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Flaadt T, Ladenstein RL, Ebinger M, Lode HN, Arnardóttir HB, Poetschger U, Schwinger W, Meisel R, Schuster FR, Döring M, Ambros PF, Queudeville M, Fuchs J, Warmann SW, Schäfer J, Seitz C, Schlegel P, Brecht IB, Holzer U, Feuchtinger T, Simon T, Schulte JH, Eggert A, Teltschik HM, Illhardt T, Handgretinger R, Lang P. Anti-GD2 Antibody Dinutuximab Beta and Low-Dose Interleukin 2 After Haploidentical Stem-Cell Transplantation in Patients With Relapsed Neuroblastoma: A Multicenter, Phase I/II Trial. J Clin Oncol 2023:JCO2201630. [PMID: 36854071 DOI: 10.1200/jco.22.01630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Patients with relapsed high-risk neuroblastoma (rHR-NB) have a poor prognosis. We hypothesized that graft-versus-neuroblastoma effects could be elicited by transplantation of haploidentical stem cells (haplo-SCT) exploiting cytotoxic functions of natural killer cells and their activation by the anti-GD2 antibody dinutuximab beta (DB). This phase I/II trial assessed safety, feasibility, and outcomes of immunotherapy with DB plus subcutaneous interleukin-2 (scIL2) after haplo-SCT in patients with rHR-NB. METHODS Patients age 1-21 years underwent T-/B-cell-depleted haplo-SCT followed by DB and scIL2. The primary end point 'success of treatment' encompassed patients receiving six cycles, being alive 180 days after end of trial treatment without progressive disease, unacceptable toxicity, acute graft-versus-host-disease (GvHD) ≥grade 3, or extensive chronic GvHD. RESULTS Seventy patients were screened, and 68 were eligible for immunotherapy. Median number of DB cycles was 6 (range, 1-9). Median number of scIL2 cycles was 3 (1-6). The primary end point was met by 37 patients (54.4%). Median observation time was 7.8 years. Five-year event-free survival (EFS) and overall survival from start of trial treatment were 43% (95% CI, 31 to 55) and 53% (95% CI, 41 to 65), respectively. Five-year EFS among patients in complete remission (CR; 52%; 95% CI, 31 to 69) or partial remission (44%; 95% CI, 27 to 60) before immunotherapy were significantly better compared with patients with nonresponse/mixed response/progressive disease (13%; 95% CI, 1 to 42; P = .026). Overall response rate in 43 patients with evidence of disease after haplo-SCT was 51% (22 patients), with 15 achieving CR (35%). Two patients developed GvHD grade 2 and 3 each. No unexpected adverse events occurred. CONCLUSION DB therapy after haplo-SCT in patients with rHR-NB is feasible, with low risk of inducing GvHD, and results in long-term remissions likely attributable to increased antineuroblastoma activity by donor-derived effector cells.
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Affiliation(s)
- Tim Flaadt
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ruth L Ladenstein
- St Anna Children's Hospital and Children's Cancer Research Institute, Department of Studies and Statistics for Integrated Research and Projects, Medical University of Vienna, Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Martin Ebinger
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Holger N Lode
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Helga Björk Arnardóttir
- Department for Studies and Statistics and Integrated Research, Children's Cancer Research Institute, Vienna, Austria
| | - Ulrike Poetschger
- Department for Studies and Statistics and Integrated Research, Children's Cancer Research Institute, Vienna, Austria
| | - Wolfgang Schwinger
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Roland Meisel
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Friedhelm R Schuster
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Michaela Döring
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter F Ambros
- CCRI, Children's Cancer Research Institute, Vienna, Department of Tumor Biology and Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Manon Queudeville
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Jürgen Schäfer
- Department for Diagnostic and Interventional Radiology, University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Christian Seitz
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Cluster of Excellence iFIT (Exc 2180) "Image-guided and Functionally Instructed Tumor Therapies," University of Tuebingen, Germany
| | - Patrick Schlegel
- Children's Medical Research Institute, The Cancer Centre for Children, The Children's Hospital Westmead, University of Sydney, Sydney, Australia
| | - Ines B Brecht
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ursula Holzer
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Hospital, University of Cologne, Cologne, Germany
| | - Johannes H Schulte
- Department of Pediatric Oncology/Hematology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Angelika Eggert
- Department of Pediatric Oncology/Hematology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Heiko-Manuel Teltschik
- Department of Hematology and Oncology, Children's Hospital Stuttgart-Olgahospital, Stuttgart, Germany
| | - Toni Illhardt
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Rupert Handgretinger
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Lang
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Cluster of Excellence iFIT (Exc 2180) "Image-guided and Functionally Instructed Tumor Therapies," University of Tuebingen, Germany
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2
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Heinz AT, Calkoen FGJ, Derbich A, Miltner L, Seitz C, Doering M, Braun C, Atar D, Schumm M, Heubach F, Arendt AM, Schulz A, Schuster FR, Meisel R, Strahm B, Finke J, Heineking B, Stetter S, Silling G, Stachel D, Gruhn B, Debatin KM, Foell J, Schulte JH, Woessmann W, Mauz-Körholz C, Tischer J, Feuchtinger T, Handgretinger R, Lang P. Automated production of specific T cells for treatment of refractory viral infections after allogeneic stem cell transplantation. Haematologica 2023. [PMID: 36794500 PMCID: PMC10388273 DOI: 10.3324/haematol.2022.281996] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Indexed: 02/17/2023] Open
Abstract
Therapy resistant viral reactivations significantly contribute to mortality after hematopoietic stem cell transplantation. Adoptive cellular therapy with virus-specific T cells has shown efficacy in various single center trials. However, scalability of this therapy is hampered by laborious production methods. In this study we describe the in-house production of virus-specific T cells (VST) in a closed system (CliniMACS Prodigy® system by Miltenyi Biotec). In addition, we report the efficacy in 26 patients with viral disease post HSCT in a retrospective analysis (ADV n=7, CMV n=8, EBV n=4, multi-viral n=7). Production of VST was successful in 100% of cases. Safety profile of VST therapy was favorable (n=2 adverse event grade 3, n=1 grade 4; all three were reversible). A response was seen in 20 of 26 patients (77%). Responding patients had a significantly better OS than patients without response (p.
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Affiliation(s)
- Amadeus T Heinz
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen.
| | | | - Alexander Derbich
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
| | - Lea Miltner
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
| | - Christian Seitz
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
| | - Michaela Doering
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
| | - Christiane Braun
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
| | - Daniel Atar
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
| | - Michael Schumm
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
| | - Florian Heubach
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
| | - Anne-Marie Arendt
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm
| | - Friedhelm R Schuster
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Duesseldorf
| | - Roland Meisel
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Duesseldorf
| | - Brigitte Strahm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg
| | - Juergen Finke
- Department of Hematology and Oncology, University Hospital Freiburg, Freiburg
| | - Beatrice Heineking
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Munich
| | - Susanne Stetter
- Department of Medicine III, University Hospital Regensburg, Regensburg
| | - Gerda Silling
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University, Aachen
| | - Daniel Stachel
- Hospital for Pediatric and Adolescent Medicine, University of Erlangen, Erlangen
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena
| | | | - Juergen Foell
- Department of Hematology and Oncology, University Children's Hospital Regensburg, Regensburg
| | - Johannes H Schulte
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen
| | - Christine Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany; Medical Faculty of the Martin-Luther-University of Halle-Wittenberg, Halle
| | - Johanna Tischer
- Department of Medicine III, Ludwig-Maximilians-University, Munich
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner University Children's Hospital, Munich
| | | | - Peter Lang
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen
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3
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Gössling KL, Fouz H, Kyrillopoulou O, Aubin M, Maecker-Kolhoff B, Adams O, Borkhardt A, Babor F, Schuster FR, Siepermann M, Schumm M, Lang P, Eiz-Vesper B, Meisel R. Clearance of Treatment Refractory Adenoviremia via Adenovirus-specific Donor T-Cell Transfer During Aplasia After αβTCR-CD19–Depleted Stem Cell Transplantation. Clin Infect Dis 2018; 68:1406-1409. [DOI: 10.1093/cid/ciy820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/28/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katharina L Gössling
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf
| | - Hiba Fouz
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf
| | - Olga Kyrillopoulou
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf
| | - Matthias Aubin
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf
| | | | - Ortwin Adams
- Institute of Virology, Heinrich Heine University, Medical Faculty, Düsseldorf
| | - Arndt Borkhardt
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf
| | - Florian Babor
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf
| | - Friedhelm R Schuster
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf
| | - Meinolf Siepermann
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf
| | - Michael Schumm
- Children’s Hospital, University Hospital Tübingen, Germany
| | - Peter Lang
- Children’s Hospital, University Hospital Tübingen, Germany
| | - Britta Eiz-Vesper
- Institute for Transfusion Medicine, Hannover Medical School, Germany
| | - Roland Meisel
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf
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4
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Gössling KL, Schipp C, Fischer U, Babor F, Koch G, Schuster FR, Dietzel-Dahmen J, Wieczorek D, Borkhardt A, Meisel R, Kuhlen M. Hematopoietic Stem Cell Transplantation in an Infant with Immunodeficiency, Centromeric Instability, and Facial Anomaly Syndrome. Front Immunol 2017; 8:773. [PMID: 28713390 PMCID: PMC5491950 DOI: 10.3389/fimmu.2017.00773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/06/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022] Open
Abstract
Immunodeficiency, centromeric instability, and facial anomaly (ICF) syndrome is a rare autosomal recessive genetic condition with severe immunodeficiency, which leads to lethal infections if not recognized and treated in early childhood. Up-to-date treatment regimens consist of prophylactic and supportive treatment of the recurrent infections. Here, we report the case of a 1-year-old boy of Moroccan consanguineous parents, who was diagnosed at 4 months of age with ICF syndrome with a homozygous missense mutation in the DNMT3B gene. He was initially admitted to the hospital with recurrent pulmonary infections from the opportunistic pathogen Pneumocystis jirovecii (PJ). Further immunological workup revealed agammaglobulinemia in the presence of B cells. After successful recovery from the PJ pneumonia, he underwent hematopoietic stem cell transplantation (HSCT) from the HLA-matched healthy sister using a chemotherapeutic conditioning regimen consisting of treosulfan, fludarabine, and thiotepa. Other than acute chemotherapy-associated side effects, no serious adverse events occurred. Six months after HSCT immune-reconstitution, he had a stable chimerism with 2.9% autologous portion in the peripheral blood and a normal differential blood cell count, including all immunoglobulin subtypes. This is one of the first cases of successful HSCT in ICF syndrome. Early diagnosis and subsequent HSCT can prevent severe opportunistic infections and cure the immunodeficiency. Centromeric instability and facial anomaly remain unaffected. Although the long-term patient outcome and the neurological development remain to be seen, this curative therapy for immunodeficiency improves life expectancy and quality of life. This case is meant to raise physicians awareness for ICF syndrome and highlight the consideration for HSCT in ICF syndrome early on.
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Affiliation(s)
- Katharina L Gössling
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Düsseldorf, Düsseldorf, Germany
| | - Cyrill Schipp
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Düsseldorf, Düsseldorf, Germany
| | - Ute Fischer
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Düsseldorf, Düsseldorf, Germany
| | - Florian Babor
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Düsseldorf, Düsseldorf, Germany
| | - Gerhard Koch
- Department of Pediatrics, Allgemeines Krankenhaus Hagen, Hagen, Germany
| | - Friedhelm R Schuster
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Düsseldorf, Düsseldorf, Germany
| | - Jutta Dietzel-Dahmen
- Medical Faculty, Department of Human Genetics, University of Düsseldorf, Düsseldorf, Germany
| | - Dagmar Wieczorek
- Medical Faculty, Department of Human Genetics, University of Düsseldorf, Düsseldorf, Germany
| | - Arndt Borkhardt
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Düsseldorf, Düsseldorf, Germany
| | - Roland Meisel
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Düsseldorf, Düsseldorf, Germany
| | - Michaela Kuhlen
- Medical Faculty, Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Düsseldorf, Düsseldorf, Germany
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5
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Ghosh S, Hönscheid A, Dückers G, Ginzel S, Gohlke H, Gombert M, Kempkes B, Klapper W, Kuhlen M, Laws HJ, Linka RM, Meisel R, Mielke C, Niehues T, Schindler D, Schneider D, Schuster FR, Speckmann C, Borkhardt A. Human RAD52 - a novel player in DNA repair in cancer and immunodeficiency. Haematologica 2016; 102:e69-e72. [PMID: 27979922 DOI: 10.3324/haematol.2016.155838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Sujal Ghosh
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany .,Infection, Immunity, Inflammation, Molecular and Cellular Immunology Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Andrea Hönscheid
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gregor Dückers
- Department of Pediatrics, Helios Hospital Krefeld, Germany
| | - Sebastian Ginzel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Holger Gohlke
- Institute for Pharmaceutical and Medicinal Chemistry, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael Gombert
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Bettina Kempkes
- Department of Gene Vectors, Helmholtz Center Munich, German Research Center for Environmental Health, Germany
| | - Wolfram Klapper
- Department of Pathology, Haematopathology Section and Lymph Node Registry, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Michaela Kuhlen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Jürgen Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - René Martin Linka
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Roland Meisel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Christian Mielke
- Institute of Clinical Chemistry and Laboratory Diagnostics, Heinrich-Heine-University, Düsseldorf, GermanyMedical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tim Niehues
- Department of Pediatrics, Helios Hospital Krefeld, Germany
| | | | | | - Friedhelm R Schuster
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Carsten Speckmann
- Centre for Chronic Immunodeficiency (CCI) and Centre of Pediatrics, University of Freiburg, Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
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6
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Seidel UJE, Grosse-Hovest L, Schlegel P, Hofmann M, Schuster FR, Meisel R, Witte KE, Aulwurm S, Pyz E, Rammensee HG, Jung G, Handgretinger R, Lang P. Abstract B144: Reduction of minimal residual disease in pediatric B-precursor acute lymphoblastic leukemia by an Fc-optimized CD19 antibody. Cancer Immunol Res 2016. [DOI: 10.1158/2326-6074.cricimteatiaacr15-b144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
B-precursor acute lymphoblastic leukemia (BCP-ALL) is the most common childhood cancer. Although this disease can be successfully treated in 80 % of patients by chemotherapy, prognosis for primary refractory or relapsed patients is very poor. Even after allogeneic stem cell transplantation (SCT), relapse rates are considerable and correlate significantly with persistent minimal residual disease (MRD) prior to or after SCT. In an MRD constellation favorable effector-target ratios prevail and thus it is well suited for immunotherapy with therapeutic antibodies.
We developed a chimeric Fc-optimized third-generation CD19 antibody (4G7SDIE) and produced it in pharmaceutical quality. This antibody mediates markedly enhanced antibody dependent cellular cytotoxicity (ADCC) through its improved capability to recruit FcγRIIIa-bearing effector cells. In this study, 4G7SDIE was applied on a compassionate need basis to pediatric patients with relapsed or refractory BCP-ALL in an MRD situation (n=14) or in relapse (n=2) (initial refractory disease, n=3; 1st relapse, n=7; ≥ 2nd relapse, n=6; 12/16 patients had previous SCT). Side effects were negligible. In all patients complete CD20+ B-cell depletion was observed during therapy. After discontinuation of 4G7SDIE therapy B cell counts recovered rapidly to normal levels. Both patients in relapse did not respond to 4G7SDIE treatment. In 9/14 MRD-positive patients, MRD was reduced by ≥ 1 log or fell below MRD-detection threshold of 10-4 over the course of treatment. 2/9 responders were receiving additional treatment.
In CD107a assays primary NK cells and γδ T cells were identified as main effector cell populations. The FcγRIIIA-V158F polymorphism had no influence on ADCC mediated by 4G7SDIE. Cytotoxicity assays confirmed sustained functionality of patient effector cells over the course of 4G7SDIE treatment. In vitro cytotoxicity assays were performed using PBMC from transplanted patients obtained at different time points of 4G7SDIE treatment. Lysis of autologous leukemic blasts was increased when 4G7SDIE or autologous patient serum taken after antibody infusion was added. After infusion of 20 mg/m2 4G7SDIE serum half-life was 34 ± 13 hours (n=3) and serum levels of 4G7SDIE remained above saturating concentrations of ≥ 700 ng/ml (EC50=65 ng/ml) at day 13 and following treatment cycle, respectively.
Notably, in 3/3 analyzed patients under 4G7SDIE therapy, a transient down modulation of CD19 surface expression on the leukemic blasts was observed. In vitro antigenic shift assays on primary leukemic blasts showed considerable but very heterogeneous shift of CD19 surface expression. Furthermore, a positive correlation between CD19 surface expression levels and 4G7SDIE mediated lysis was observed. These observations hint at in vivo tumor escape mechanisms and furthermore indicate selective pressure exerted by immunotherapy with 4G7SDIE, underlining its therapeutic potential, but also delineating possible limitations.
In conclusion, promising anti-leukemic effects of the 4G7SDIE antibody have been observed in vitro and in vivo. We are currently preparing a phase I/IIa trial.
Citation Format: Ursula Joerdis Eva Seidel, Ludger Grosse-Hovest, Patrick Schlegel, Martin Hofmann, Friedhelm R. Schuster, Roland Meisel, Kai-Erik Witte, Steffen Aulwurm, Elwira Pyz, Hans-Georg Rammensee, Gundram Jung, Rupert Handgretinger, Peter Lang. Reduction of minimal residual disease in pediatric B-precursor acute lymphoblastic leukemia by an Fc-optimized CD19 antibody. [abstract]. In: Proceedings of the CRI-CIMT-EATI-AACR Inaugural International Cancer Immunotherapy Conference: Translating Science into Survival; September 16-19, 2015; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(1 Suppl):Abstract nr B144.
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Affiliation(s)
- Ursula Joerdis Eva Seidel
- 1University Children's Hospital Tübingen, Department of General Paediatrics, Oncology/Haematology, Tuebingen, Germany,
| | - Ludger Grosse-Hovest
- 2SYNIMMUNE GmbH, Tuebingen, Germany,
- 3University of Tübingen, Interfaculty Institute for Cell Biology, Department of Immunology, Tuebingen, Germany,
| | - Patrick Schlegel
- 1University Children's Hospital Tübingen, Department of General Paediatrics, Oncology/Haematology, Tuebingen, Germany,
| | - Martin Hofmann
- 2SYNIMMUNE GmbH, Tuebingen, Germany,
- 3University of Tübingen, Interfaculty Institute for Cell Biology, Department of Immunology, Tuebingen, Germany,
| | - Friedhelm R. Schuster
- 4Heinrich Heine University, Department of Paediatric Oncology, Haematology and Immunology, Duesseldorf, Germany,
| | - Roland Meisel
- 4Heinrich Heine University, Department of Paediatric Oncology, Haematology and Immunology, Duesseldorf, Germany,
| | - Kai-Erik Witte
- 1University Children's Hospital Tübingen, Department of General Paediatrics, Oncology/Haematology, Tuebingen, Germany,
| | - Steffen Aulwurm
- 2SYNIMMUNE GmbH, Tuebingen, Germany,
- 3University of Tübingen, Interfaculty Institute for Cell Biology, Department of Immunology, Tuebingen, Germany,
| | - Elwira Pyz
- 3University of Tübingen, Interfaculty Institute for Cell Biology, Department of Immunology, Tuebingen, Germany,
| | - Hans-Georg Rammensee
- 3University of Tübingen, Interfaculty Institute for Cell Biology, Department of Immunology, Tuebingen, Germany,
- 5German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tuebingen, Tuebingen, Germany
| | - Gundram Jung
- 3University of Tübingen, Interfaculty Institute for Cell Biology, Department of Immunology, Tuebingen, Germany,
- 5German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tuebingen, Tuebingen, Germany
| | - Rupert Handgretinger
- 1University Children's Hospital Tübingen, Department of General Paediatrics, Oncology/Haematology, Tuebingen, Germany,
- 5German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tuebingen, Tuebingen, Germany
| | - Peter Lang
- 1University Children's Hospital Tübingen, Department of General Paediatrics, Oncology/Haematology, Tuebingen, Germany,
- 5German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tuebingen, Tuebingen, Germany
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7
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Schuster FR, Stanglmaier M, Woessmann W, Winkler B, Siepermann M, Meisel R, Schlegel PG, Hess J, Lindhofer H, Borkhardt A, Buhmann R. Immunotherapy with the trifunctional anti-CD20 x anti-CD3 antibody FBTA05 (Lymphomun) in paediatric high-risk patients with recurrent CD20-positive B cell malignancies. Br J Haematol 2014; 169:90-102. [PMID: 25495919 DOI: 10.1111/bjh.13242] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/04/2014] [Indexed: 12/23/2022]
Abstract
Children with B cell malignancies refractory to standard therapy are known to have a poor prognosis and very limited treatment options. Here, we report on the treatment and follow-up of ten patients diagnosed with relapsed or refractory mature B-cell Non Hodgkin Lymphoma (B-NHL), Burkitt leukaemia (B-AL) or pre B-acute lymphoblastic leukaemia (pre B-ALL). All children were treated with FBTA05 (now designated Lymphomun), an anti-CD3 x anti-CD20 trifunctional bispecific antibody (trAb) in compassionate use. Within individual treatment schedules, Lymphomun was applied (a) after allogeneic stem cell transplantation (allo-SCT, n = 6) to induce sustained long-term remission, or (b) stand alone prior to subsequent chemotherapy to eradicate residual disease before allo-SCT (n = 4). Nine of ten children displayed a clinical response: three stable diseases (SD), one partial remission (PR) and five induced or sustained complete remissions (CR). Five of these nine responders died during follow-up. The other patients still maintain CR with a current overall survival of 874-1424 days (median: 1150 days). In conclusion, despite the dismal clinical prognosis of children refractory to standard therapy, immunotherapy with Lymphomun resulted in a favourable clinical outcome in this cohort of refractory paediatric patients.
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Affiliation(s)
- Friedhelm R Schuster
- Department of Paediatric Oncology, Haematology and Immunology, University of Duesseldorf, Duesseldorf, Germany
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8
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Ghosh S, Schuster FR, Adams O, Babor F, Borkhardt A, Comoli P, Handgretinger R, Lang P, Laws HJ, Siepermann M, Meisel R. Haploidentical stem cell transplantation in DOCK8 deficiency - Successful control of pre-existing severe viremia with a TCRaß/CD19-depleted graft and antiviral treatment. Clin Immunol 2014; 152:111-4. [PMID: 24667686 DOI: 10.1016/j.clim.2014.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/13/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Sujal Ghosh
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany.
| | - Friedhelm R Schuster
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany
| | - Ortwin Adams
- Institute of Virology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany
| | - Florian Babor
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany
| | - Arndt Borkhardt
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany
| | - Patrizia Comoli
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Peter Lang
- Children's University Hospital, University of Tuebingen, Tuebingen, Germany
| | - Hans-Jürgen Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany
| | - Meinolf Siepermann
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany
| | - Roland Meisel
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany
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9
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Schuster FR, Meisel R, Führer M, Reuther S, Hauer J, Tischer J, Feuchtinger T, Laws HJ, Kolb HJ, Borkhardt A. Anti-leukaemic activity of a novel haploidentical-transplantation approach employing unmanipulated bone marrow followed by CD6-depleted peripheral blood stem cells in children with refractory/relapsed acute leukaemia. Br J Haematol 2013; 162:802-7. [DOI: 10.1111/bjh.12455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/22/2013] [Indexed: 01/11/2023]
Affiliation(s)
- Friedhelm R. Schuster
- Clinic of Paediatric Oncology, Haematology and Clinical Immunology; Centre for Child and Adolescent Health; Medical Faculty; Heinrich-Heine-University Düsseldorf; Düsseldorf; Germany
| | - Roland Meisel
- Clinic of Paediatric Oncology, Haematology and Clinical Immunology; Centre for Child and Adolescent Health; Medical Faculty; Heinrich-Heine-University Düsseldorf; Düsseldorf; Germany
| | - Monika Führer
- Dr. von Haunersches Kinderspital; Ludwig-Maximilians-Universität; Munich; Germany
| | - Susanne Reuther
- Clinic of Paediatric Oncology, Haematology and Clinical Immunology; Centre for Child and Adolescent Health; Medical Faculty; Heinrich-Heine-University Düsseldorf; Düsseldorf; Germany
| | - Julia Hauer
- Clinic of Paediatric Oncology, Haematology and Clinical Immunology; Centre for Child and Adolescent Health; Medical Faculty; Heinrich-Heine-University Düsseldorf; Düsseldorf; Germany
| | - Johanna Tischer
- Medizinische Klinik und Poliklinik III; Klinikum Großhadern; Ludwig-Maximilians-Universität; Munich; Germany
| | | | - Hans-Jürgen Laws
- Clinic of Paediatric Oncology, Haematology and Clinical Immunology; Centre for Child and Adolescent Health; Medical Faculty; Heinrich-Heine-University Düsseldorf; Düsseldorf; Germany
| | - Hans-Jochem Kolb
- Medizinische Klinik und Poliklinik III; Klinikum Großhadern; Ludwig-Maximilians-Universität; Munich; Germany
| | - Arndt Borkhardt
- Clinic of Paediatric Oncology, Haematology and Clinical Immunology; Centre for Child and Adolescent Health; Medical Faculty; Heinrich-Heine-University Düsseldorf; Düsseldorf; Germany
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10
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Krell PFI, Reuther S, Fischer U, Keller T, Weber S, Gombert M, Schuster FR, Asang C, Stepensky P, Strahm B, Meisel R, Stoye J, Borkhardt A. Next-generation-sequencing-spectratyping reveals public T-cell receptor repertoires in pediatric very severe aplastic anemia and identifies a β chain CDR3 sequence associated with hepatitis-induced pathogenesis. Haematologica 2013; 98:1388-96. [PMID: 23716544 DOI: 10.3324/haematol.2012.069708] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Current diagnostic approaches that characterize T-cell deficiency by analyzing diversity of T-cell receptor sequences effectuate limited informational gain about the actual restrictiveness. For deeper insight into T-cell receptor repertoires we developed next-generation-sequencing-spectratyping, which employs high coverage Roche/454 sequencing of T-cell receptor (β)-chain amplicons. For automated analysis of high-throughput-sequencing data, we developed a freely available software, the TCR profiler. Gene usage, length, encoded amino acid sequence and sequence diversity of the complementarity determining region 3 were determined and comprehensively integrated into a novel complexity score. Repertoires of CD8(+) T cells from children with idiopathic or hepatitis-induced very severe aplastic anemia (n=7), children two months after bone marrow transplantation (n=7) and healthy controls (children n=5, adults n=5) were analyzed. Complexity scores clearly distinguished between healthy and diseased, and even between different immune deficiency states. The repertoire of aplastic anemia patients was dominated by public (i.e. present in more than one person) T-cell receptor clonotypes, whereas only 0.2% or 1.9% were public in normal children and adults, respectively. The CDR3 sequence ASSGVGFSGANVLT was highly prevalent in 3 cases of hepatitis-induced anemia (15-32% of all sequences), but was only low expressed in idiopathic aplastic anemia (2-5%, n=4) or healthy controls (<1%). Fifteen high frequent sequences were present exclusively in aplastic anemia patients. Next-generation-sequencing-spectratyping allows in-depth analysis of T-cell receptor repertoires and their restriction in clinical samples. A dominating clonotype was identified in hepatitis-induced anemia that may be associated with disease pathogenesis and several aplastic-anemia-associated, putatively autoreactive clonotypes were sequenced.
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Affiliation(s)
- Pina F I Krell
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children’s Hospital, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
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11
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Chen C, Akanay-Diesel S, Schuster FR, Klee D, Schmidt KG, Donner BC. An unusual manifestation of post-transplant lymphoproliferative disorder in the lip after pediatric heart transplantation. Pediatr Transplant 2012; 16:E320-4. [PMID: 22404497 DOI: 10.1111/j.1399-3046.2012.01673.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PTLD is a serious and frequently observed complication after solid organ transplantation. We present a six-yr-old girl with a rapidly growing, solid tumor of the lip four yr after orthotopic heart transplantation, which was classified as monomorphic PTLD with the characteristics of a diffuse large B-cell lymphoma. Treatment with reduction in immunosuppression, ganciclovir, and anti B-cell monoclonal antibody (rituximab) resulted in full remission since 12 months. To the best of our knowledge, this report is the first description of PTLD in the lip in a pediatric patient after heart transplantation in the English literature.
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Affiliation(s)
- C Chen
- Department of Pediatric Cardiology and Pneumology, University Düsseldorf, Düsseldorf, Germany
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12
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Ghosh S, Schuster FR, Fuchs I, Laws HJ, Borkhardt A, Meisel R. Treosulfan-based conditioning in DOCK8 deficiency: complete lympho-hematopoietic reconstitution with minimal toxicity. Clin Immunol 2012; 145:259-61. [PMID: 23128504 DOI: 10.1016/j.clim.2012.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/06/2012] [Indexed: 11/24/2022]
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13
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Reuther S, Schmetzer H, Schuster FR, Krell P, Grabrucker C, Liepert A, Kroell T, Kolb HJ, Borkhardt A, Buhmann R. In vitro-induced response patterns of antileukemic T cells: characterization by spectratyping and immunophenotyping. Clin Exp Med 2012; 13:29-48. [PMID: 22441559 DOI: 10.1007/s10238-012-0180-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 02/28/2012] [Indexed: 11/24/2022]
Abstract
Myeloid leukemic cells can be induced to differentiate into leukemia-derived dendritic cells (DCleu) regaining the stimulatory capacity of professional DCs while presenting the leukemic antigen repertoire. But so far, the induced antileukemic T-cell responses are variable both in specificity and in efficacy. In an attempt to elucidate the underlying causes of different T-cell response patterns, T-cell receptor (TR) Vβ chain rearrangements were correlated with the T cells corresponding immunophenotypic profile, as well as their proliferative response and cytolytic capacities. In three different settings, donor T cells, either human leukocyte antigen matched or mismatched (haploidentical), or autologous T cells were repeatedly stimulated with myeloid blasts or leukemia-derived DC/DCleus from the corresponding patients diseased from acute myeloid leukemia (AML). Although no significant differences in T-cell proliferation were observed, the T-cell-mediated cytolytic response pattern varied considerably and even caused blast proliferation in two cases. Spectratyping revealed a remarkable restriction (>75% of normal level) of the CD4+ or CD8+-TR repertoire of blast- or DC/DCleu-stimulated T cells. Although in absolute terms, DC/DCleu stimulation induced the highest grade of restriction in the CD8+ T-cell subset, the CD4+ T-cell compartment seemed to be relatively more affected. But most importantly, in vitro stimulation with DC/DCleu resulted into an identical TR restriction pattern (β chain) that could be identified in vivo in a patient sample 3 months after allo-SCT. Thus, in vitro tests combining functional flow cytometry with spectratyping might provide predictive information about T cellular response patterns in vivo.
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Affiliation(s)
- Susanne Reuther
- Faculty of Medical, Department of Paediatric Oncology, Haematology and Immunology, University Dusseldorf, 40225, Dusseldorf, Germany
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14
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Fischer U, Ruckert C, Hubner B, Eckermann O, Binder V, Bakchoul T, Schuster FR, Merk S, Klein HU, Führer M, Dugas M, Borkhardt A. CD34+ gene expression profiling of individual children with very severe aplastic anemia indicates a pathogenic role of integrin receptors and the proapoptotic death ligand TRAIL. Haematologica 2012; 97:1304-11. [PMID: 22315490 DOI: 10.3324/haematol.2011.056705] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
UNLABELLED BACKGROUND Very severe aplastic anemia is characterized by a hypoplastic bone marrow due to destruction of CD34(+) stem cells by autoreactive T cells. Investigation of the pathomechanism by patient-specific gene expression analysis of the attacked stem cells has previously been impractical because of the scarcity of these cells at diagnosis. DESIGN AND METHODS Employing unbiased RNA amplification, patient-specific gene expression profiling was carried out for CD34(+) cells from patients newly diagnosed with very severe aplastic anemia (n=13), refractory anemia (n=8) and healthy controls (n=10). These data were compared to profiles of myelodysplastic disease (n=55), including refractory anemia (n=18). To identify possible targets of autoimmune attack, presence of autoreactive antibodies was tested in pre-therapeutic sera of patients with very severe aplastic anemia (n=19). RESULTS CD34(+) gene expression profiling distinguished between healthy controls, children with aplastic or refractory anemia and clonal disease. Interferon stimulated genes such as the apoptosis inducing death ligand TRAIL were strongly up-regulated in CD34(+) cells of patients with aplastic anemia, in particular in patients responding to immunosuppressive treatment. In contrast, mRNA expression of integrin GPVI and the integrin complexes GPIa/IIa, GPIIb/IIIa, GPIB/GPIX/GPV was significantly down-regulated and corresponding antibodies were detected in 7 of 11 profiled patients and in 11 of 19 aplastic anemia patients. CONCLUSIONS As a potential diagnostic tool, patient-specific gene expression profiling of CD34(+) stem cells made it possible to make the difficult differential diagnosis of most patients with aplastic and refractory anemia. Profiling indicated a prognostic correlation of TRAIL expression and patient benefit from immunosuppressive therapy. Downregulation of integrin expression and concurrent presence of autoreactive anti-integrin-antibodies suggested a previously unrecognized pathological role of integrins in aplastic anemia.
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Affiliation(s)
- Ute Fischer
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany
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15
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Miese FR, Schuster FR, Pierstorff K, Karenfort M, Laws HJ, Borkhardt A, Saleh A. Magnetization transfer imaging provides no evidence of demyelination in methotrexate-induced encephalopathy. AJNR Am J Neuroradiol 2010; 32:E110-2. [PMID: 20651019 DOI: 10.3174/ajnr.a2181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Subacute MTX-induced encephalopathy is characterized by an abrupt onset of focal neurologic deficits within days after intrathecal or systemic therapy. Demyelination is one proposed mechanism. We describe the neuroimaging features of 2 patients with clinical symptoms of subacute encephalopathy after intrathecal and systemic MTX therapy. DWI showed restricted diffusion, indicating cytotoxic edema. MTI yielded no evidence of demyelination in either patient because there was no loss of MTR in areas of restricted diffusion.
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Affiliation(s)
- F R Miese
- Institute of Radiology, Center for Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany.
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16
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Lehrnbecher T, Schmidt S, Koehl U, Schuster FR, Uharek L, Klingebiel T, Tramsen L. Adoptive antifungal T cell immunotherapy--into the clinic? Med Mycol 2010; 49 Suppl 1:S164-9. [PMID: 20586680 DOI: 10.3109/13693786.2010.497953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The morbidity and mortality rates of invasive fungal infection in allogeneic stem cell recipients are still unacceptably high and have not been significantly improved by alternative antifungal strategies to date. Over the last few years, rapid methods for the clinical-scale generation of functionally active and well characterized antifungal T(H)1 cells have become available. In addition, current data on the use of donor-derived virus-specific T cells in allogeneic stem cell transplantation suggest that the risk of severe adverse events, in particular the risk of graft-versus-host disease, is negligible. Therefore, adoptive antifungal immunotherapeutic strategies should be evaluated in clinical trials. However, one has to recognize that these trials are only meaningful with sufficiently large and homogenous cohorts of patients and if the settings of adoptive antifungal immunotherapy are comparable. Ultimately, the strategy of adoptively transferring antifungal immune responses might improve the outcome in hematopoietic stem cell recipients suffering from invasive fungal infection.
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Affiliation(s)
- Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Children's Hospital III, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt, Germany.
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17
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Wildenhain S, Ruckert C, Röttgers S, Harbott J, Ludwig WD, Schuster FR, Beldjord K, Binder V, Slany R, Hauer J, Borkhardt A. Expression of cell-cell interacting genes distinguishes HLXB9/TEL from MLL-positive childhood acute myeloid leukemia. Leukemia 2010; 24:1657-60. [PMID: 20596032 DOI: 10.1038/leu.2010.146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Schuster FR, Buhmann R, Reuther S, Hubner B, Grabrucker C, Liepert A, Reibke R, Lichtner P, Yang T, Kroell T, Kolb HJ, Borkhardt A, Schmetzer H. Improved effector function of leukemia-specific T-lymphocyte clones trained with AML-derived dendritic cells. Cancer Genomics Proteomics 2008; 5:275-286. [PMID: 19129558] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Recently it was shown that myeloid leukemic cells can be induced to differentiate into leukemia-derived dendritic cells (DCleu), regaining the stimulatory capacity of professional DCs while presenting the leukemic antigen repertoire. But so far, the induced antileukemic T-cell responses have varied in specificity and efficacy, or have even mediated opposite effects. In an attempt to further characterize the DC/DCleu induced T-cell response pattern, immunoscope spectratyping, a novel and powerful tool to detect T-cell receptor (TCR) rearrangements was used in combination with functional flow cytometry and non-radioactive fluorolysis assays. Human leucocyte antigen (HLA) matched donor T-cells were repeatedly stimulated, either with leukemic blasts (French-American-British, FAB M4eo) or the corresponding blast-derived DCs. Functional comparison revealed no significant difference in their T-cell stimulatory capacity, while the DC/DCleu fraction favored T-cells with a higher lytic activity, comprising a higher proportion of T-memory CD45R0+ cells. Stimulation with blasts and DC/DCleu induced a similar TCR restriction pattern, while stimulation with DC/DCleu favored the CD4 T-cell subset and seemed to cause a higher grade of restriction. In conclusion, a combined strategy using spectratyping with functional tests might not only provide useful information about the specificity and efficacy of the induced T-cell response, but also pave the way to gain effective T-cell clones for therapeutic use.
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MESH Headings
- Antigens, CD/immunology
- Antigens, CD/metabolism
- Blast Crisis
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- Dendritic Cells/cytology
- Dendritic Cells/immunology
- Dendritic Cells/metabolism
- Flow Cytometry
- Gene Rearrangement
- Humans
- Immunophenotyping
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Lymphocyte Activation
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- T-Lymphocytes/cytology
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
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Affiliation(s)
- Friedhelm R Schuster
- Department of Pediatric Oncology, Hematology and Immunology, Heinrich Heine University Medical Center, Dusseldorf, Germany
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19
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Hauer J, Tosi S, Schuster FR, Harbott J, Kolb HJ, Borkhardt A. Graft versus leukemia effect after haploidentical HSCT in a MLL-negative infant AML with HLXB9/ETV6 rearrangement. Pediatr Blood Cancer 2008; 50:921-3. [PMID: 17960638 DOI: 10.1002/pbc.21376] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recently published data show an extremely poor survival of infants with AML and HLXB9/ETV6 rearrangement which is the fusion, resulting from the translocation t(7;12)(q36;p13). None of the patients reported survived a period of 3 years, including four patients who have received allogeneic hematopoietic stem cell transplantation (HSCT). Herein, we report the clinical course of an 8-month-old patient with acute myeloid leukemia, M2 subtype and with a HLXB9/TEL rearrangement. The patient received a haploidentical HSCT in relapse situation without any prior re-induction. The patient became MRD-negative over a period of 53 days after HSCT. This case reinforces the potential benefit of a graft-versus-leukemia effect in the haploidentical setting even in chemoresistant myeloid leukemias with poor-prognosis molecular features.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 7/genetics
- Female
- Graft vs Leukemia Effect
- Haplotypes
- Hematopoietic Stem Cell Transplantation
- Homeodomain Proteins/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Infant
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/therapy
- Neoplasm Recurrence, Local/therapy
- Oncogene Proteins, Fusion/genetics
- Proto-Oncogene Proteins c-ets/genetics
- Repressor Proteins/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription Factors/genetics
- Translocation, Genetic
- ETS Translocation Variant 6 Protein
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Affiliation(s)
- Julia Hauer
- Pediatric Hematology & Oncology, LMU Munich, Dr. von Haunersches Children's Hospital, Munich, Germany.
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20
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Meissner B, Borkhardt A, Dilloo D, Fuchs D, Friedrich W, Handgretinger R, Peters C, Schrauder A, Schuster FR, Vormoor J, Maecker B, Sykora KW, Zintl F, Welte K, Sauer M. Relapse, not regimen-related toxicity, was the major cause of treatment failure in 11 children with Down syndrome undergoing haematopoietic stem cell transplantation for acute leukaemia. Bone Marrow Transplant 2007; 40:945-9. [PMID: 17768387 DOI: 10.1038/sj.bmt.1705844] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report a retrospective analysis of 11 children with Down syndrome (DS) treated by SCT in eight German/Austrian SCT centres. Indications for transplantation were acute lymphoblastic leukaemia (N=8) and acute myeloid leukaemia (N=3). A reduced intensity conditioning (RIC) containing 2 Gy TBI was given to two patients, another five received a myeloablative regimen with 12 Gy TBI. Treosulphan or busulphan was used in the remaining four children. Four of eleven (36%) patients are alive. All of them were treated with a myeloablative regimen. One of the four surviving children relapsed 9 months after SCT and is currently receiving palliative outpatient treatment. The main cause of death was relapse (5/11). Two children died of regimen-related toxicity (RRT), one from severe exfoliative dermatitis and multiorgan failure after a treosulphan-containing regimen, the other from GvHD-related infections after RIC. Acute GvHD of the skin was observed in 10 of 10 evaluable patients, and chronic GvHD in 4 of 8. Our data show that DS patients can tolerate commonly used, fully myeloablative preparative regimens. The major cause of death is relapse rather than RRT resulting in an event-free survival of 18% and over all survival of 36%.
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Affiliation(s)
- B Meissner
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany
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21
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Tramsen L, Beck O, Schuster FR, Hunfeld KP, Latgé JP, Sarfati J, Röger F, Klingebiel T, Koehl U, Lehrnbecher T. Generation and characterization of anti-Candida T cells as potential immunotherapy in patients with Candida infection after allogeneic hematopoietic stem-cell transplant. J Infect Dis 2007; 196:485-92. [PMID: 17597464 DOI: 10.1086/519389] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 03/07/2007] [Indexed: 11/03/2022] Open
Abstract
Because lymphocytes play a major role in the host response to Candida infection, adoptive transfer of anti-Candida T cells might be a therapeutic option in patients undergoing allogeneic hematopoietic stem-cell transplant (alloHSCT) who have invasive Candida infection. Using the interferon (IFN)- gamma secretion assay, we isolated human anti-Candida T cells after stimulation with a cellular extract of C. albicans. These cells were expanded within 4 weeks to an average number of 2.6x107 T helper 1 type lymphocytes and significantly lost their alloreactive potential, compared with the original cell population. The generated cells were also stimulated by antigens of C. tropicalis but not by antigens of C. glabrata or various molds. In addition, generated anti-Candida T cells were able to induce damage to C. albicans hyphae and significantly increased hyphal damage induced by human neutrophils. Our data suggest that the generation of functionally active anti-Candida T cells is feasible and may be a promising treatment option for patients undergoing alloHSCT.
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Affiliation(s)
- Lars Tramsen
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe University, Frankfurt, D-60590, Germany
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22
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Albert MH, Becker B, Schuster FR, Klein B, Binder V, Adam K, Nienhoff C, Führer M, Borkhardt A. Oral graft vs. host disease in children--treatment with topical tacrolimus ointment. Pediatr Transplant 2007; 11:306-11. [PMID: 17430488 DOI: 10.1111/j.1399-3046.2006.00666.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Oral chronic graft vs. host disease (GVHD) frequently presents in patients with sclerotic features of skin GVHD and is often associated with considerable limitations of oral food intake and decreased quality of life. Systemic tacrolimus is efficacious for prophylaxis and treatment of acute and chronic GVHD and topical tacrolimus has shown activity in chronic GVHD skin lesions. We therefore initiated a pilot study to investigate the safety and efficacy of topical tacrolimus ointment in children with oral GVHD. Six patients suffering from oral GVHD (five chronic and one acute) were included in the study. Tacrolimus ointment 0.1% was applied twice daily using sterile gauze. The only side-effects observed were a slight burning discomfort after the first application in one patient and after food intake in another patient. Tacrolimus was absorbed systemically in four of six patients. Of six patients, we observed a complete response in two, a very good partial response (VGPR) in two, and a PR in two patients, respectively. We conclude that topical application of tacrolimus ointment holds promise as a safe and efficacious treatment for oral GVHD in children. The Food and Drug Administration has recently issued a health advisory about a potential cancer risk associated with topical tacrolimus treatment of the skin; therefore, its benefits should be weighed against its potential risks and diligent long-term follow-up should be carried out especially in children.
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Affiliation(s)
- Michael H Albert
- Department of Pediatric Hematology/Oncology, Dr von Haunersches Kinderspital, Ludwig Maximilians University, Munich, Germany.
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23
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Grigull L, Kuehlke O, Beilken A, Sander A, Linderkamp C, Schmid H, Seidemann K, Sykora KW, Schuster FR, Welte K. Intravenous and oral sequential itraconazole antifungal prophylaxis in paediatric stem cell transplantation recipients: a pilot study for evaluation of safety and efficacy. Pediatr Transplant 2007; 11:261-6. [PMID: 17430480 DOI: 10.1111/j.1399-3046.2006.00643.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This single-centre, retrospective, observational pilot study was performed to evaluate the safety and efficacy of intravenous and oral itraconazole prophylaxis in paediatric haematopoietic stem cell transplantation (HCT). Study end-points were proven invasive fungal infection (IFI), survival, adverse reactions and graft-vs.-host disease (GVHD); 53 children and one young adult (median age 8.6 yr; range 0.4-18.3) transplanted between November 2001 and August 2004 were included in this study. Itraconazole was given intravenously from day +3 after HCT until oral medication became possible and continued until day +100 after HCT. Two proven new IFI in the itraconazole group (candidiasis, n = 1; aspergillosis, n = 1) were observed. After a median follow-up of 1.6 yr (0.3-6.1), six deaths (8%) were seen; 24 patients (45%) developed GVHD degree I-II, three children (6%) had GVHD degree III-IV. In 11 of 53 patients (21%), itraconazole prophylaxis was discontinued prematurely, mostly because of fever of unknown origin (n = 7). In total, 21 of 53 (40%) of the children had abnormal results of laboratory investigations during the prophylaxis. The results of this pilot study indicate that itraconazole prophylaxis during HCT in children is feasible and safe, despite abnormal laboratory results. The efficacy in terms of prevention of IFI, however, has to be addressed in a prospective large-scale study.
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Affiliation(s)
- L Grigull
- Department of Paediatric Hematology and Oncology, Children's Hospital, Hannover Medical University, Hannover, Germany.
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24
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Feuchtinger T, Matthes-Martin S, Richard C, Lion T, Fuhrer M, Hamprecht K, Handgretinger R, Peters C, Schuster FR, Beck R, Schumm M, Lotfi R, Jahn G, Lang P. Safe adoptive transfer of virus-specific T-cell immunity for the treatment of systemic adenovirus infection after allogeneic stem cell transplantation. Br J Haematol 2006; 134:64-76. [PMID: 16803570 DOI: 10.1111/j.1365-2141.2006.06108.x] [Citation(s) in RCA: 288] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During periods of immunosuppression, such as postallogeneic stem cell transplantation (SCT), patients are at significant risk for severe viral infections. Human adenovirus (HAdV) infection is a serious complication post-SCT, especially in children. Virus-specific T cells are essential for the clearance of HAdV, as antiviral chemotherapy has revealed limited success. We present feasibility data for a new treatment option using virus-specific donor T cells for adoptive transfer of immunity to patients with HAdV-infection/reactivation. Virus-specific donor T cells were isolated and infused into nine children with systemic HAdV infection after SCT. Isolation was based on gamma-interferon (IFN-gamma) secretion after short in vitro stimulation with viral antigen, resulting in a combination of CD4(+) and CD8(+) T cells. 1.2-50 x 10(3)/kg T cells were infused for adoptive transfer. Isolated cells showed high specificity and markedly reduced alloreactivity in vitro. Adoptive transfer of HAdV-specific immunity was successful in five of six evaluable patients, documented by a dose-independent and sustained in vivo expansion of HAdV-specific T cells, associated with a durable clearance/decrease of viral copies. T-cell infusion was well tolerated in all nine patients, except one case with graft-versus-host disease II of the skin. In conclusion, induction of a specific T-cell response through adoptive transfer was feasible and effective. When performed early in the course of infection, adoptive T-cell transfer may protect from HAdV-related complications.
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Affiliation(s)
- Tobias Feuchtinger
- Department of Paediatric Haematology/Oncology, University Children's Hospital, Eberhard-Karls-University, Tuebingen, Germany.
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25
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Affiliation(s)
- B C Becker
- Dr v Haunersches Children's Hospital, LMU Munich, Germany.
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26
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Abstract
Infectious complications are a major cause of morbidity and mortality in pediatric and adult patients undergoing hematopoietic stem cell transplantation. The incidence and the severity code of infections depend on the function of the host's immune system. This function is strongly correlated to the application of immune suppressive therapy and the speed of immune reconstitution after stem cell transplantation (SCT). The immune reconstitution can be divided into an early, intermediate and a late phase. This article describes the risk of infections during the different phases of immune reconstitution after stem cell transplantation in children. The basic differences between conventional treated oncologic, autologous and allogenic transplanted children will be presented. Beside the risk in the phase of aplasia there should be pointed out that long term immune deficiency is a strong factor for developing a severe infection after SCT.
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Affiliation(s)
- F R Schuster
- Hämatologisch/Onkologische Abteilung, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München.
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27
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Schuster FR, Simon A, Laws HJ, Beutel K, Groll AH, Jäger G, Schuster V. [Viral infections in pediatric cancer patients]. Klin Padiatr 2006; 217 Suppl 1:S67-84. [PMID: 16288353 DOI: 10.1055/s-2005-872519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Children with cancer or stem cell transplantation (SCT) are at considerable risk to develop life threatening viral infections. Due to both underlying disease and immunosuppressive therapy lymphocyte number and function are low and the cellular immunity against viral infections is restricted or missing. As immunosuppressive treatment regimens and mismatched or T-cell-depleted stem cell products are being used increasingly, viral infections will become an even greater problem in the future. PCR-based methods have become an indispensable tool for early recognition, preemptive therapy, and monitoring therapeutic responses by qualitative and quantitative approaches. Assays are now available that allow for parallel screening of the 16 most common viral agents. Responses to antiviral therapy are often limited in immunocompromised patients and mainly depend on the time of their initiation. Most antiviral agents have a toxicity profile that may become clinically relevant and curtail antiviral therapy. New options for treatment are therefore warranted. For the next future, these may include the transfer of specific T-cells and other immunotherapeutic approaches. This article provides the recommendations of the Infectious Diseases Working Party of the German Society for Pediatric Hematology/Oncology (GPOH) and the German Society for Pediatric Infectious Diseases (DGPI) for diagnosis and treatment of viral infections in children with cancer or post HSCT. They are based on the results of clinical trials, case series and expert opinions using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA).
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Affiliation(s)
- F R Schuster
- Abteilung Hämatologie und Onkologie, Dr. von Haunersches Kinderspital, Universität München.
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Groll AH, Attarbaschi A, Schuster FR, Herzog N, Grigull L, Dworzak MN, Beutel K, Laws HJ, Lehrnbecher T. Treatment with caspofungin in immunocompromised paediatric patients: a multicentre survey. J Antimicrob Chemother 2006; 57:527-35. [PMID: 16431856 DOI: 10.1093/jac/dkl009] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although a paediatric dosage has not been established, caspofungin is occasionally used in paediatric patients. We conducted a multicentre retrospective survey to obtain data on immunocompromised paediatric patients considered to require caspofungin therapy. METHODS The survey identified 64 patients (median age: 11.5 years; 25 females, 39 males) with haematological malignancies (48), marrow failure (9), solid tumours (3), haematological disorders (2) and congenital immunodeficiency (2) who received caspofungin for proven (17), probable (14) and possible (17) invasive fungal infections or empirically (16). Caspofungin was administered until intolerance or maximum efficacy at dosages individually determined by the responsible physician for refractory infection (38), intolerance of other agents (10) or as best therapeutic option (16). RESULTS The 64 patients received caspofungin for a median of 37 days (range 3-218) as single agent (20) or in combination (44). The median daily maintenance dosage was 1.07 mg/kg (95% CI 1.09-1.35; range 0.40-2.92) or 34.3 mg/m2 (95% CI 32.3-37.3; range 16.3-57.5). In none of the patients was therapy discontinued due to adverse events (AEs). Clinical AEs were mild to moderate and observed in 34 patients (53.1%). While mean glutamate pyruvate transaminase and glutamate oxalate transaminase values were slightly (P < 0.005) higher at the end of treatment (EOT), serum bilirubin, alkaline phosphatase and creatinine values were not different from baseline. Complete responses, partial responses or stabilization were observed in 5/7/3 of 17 patients with proven, in 3/4/3 of 14 patients with probable and in 7/6/1 of 15 evaluable patients with possible invasive infections. Thirteen of 16 patients on empirical therapy completed without breakthrough infection. Overall survival was 75% at the EOT and 70% at 3 months post-EOT, respectively. CONCLUSIONS Caspofungin displayed favourable safety and tolerance and may have useful antifungal efficacy in severely immunocompromised paediatric patients.
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Affiliation(s)
- Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Paediatric Haematology/Oncology, Children's University Hospital, Muenster, Germany.
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29
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Schuster FR, Führer M, Woessmann W, Reiter A, Harbott J, Viehmann S, Borkhardt A. Treatment of relapsed acute myelogeneous leukaemia with MLL/AF6 fusion after stem cell transplantation by intensive reinduction followed by adoptive immunotherapy. Leukemia 2005; 19:1273-4; author reply 1275-6. [PMID: 15902291 DOI: 10.1038/sj.leu.2403791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/immunology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Chromosomes, Human, Pair 6/genetics
- Female
- Graft vs Host Disease/etiology
- Humans
- Immunotherapy, Adoptive
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Male
- Mycoses/etiology
- Myeloid-Lymphoid Leukemia Protein
- Oncogene Proteins, Fusion/genetics
- RNA, Messenger/genetics
- Recurrence
- Remission Induction
- Stem Cell Transplantation
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