BR, Sees JA, Chitphakdithai P, Confer DL, Pulsipher MA, Shah NN, Switzer GE, Shaw BE, Wingard JR. Impact of Autologous Blood Transfusion after Bone Marrow Harvest on Donor Health and Outcome. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Prokopishyn NL, Logan BR, Kiefer DM, Sees JA, Chitphakdithai P, Ahmed IA, Anderlini PN, Beitinjaneh AM, Bredeson C, Cerny J, Chhabra S, Daly A, Diaz MA, Farhadfar N, Frangoul HA, Ganguly S, Gastineau DA, Gergis U, Hale GA, Hematti P, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Murthy HS, Norkin M, Olsson RF, Papari M, Savani BN, Szer J, Waller EK, Wirk B, Yared JA, Pulsipher MA, Shah NN, Switzer GE, O'Donnell PV, Confer DL, Shaw BE. The Concentration of Total Nucleated Cells in Harvested Bone Marrow for Transplantation Has Decreased over Time. Biol Blood Marrow Transplant 2019; 25:1325-1330. [PMID: 30716454 PMCID: PMC6615955 DOI: 10.1016/j.bbmt.2019.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
Bone marrow (BM) is an essential source of hematopoietic stem cell grafts for many allogeneic hematopoietic cell transplant (HCT) recipients, including adult patients (for specific diseases and transplantation strategies) and the majority of pediatric recipient. However, since the advent of granulocyte colony-stimulating factor-mobilized peripheral blood stem cell (PBSC) grafts, there has been a significant decrease in the use of BM in HCT, thought to be due mainly to the increased logistical challenges in harvesting BM compared with PBSCs, as well as generally no significant survival advantage of BM over PBSCs. The decreased frequency of collection has the potential to impact the quality of BM harvests. In this study, we examined >15,000 BM donations collected at National Marrow Donor Program centers between 1994 and 2016 and found a significant decline in the quality of BM products, as defined by the concentration of total nucleated cells (TNCs). The mean TNC concentration in BM donations dropped from 21.8 × 106 cells/mL in the earliest era (1994 to 1996) to 18.7 × 106 cells/mL in the most recent era (2012 to 2016) (means ratio, .83; P < .001). This decline in BM quality was seen despite the selection of more donors perceived to be optimal (eg, younger and male). Multivariate regression analysis showed that higher-volume centers (performing >30 collections per era) had better-quality harvests with higher concentrations of TNCs collected. In conclusion, we have identified a significant decrease in the quality of BM collections over time, and lower-volume collection centers had poorer-quality harvests. In this analysis, we could not elucidate the direct cause for this finding, suggesting the need for further studies to investigate the key factors responsible and to explore the impact on transplant recipients.
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Affiliation(s)
- Nicole L Prokopishyn
- Department of Pathology and Laboratory Medicine,University of Calgary, Calgary, Alberta, Canada
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Jennifer A Sees
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Ibrahim A Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Paolo N Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Haydar A Frangoul
- Division of Pediatric-Hematology and Oncology, The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, Tennessee
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas
| | | | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Gregory A Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Kimberly A Kasow
- Department of Pediatrics in the Division of Hematology-Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jane L Liesveld
- Strong Memorial Hospital-University of Rochester Medical Center, Rochester, New York
| | - Hemant S Murthy
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Maxim Norkin
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Mona Papari
- ITxM Clinical Services Cord Blood Lab, Rosemont, Illinois
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey Szer
- Clinical Haematology at Peter MacCalluma Cancer Centre and The Royal Melbourne Hospital, Victoria, Australia
| | - Edmund K Waller
- Department of Hematology and Meidcal Oncology, Emory University Hospital, Atlanta, Georgia
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul V O'Donnell
- Department of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Haddad E, Logan BR, Griffith LM, Buckley RH, Parrott RE, Prockop SE, Small TN, Chaisson J, Dvorak CC, Murnane M, Kapoor N, Abdel-Azim H, Hanson IC, Martinez C, Bleesing JJH, Chandra S, Smith AR, Cavanaugh ME, Jyonouchi S, Sullivan KE, Burroughs L, Skoda-Smith S, Haight AE, Tumlin AG, Quigg TC, Taylor C, Dávila Saldaña BJ, Keller MD, Seroogy CM, Desantes KB, Petrovic A, Leiding JW, Shyr DC, Decaluwe H, Teira P, Gillio AP, Knutsen AP, Moore TB, Kletzel M, Craddock JA, Aquino V, Davis JH, Yu LC, Cuvelier GDE, Bednarski JJ, Goldman FD, Kang EM, Shereck E, Porteus MH, Connelly JA, Fleisher TA, Malech HL, Shearer WT, Szabolcs P, Thakar MS, Vander Lugt MT, Heimall J, Yin Z, Pulsipher MA, Pai SY, Kohn DB, Puck JM, Cowan MJ, O'Reilly RJ, Notarangelo LD. SCID genotype and 6-month posttransplant CD4 count predict survival and immune recovery. Blood 2018; 132:1737-1749. [PMID: 30154114 PMCID: PMC6202916 DOI: 10.1182/blood-2018-03-840702] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [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: 03/26/2018] [Accepted: 08/20/2018] [Indexed: 12/26/2022] Open
Abstract
The Primary Immune Deficiency Treatment Consortium (PIDTC) performed a retrospective analysis of 662 patients with severe combined immunodeficiency (SCID) who received a hematopoietic cell transplantation (HCT) as first-line treatment between 1982 and 2012 in 33 North American institutions. Overall survival was higher after HCT from matched-sibling donors (MSDs). Among recipients of non-MSD HCT, multivariate analysis showed that the SCID genotype strongly influenced survival and immune reconstitution. Overall survival was similar for patients with RAG, IL2RG, or JAK3 defects and was significantly better compared with patients with ADA or DCLRE1C mutations. Patients with RAG or DCLRE1C mutations had poorer immune reconstitution than other genotypes. Although survival did not correlate with the type of conditioning regimen, recipients of reduced-intensity or myeloablative conditioning had a lower incidence of treatment failure and better T- and B-cell reconstitution, but a higher risk for graft-versus-host disease, compared with those receiving no conditioning or immunosuppression only. Infection-free status and younger age at HCT were associated with improved survival. Typical SCID, leaky SCID, and Omenn syndrome had similar outcomes. Landmark analysis identified CD4+ and CD4+CD45RA+ cell counts at 6 and 12 months post-HCT as biomarkers predictive of overall survival and long-term T-cell reconstitution. Our data emphasize the need for patient-tailored treatment strategies depending upon the underlying SCID genotype. The prognostic significance of CD4+ cell counts as early as 6 months after HCT emphasizes the importance of close follow-up of immune reconstitution to identify patients who may need additional intervention to prevent poor long-term outcome.
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Affiliation(s)
- Elie Haddad
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Linda M Griffith
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | | | | - Susan E Prockop
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Trudy N Small
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Chaisson
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christopher C Dvorak
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Megan Murnane
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Neena Kapoor
- Blood and Marrow Transplant Program, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Hisham Abdel-Azim
- Blood and Marrow Transplant Program, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Caridad Martinez
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jack J H Bleesing
- Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Sharat Chandra
- Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Angela R Smith
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN
| | | | - Soma Jyonouchi
- Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kathleen E Sullivan
- Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lauri Burroughs
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Seattle Children's Hospital, Seattle, WA
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Emory/Children's Healthcare of Atlanta, Atlanta, GA
| | - Audrey G Tumlin
- Aflac Cancer and Blood Disorders Center, Emory/Children's Healthcare of Atlanta, Atlanta, GA
| | - Troy C Quigg
- Texas Transplant Institute, Methodist Children's Hospital, San Antonio, TX
| | - Candace Taylor
- Texas Transplant Institute, Methodist Children's Hospital, San Antonio, TX
| | - Blachy J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Michael D Keller
- Division of Blood and Marrow Transplantation, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Kenneth B Desantes
- American Family Children's Hospital, University of Wisconsin, Madison, WI
| | - Aleksandra Petrovic
- Blood and Marrow Transplant, John Hopkins All Children's Hospital, St. Petersburg, FL
| | - Jennifer W Leiding
- Blood and Marrow Transplant, John Hopkins All Children's Hospital, St. Petersburg, FL
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL
| | - David C Shyr
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | - Hélène Decaluwe
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Pierre Teira
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Alfred P Gillio
- Institute for Pediatric Cancer and Blood Disorders, Hackensack University Medical Center, Hackensack, NJ
| | - Alan P Knutsen
- Pediatric Allergy and Immunology, Saint Louis University, Cardinal Glennon Children's Medical Center, St. Louis, MO
| | - Theodore B Moore
- Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Morris Kletzel
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John A Craddock
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Victor Aquino
- Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey H Davis
- Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Lolie C Yu
- Division of Hematology/Oncology and Hematopoietic Stem Cell Transplantation, The Center for Cancer and Blood Disorders, Children's Hospital/Louisiana State University Medical Center, New Orleans, LA
| | - Geoffrey D E Cuvelier
- Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | | | - Frederick D Goldman
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth M Kang
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Evan Shereck
- Division of Pediatric Hematology/Oncology, Oregon Health and Science University, Portland, OR
| | - Matthew H Porteus
- Pediatric Stem Cell Transplantation, Stanford University, Stanford, CA
| | | | - Thomas A Fleisher
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Harry L Malech
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | | | | - Monica S Thakar
- Pediatric Blood and Marrow Transplant Program, Division of Hematology, Oncology, and Blood Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Mark T Vander Lugt
- Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, MI; and
| | - Jennifer Heimall
- Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ziyan Yin
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Michael A Pulsipher
- Blood and Marrow Transplant Program, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Sung-Yun Pai
- Hematology-Oncology, Boston Children's Hospital, Boston, MA
| | - Donald B Kohn
- Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Jennifer M Puck
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Morton J Cowan
- Pediatric Allergy, Immunology, and Blood and Marrow Transplant Division, University of California, San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Richard J O'Reilly
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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Carpenter PA, Logan BR, Lee SJ, Weisdorf DJ, Johnston L, Costa LJ, Kitko CL, Bolaños-Meade J, Sarantopoulos S, Alousi AM, Abhyankar S, Waller EK, Mendizabal A, Zhu J, O'Brien KA, Lazaryan A, Wu J, Nemecek ER, Pavletic SZ, Cutler CS, Horowitz MM, Arora M. A phase II/III randomized, multicenter trial of prednisone/sirolimus versus prednisone/ sirolimus/calcineurin inhibitor for the treatment of chronic graft- versus-host disease: BMT CTN 0801. Haematologica 2018; 103:1915-1924. [PMID: 29954931 PMCID: PMC6278959 DOI: 10.3324/haematol.2018.195123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/26/2018] [Indexed: 12/17/2022] Open
Abstract
Initial therapy of chronic graft-versus-host disease is prednisone ± a calcineurin-inhibitor, but most patients respond inadequately. In a randomized, adaptive, phase II/III, multicenter trial we studied whether prednisone/sirolimus or prednisone/sirolimus/photopheresis was more effective than prednisone/sirolimus/calcineurin-inhibitor for treating chronic graft-versus-host disease in treatment-naïve or early inadequate responders. Primary endpoints of this study were proportions of subjects alive without relapse or secondary therapy with 6-month complete or partial response in phase II, or with 2-year complete response in phase III. The prednisone/sirolimus/photopheresis arm closed prematurely because of slow accrual and the remaining two-drug versus three-drug study ended in phase II due to statistical futility with 138 evaluable subjects. The two-drug and three-drug arms did not differ in rates of 6-month complete or partial response (48.6% versus 50.0%, P=0.87), or 2-year complete response (14.7% versus 15.5%, P=0.90). Serum creatinine values >1.5 times baseline were less frequent in the calcineurin-inhibitor-free arm at 2 months (1.5% versus 11.7%, P=0.025) and 6 months (7.8% versus 24.0%, P=0.016). Higher adjusted Short Form-36 Physical Component Summary and Physical Functioning scores were seen in the two-drug arm at both 2 months (P=0.02 and P=0.04, respectively) and 6 months (P=0.007 and P=0.001, respectively). Failure-free survival and overall survival rates at 2 years were similar for patients in the the two-drug and three-drug arms (48.6% versus 46.2%, P=0.78; 81.5% versus 74%, P=0.28). Based on similar long-term outcomes, prednisone/sirolimus is a therapeutic alternative to prednisone/sirolimus/calcineurin-inhibitor for chronic graft-versus-host disease, being easier to administer and better tolerated. Clinicaltrials.gov identifier: NCT01106833.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amin M Alousi
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Jiaxi Zhu
- The Emmes Corporation, Rockville, MD
| | | | | | - Juan Wu
- The Emmes Corporation, Rockville, MD
| | | | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD
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Jacobsohn DA, Loken MR, Fei M, Adams A, Brodersen LE, Logan BR, Ahn KW, Shaw BE, Kletzel M, Olszewski M, Khan S, Meshinchi S, Keating A, Harris A, Teira P, Duerst RE, Margossian SP, Martin PL, Petrovic A, Dvorak CC, Nemecek ER, Boyer MW, Chen AR, Davis JH, Shenoy S, Savasan S, Hudspeth MP, Adams RH, Lewis VA, Kheradpour A, Kasow KA, Gillio AP, Haight AE, Bhatia M, Bambach BJ, Haines HL, Quigg TC, Greiner RJ, Talano JAM, Delgado DC, Cheerva A, Gowda M, Ahuja S, Ozkaynak M, Mitchell D, Schultz KR, Fry TJ, Loeb DM, Pulsipher MA. Outcomes of Measurable Residual Disease in Pediatric Acute Myeloid Leukemia before and after Hematopoietic Stem Cell Transplant: Validation of Difference from Normal Flow Cytometry with Chimerism Studies and Wilms Tumor 1 Gene Expression. Biol Blood Marrow Transplant 2018; 24:2040-2046. [PMID: 29933069 DOI: 10.1016/j.bbmt.2018.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 05/02/2018] [Accepted: 06/07/2018] [Indexed: 12/15/2022]
Abstract
We enrolled 150 patients in a prospective multicenter study of children with acute myeloid leukemia undergoing hematopoietic stem cell transplantation (HSCT) to compare the detection of measurable residual disease (MRD) by a "difference from normal" flow cytometry (ΔN) approach with assessment of Wilms tumor 1 (WT1) gene expression without access to the diagnostic specimen. Prospective analysis of the specimens using this approach showed that 23% of patients screened for HSCT had detectable residual disease by ΔN (.04% to 53%). Of those patients who proceeded to transplant as being in morphologic remission, 10 had detectable disease (.04% to 14%) by ΔN. The disease-free survival of this group was 10% (0 to 35%) compared with 55% (46% to 64%, P < .001) for those without disease. The ΔN assay was validated using the post-HSCT specimen by sorting abnormal or suspicious cells to confirm recipient or donor origin by chimerism studies. All 15 patients who had confirmation of tumor detection relapsed, whereas the 2 patients with suspicious phenotype cells lacking this confirmation did not. The phenotype of the relapse specimen was then used retrospectively to assess the pre-HSCT specimen, allowing identification of additional samples with low levels of MRD involvement that were previously undetected. Quantitative assessment of WT1 gene expression was not predictive of relapse or other outcomes in either pre- or post-transplant specimens. MRD detected by ΔN was highly specific, but did not identify most relapsing patients. The application of the assay was limited by poor quality among one-third of the specimens and lack of a diagnostic phenotype for comparison.
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Affiliation(s)
- David A Jacobsohn
- Division of Blood and Marrow Transplantation Center for Cancer and Blood Disorders, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | | | - Mingwei Fei
- Center for International Blood and Marrow Transplant Research; Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alexia Adams
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | | | - Brent R Logan
- Center for International Blood and Marrow Transplant Research; Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research; Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research; Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Morris Kletzel
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Marie Olszewski
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sana Khan
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Amy Keating
- University of Colorado - Children's Hospital, Aurora, CO, USA
| | - Andrew Harris
- Blood and Marrow Transplant Program, University of Michigan Health System, Ann Arbor, MI, USA
| | - Pierre Teira
- Département de pédiatrie, CHU Sainte Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Reggie E Duerst
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Steven P Margossian
- Department of Pediatric Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul L Martin
- Pediatric Blood and Marrow Transplant, Duke University Medical School, Durham, NC, USA
| | - Aleksandra Petrovic
- Pediatric Hematology-Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Christopher C Dvorak
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Eneida R Nemecek
- Pediatric Blood & Marrow Transplant Program, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | - Michael W Boyer
- Pediatric Hematology/Oncology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Allen R Chen
- Pediatric Bone Marrow Transplantation, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Jeffrey H Davis
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Shalini Shenoy
- Pediatric Hematology-Oncology, St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, MO, USA
| | - Sureyya Savasan
- General Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA
| | - Michelle P Hudspeth
- Division of Pediatric Hematology/Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Roberta H Adams
- Hematology / Oncology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Victor A Lewis
- Departments of Oncology, Paediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Albert Kheradpour
- Pediatric Hematology-Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Kimberly A Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina Chapel Hill, NC, USA
| | - Alfred P Gillio
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Ann E Haight
- Division of Hematology/Oncology - Bone Marrow, Pediatric Hematology & Medical Oncology, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Monica Bhatia
- Stem Cell Transplantation, Morgan Stanley Children's Hospital of New York-Presbyterian - Columbia University Medical Center, New York, NY, USA
| | - Barbara J Bambach
- Pediatrics, Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Hilary L Haines
- Division of Hematology and Oncology, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Troy C Quigg
- Pediatric Hematology - Medical Oncology, Texas Transplant Institute, Methodist Children's Hospital, San Antonio, TX, USA
| | - Robert J Greiner
- Pediatric Hematology/Oncology, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Julie-An M Talano
- Department of Pediatric Hematology Oncology, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - David C Delgado
- Department of Pediatrics, Division of Hematology/Oncology, Riley Children's Hospital at Indiana University Health, Indianapolis, IN, USA
| | - Alexandra Cheerva
- Pediatric Medical Oncology, Norton Children's Hospital, University of Louisville Hospital, Louisville, KY, USA
| | - Madhu Gowda
- Pediatric Hematology and Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, USA
| | - Sanjay Ahuja
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Mehmet Ozkaynak
- Pediatric Hematology/Oncology, Westchester Medical Center, Westchester, NY, USA
| | - David Mitchell
- Hematology Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kirk R Schultz
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Terry J Fry
- Pediatric Oncology Branch, National Institutes of Health, Bethesda, MD, USA
| | - David M Loeb
- Pediatric Oncology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
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Knight JM, Kerswill SA, Hari P, Cole SW, Logan BR, D’Souza A, Shah NN, Horowitz MM, Stolley MR, Sloan EK, Giles KE, Costanzo ES, Hamadani M, Chhabra S, Dhakal B, Rizzo JD. Repurposing existing medications as cancer therapy: design and feasibility of a randomized pilot investigating propranolol administration in patients receiving hematopoietic cell transplantation. BMC Cancer 2018; 18:593. [PMID: 29793446 PMCID: PMC5968588 DOI: 10.1186/s12885-018-4509-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Repurposing existing medications for antineoplastic purposes can provide a safe, cost-effective, and efficacious means to further augment available cancer care. Clinical and preclinical studies suggest a role for the ß-adrenergic antagonist (ß-blocker) propranolol in reducing rates of tumor progression in both solid and hematologic malignancies. In patients undergoing hematopoietic cell transplantation (HCT), the peri-transplant period is a time of increased activity of the ß-adrenergically-mediated stress response. METHODS We conducted a proof-of-concept randomized controlled pilot study assessing the feasibility of propranolol administration to patients between ages 18-75 who received an autologous HCT for multiple myeloma. Feasibility was assessed by enrollment rate, tolerability, adherence, and retention. RESULTS One hundred fifty-four patients underwent screening; 31 (20%) enrolled in other oncology trials that precluded dual trial enrollment and 9 (6%) declined to enroll in the current trial. Eighty-nine (58%) did not meet eligibility requirements and 25 (16%) were eligible; of the remaining eligible patients, all were successfully enrolled and randomized. The most common reasons for ineligibility were current ß-blocker use, age, logistics, and medical contraindications. 92% of treatment arm patients tolerated and remained on propranolol for the study duration; 1 patient discontinued due to hypotension. Adherence rate in assessable patients (n = 10) was 94%. Study retention was 100%. CONCLUSIONS Findings show that it is feasible to recruit and treat multiple myeloma patients with propranolol during HCT, with the greatest obstacle being other competing oncology trials. These data support further studies examining propranolol and other potentially repurposed drugs in oncology populations. TRIAL REGISTRATION This randomized controlled trial was registered at clinicaltrials.gov with the identifier NCT02420223 on April 17, 2015.
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Affiliation(s)
- Jennifer M. Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | | | - Parameswaran Hari
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Steve W. Cole
- Department of Medicine, Division of Hematology-Oncology, and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Brent R. Logan
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
- Division of Biostatistics, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, USA
| | - Anita D’Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
| | - Nirav N. Shah
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Mary M. Horowitz
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
| | | | - Erica K. Sloan
- Monash Institute of Pharmaceutical Sciences, Monash University, Clayton, VIC Australia
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, and UCLA AIDS Institute, UCLA, Los Angeles, CA USA
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, VIC Australia
| | | | - Erin S. Costanzo
- Carbone Cancer Center and Department of Psychiatry, University of Wisconsin-Madison, Madison, WI USA
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - J. Douglas Rizzo
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
- Center for International Blood and Marrow Transplant Research; Medical College of Wisconsin, Milwaukee, WI USA
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Abstract
Competing risks endpoints arise when patients can fail therapy from several causes. Analyzing these outcomes allows one to assess directly the benefit of treatment on a primary cause of failure in a clinical trial setting. Regression models can be used in clinical trials to adjust for residual imbalances in patient characteristics, improving the power to detect treatment differences. But, none of the competing risks methods currently available for use in group sequential trials adjust for covariates. We propose a group sequential test for treatment effect that, because it is based on the Fine-Gray model, permits adjustment for covariates. Our derivations show that its sequence of test statistics has an asymptotic distribution with an independent increments structure, which allows standard techniques such as O'Brien-Fleming designs and error spending functions to be employed to meet type I error rate and power specifications. We demonstrate the test in a reanalysis of BMT CTN 0402, a phase III clinical trial that evaluated an experimental treatment for the prevention of adverse outcomes following blood and marrow transplant. Moreover, using a simulation study of randomized group sequential trials, we demonstrate that the proposed method preserves the type I error rate and power at their nominal levels in the presence of influential covariates.
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Affiliation(s)
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
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46
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Brogile L, Thakar M, Logan BR, Artz A, Jacobsohn DA, Bunin NJ, Burroughs L, Martinez C, Nelson AS, Woolfrey AE, Pasquini MC, Sorror ML. Evaluation of the Hematopoietic Cell Comorbidity Index (HCT-CI) in Recipients of Allogeneic Transplantation for Non-Malignant. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.590] [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: 10/18/2022]
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47
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Knight J, Rizzo JD, Wang T, He N, Logan BR, Spellman SR, Lee SJ, Cole S. Genomic Mechanisms of SES-Related Outcome Disparities in Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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48
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Zinter MS, Logan BR, Zhu X, Sapru A, Abraham A, Aljurf MD, Arnold SD, Artz A, Auletta JJ, Chhabra S, Copelan E, Duncan C, Fretham C, Gale RP, Guinan E, Hematti P, Keating AK, Marks DI, Savani BN, Olsson R, Ustun C, Williams KM, Pasquini MC, Dvorak CC. Improved Mortality Prognostication for Critically Ill Pediatric Hematopoietic Cell Transplant Patients: Results From a Virtual Pediatric Systems (VPS) and Center for International Blood and Marrow Transplant Research (CIBMTR) Database Merger. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.034] [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: 11/16/2022]
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49
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Knight J, Rizzo JD, Hari P, Kerswill S, D'Souza A, Logan BR, Hamadani M, Chhabra S, Dhakal B, Shah N, Cole S. Propranolol Inhibits Stress-Related Gene Expression Profiles Associated with Adverse Clinical Outcomes in Autologous Hematopoietic Cell Transplantation Recipients. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.183] [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: 10/18/2022]
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50
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Leiding JW, Logan BR, Yin Z, Arbuckle E, Bleesing JJ, Sullivan KE, Heimall J, Burroughs L, Skoda-Smith S, Chandrakasan S, Yu LC, Oshrine BR, Cuvelier GD, Thakar M, Chen K, Shenoy S, Saldana BD, Weinacht KG, Joshi A, Boulad F, Quigg TC, Dvorak CC, Knutsen A, Chong H, Miller HK, de la Morena MT, DeSantes K, Cowan MJ, Notarangelo LD, Kohn DB, Pai SY, Stenger E, Puck J, Kapoor N, Pulsipher MA, Haddad E, Griffith LM, Shearer W, Malech HL, Parikh S, Marsh RA, Kang EM. Resolution of CGD Related Colitis after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Chronic Granulomatous Disease—Early Results From the 6903 Study of the Primary Immune Deficiency Treatment Consortium (PIDTC). Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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