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Crocchiolo R, Frassati C, Gallina AM, Pedini P, Maioli S, Veronese L, Pani A, Scaglione F, D'Amico F, Crucitti L, Sacchi N, Rossini S, Picard C. Strong humoral response after Covid-19 vaccination correlates with the common HLA allele A*03:01 and protection from breakthrough infection. HLA 2024; 103:e15421. [PMID: 38433722 DOI: 10.1111/tan.15421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
Few data exist on the role of genetic factors involving the HLA system on response to Covid-19 vaccines. Moving from suggestions of a previous study investigating the association of some HLA alleles with humoral response to BNT162b2, we here compared the HLA allele frequencies among weak (n = 111) and strong (n = 123) responders, defined as those healthcare workers with the lowest and the highest anti-Spike antibody levels after vaccination. Individuals with clinical history of Covid-19 or positive anti-nucleocapside antibodies were excluded. We found the common HLA-A*03:01 allele as an independent predictor of strong humoral response (OR = 12.46, 95% CI: 4.41-35.21, p < 0.0001), together with younger age of vaccines (p = 0.004). Correlation between antibody levels and protection from breakthrough infection has been observed, with a 2-year cumulative incidence of 42% and 63% among strong and weak responders, respectively (p = 0.03). Due to the high frequency of HLA-A*03:01 and the need for seasonal vaccinations against SARS-CoV-2 mutants, our findings provide useful information about the inter-individual differences observed in humoral response after Covid-19 vaccine and might support further studies on the next seasonal vaccines.
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Affiliation(s)
- Roberto Crocchiolo
- Dipartimento dei Servizi, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Anna Maria Gallina
- Italian Bone Marrow Donor Registry, E.O. Ospedali Galliera Genova, Genova, Italy
| | | | | | - Luca Veronese
- Dipartimento dei Servizi, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Arianna Pani
- Dipartimento dei Servizi, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Francesco Scaglione
- Dipartimento dei Servizi, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Federico D'Amico
- Dipartimento dei Servizi, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Lara Crucitti
- Hematology Department, Azienda Sanitaria Provinciale di Trapani, Castelvetrano, Italy
| | - Nicoletta Sacchi
- Italian Bone Marrow Donor Registry, E.O. Ospedali Galliera Genova, Genova, Italy
| | - Silvano Rossini
- Dipartimento dei Servizi, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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2
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Crocchiolo R. Toward a definition of immunological risk for patients with anti-HLA antibodies before stem cell transplantation. Blood Transfus 2024; 22:93-95. [PMID: 37847209 PMCID: PMC10920066 DOI: 10.2450/bloodtransfus.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
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3
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Cornillon J, Crocchiolo R, Dubois V, Guidicelli G, Jorge-Cordeiro D, Meunier MC, Michiels S, Timmermans A, Villemonteix J, Yakoub-Agha I, Ahmad I. [Unrelated donor selection for allogeneic hematopoietic stem cell transplantation: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2024; 111:S1-S13. [PMID: 37690877 DOI: 10.1016/j.bulcan.2023.07.008] [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: 04/11/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
The selection of a donor is an essential element in allogeneic hematopoietic stem cell transplantation. In the absence of an HLA-matched related donor, the selection of an unrelated donor is considered, and is currently the most common type of allogenic donor used in practice. Many criteria are considered for the selection when multiple donors are available, particularly in case of partial match. The aim of this workshop is to assist in the selection of an unrelated donor, in keeping with recent data from the literature.
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Affiliation(s)
- Jérôme Cornillon
- Centre hospitalo-universitaire de Saint-Étienne 42, département d'hématologie et de thérapie cellulaire, Saint-Étienne, France.
| | | | | | | | - Debora Jorge-Cordeiro
- Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Saint-Louis, laboratoire d'immunologie, Paris, France
| | - Marie-Christine Meunier
- Hôpital Maisonneuve-Rosemont, Optilab-CHUM, laboratoire de diagnostic moléculaire et cytogénétique, Montréal, Québec, Canada
| | - Sandra Michiels
- Hôpital universitaire de Bruxelles, institut Jules-Bordet, unité de transplantation-hématologie, Bruxelles, Belgique
| | - Aurélie Timmermans
- Hôpital universitaire de Bruxelles, institut Jules-Bordet, unité de transplantation-hématologie, Bruxelles, Belgique
| | - Juliette Villemonteix
- Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Saint-Louis, laboratoire d'immunologie, Paris, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Inserm U1286, Infinite, université de Lille, 59000 Lille, France
| | - Imran Ahmad
- Université de Montréal, hôpital Maisonneuve-Rosemont, institut universitaire d'hématologie-oncologie & de thérapie cellulaire, Montréal, Québec, Canada
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4
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Zappaterra A, Civettini I, Cafro AM, Pezzetti L, Pierini S, Anghilieri M, Bellio L, Bertazzoni P, Grillo G, Minga P, Pioltelli ML, Ravano E, Sassone M, Viganò CV, Volpato EB, Gambacorti-Passerini C, Rossini S, Cairoli R, Crocchiolo R. Anti-CD38 monoclonal antibody impairs CD34+ mobilization and affects clonogenic potential in multiple myeloma patients. Blood Transfus 2024:BloodTransfus.667. [PMID: 38315530 DOI: 10.2450/bloodtransfus.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/26/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Induction with daratumumab-based regimens followed by autologous stem cell transplantation is the current standard for newly diagnosed multiple myeloma (NDMM) patients eligible for intensive chemotherapy. However, concerns emerged regarding potential negative effects following daratumumab-based treatment on CD34+ mobilization. We here compared CD34+ mobilization and clonogenic potential between daratumumab and non-daratumumab based therapy without upfront plerixafor administration among patients affected by NDMM. MATERIALS AND METHODS Clinical, mobilization and clonogenic data from 41 consecutively enrolled NDMM patients were analyzed. Patients underwent collection of autologous CD34+ by apheresis at the ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, from January 2021 to March 2023. Clonogenicity analysis was performed on BFU-E and CFU-GM. RESULTS Seventy-five percent of daratumumab-treated patients underwent >1 apheresis, compared to 24% of non-daratumumab patients (p=0.0017). Daratumumab-treated patients had significantly lower CD34+ count (mean 38 vs 79/μL, respectively; p=0.0011), with a median CD34+ harvest of 3.98×106/kg (range 1.68-9.18) vs 6.87×106/kg (range 1.63-16.85) in non-daratumumab-treated (p=0.0006). In multivariate analysis the likelihood of undergoing >1 apheresis was significantly higher in older patients (OR 1.2, 95% CI 1-1.4, Z=2.10, p=0.03) and daratumumab-treated patients (OR 15, 95% CI 2.8-129, p=0.004). Moreover, daratumumab-based induction therapy demonstrated an independent negative association with BFU-E colony formation (p=0.0148), even when accounting for patient age and CD34+ levels. DISCUSSION Our findings underscore the impact of daratumumab-based treatment on CD34+ mobilization in a real-life, upfront plerixafor-free population of NDMM patients. Higher probability of requiring multiple apheresis occurred among daratumumab-treated patients. Interestingly, the observation that daratumumab might negatively impact BFU-E colony formation, independent of CD34+ cell count, offers novel biological perspectives. Appropriate strategies should be adopted by the Apheresis teams to mitigate these potential negative effects.
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Affiliation(s)
- Arianna Zappaterra
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Ivan Civettini
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy
| | - Anna Maria Cafro
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Laura Pezzetti
- Cellular Therapy Laboratory, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Silvia Pierini
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy
| | | | - Laura Bellio
- Immunohematology and Transfusion Medicine Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Paola Bertazzoni
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giovanni Grillo
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Periana Minga
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Maria L Pioltelli
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Emanuele Ravano
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Clara V Viganò
- Onco-hematology Division, Manzoni Hospital, Lecco, Italy
| | - Elisabetta B Volpato
- Immunohematology and Transfusion Medicine Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy
| | - Silvano Rossini
- Immunohematology and Transfusion Medicine Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Roberto Cairoli
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Roberto Crocchiolo
- Immunohematology and Transfusion Medicine Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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5
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Leone G, Baldini V, Bramanti S, Crocchiolo R, Gattillo S, Ermini S, Giudice V, Ferrero I, Moscato T, Milani R, Gozzer M, Piccirillo N, Tassi C, Tassi V, Coluccia P. Managing leukapheresis in adult and pediatric patients eligible for chimeric antigen receptor T-cell therapy: suggestions from an Italian Expert Panel. Blood Transfus 2023; 21:514-525. [PMID: 37146295 PMCID: PMC10645345 DOI: 10.2450/bloodtransfus.471] [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] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/18/2023] [Indexed: 05/07/2023]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy relies on T cells engineered to target specific tumor antigens such as CD-19 in B-cell malignancies. In this setting, the commercially available products have offered a potential long-term cure for both pediatric and adult patients. Yet manufacturing CAR T cells is a cumbersome, multistep process, the success of which strictly depends on the characteristics of the starting material, i.e., lymphocyte collection yield and composition. These, in turn, might be affected by patient factors such as age, performance status, comorbidities, and previous therapies. Ideally, CAR T-cell therapies are a one-off treatment; therefore, optimization and the possible standardization of the leukapheresis procedure is critical, also in view of the novel CAR T cells currently under investigation for hematological malignancies and solid tumors. The most recent Best Practice recommendations for the management of children and adults undergoing CAR T-cell therapy provide a comprehensive guide to their use. However, their application in local practice is not straightforward and some grey areas remain. An Italian Expert Panel of apheresis specialists and hematologists from the centers authorized to administer CAR T-cell therapy took part in a detailed discussion on the following: 1) pre-apheresis patient evaluation; 2) management of the leukapheresis procedure, also in special situations represented by low lymphocyte count, peripheral blastosis, pediatric population <25 kg, and the COVID-19 outbreak; and 3) release and cryopreservation of the apheresis unit. This article presents some of the important challenges that must be faced to optimize the leukapheresis procedure and offers suggestions as to how to improve it, some of which are specific to the Italian setting.
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Affiliation(s)
- Giovanna Leone
- Unit of Immuno-Hematology and Transfusion Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Stefania Bramanti
- Cancer Center, Humanitas Cancer Center, IRCCS, Rozzano, Milan, Italy
| | | | - Salvatore Gattillo
- Immuno-Hematology and Transfusion Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Stefano Ermini
- Transfusion Service, University Hospital Meyer, Children’s Hospital, Florence, Italy
| | - Valeria Giudice
- Immuno-Hematology and Transfusion Medicine Unit, University Hospital Sant’ Orsola-Malpighi, Bologna, Italy
| | - Ivana Ferrero
- Stem Cell Transplantation and Cellular Therapy Laboratory, Paediatric Onco-Hematology Division, Regina Margherita Children’s Hospital, City of Health and Science of Turin, Turin, Italy
| | - Tiziana Moscato
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Raffaella Milani
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Gozzer
- Hematology, Department of Translational and Precision Medicine, Sapienza University Policlinico Umberto I, Rome, Italy
| | - Nicola Piccirillo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Complex Operational Unit of Blood Transfusion, Gemelli University Hospital IRCCS, Rome, Italy
| | - Cristina Tassi
- Stem Cell Transplantation and Cellular Therapy Laboratory, Paediatric Onco-Hematology Division, Regina Margherita Children’s Hospital, City of Health and Science of Turin, Turin, Italy
| | - Valter Tassi
- Blood Bank and Immunohematology, City of Health and Science of Turin, Turin, Italy
| | - Paola Coluccia
- Immunohematology and Transfusion Medicine Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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6
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Soldarini M, Cafro A, Bertazzoni P, Pioltelli M, Cornacchini G, Lando G, Sommaruga E, Milano A, Cairoli R, Rossini S, Crocchiolo R. Plasma cell-directed therapy and anti-HLA antibody production: A successful combination? Curr Res Transl Med 2023; 71:103391. [PMID: 37079966 DOI: 10.1016/j.retram.2023.103391] [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] [Received: 03/30/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Affiliation(s)
| | | | | | | | | | - Giuliana Lando
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Antonio Milano
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy; Università degli studi Milano Bicocca - Dipartimento di Scienze della Salute, Italy
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7
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Souchet L, Masouridi S, Marçais A, Ibrahim A, Chauvel C, Turquet E, Derail M, Yakoub-Agha I, Crocchiolo R. [Diagnosis, prophylaxis and therapeutic management of acute GVH: Guidelines from the SFGM-TC]. Bull Cancer 2023; 110:S79-S87. [PMID: 36437127 DOI: 10.1016/j.bulcan.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
Acute GVHD is a potentially severe complication of hematopoietic stem cell transplantation, responsible for morbidity and mortality that can affect the prognosis after transplantation. Within the framework of the 12th workshop of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), diagnostic modalities of acute GVHD are updated. The conventional prevention (depending on donor, conditioning, and stem cell source) and treatment schemes (depending on affected organ and intensity) of aGVHD are clarified, and new therapeutic options are discussed.
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Affiliation(s)
- Laetitia Souchet
- Hôpital Pitié Salpêtrière, Service d'hématologie clinique, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Stavroula Masouridi
- Hôpitaux universitaires de Genève, Service d'hématologie, 4, rue Gabrielle-Perret-Gentil, 1211 Genève, Suisse
| | - Ambroise Marçais
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Service Hématologie Adultes, Hôpital Necker Enfants Malades, Paris, France
| | | | | | - Eric Turquet
- CHU Rennes, Service d'hématologie, Rennes, France
| | | | | | - Roberto Crocchiolo
- Service d'Aphérèse Thérapeutique, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italie
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8
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Crocchiolo R, Rombolà G. Human Leucocyte Antigen System and Selection of Unrelated Hematopoietic Stem Cell Donors: Impact of Patient-Donor (Mis)matching and New Challenges with the Current Technologies. J Clin Med 2023; 12:jcm12020646. [PMID: 36675576 PMCID: PMC9862309 DOI: 10.3390/jcm12020646] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The selection of hematopoietic stem cell donors for allogeneic transplantation (allo-HSCT) is mainly driven by human leucocyte antigen (HLA) matching between patient and donor, with HLA-identical matched siblings being the preferred choice in most situations. Although other clinical and demographical variables matter, especially, donor age, which is unequivocally associated with better transplant outcomes, the histocompatibility criteria have a central role in the search for the best donor, particularly in the setting of unrelated allo-HSCT where HLA disparities between patient and donor are frequent. The present review is focused on the role of HLA incompatibilities on patient outcome according to the most recent literature, in an attempt to guide transplant physicians and search coordinators during the process of adult unrelated-donor selection. The technological progresses in HLA typing, i.e., with next-generation sequencing (NGS), now allow disclosing a growing number of HLA incompatibilities associated with a heterogeneous and sometimes unknown spectrum of clinical severity. Their immunogenic characteristics, i.e., their position inside or outside the antigen recognition domain (ARD), their permissiveness, their intronic or exonic nature and even the expected expression of the HLA loci where those mismatches occur, will be presented and discussed here, integrating the advances in the immunobiology of transplantation with survival and toxicity outcomes reported in the most relevant studies, within the perspective of improving donor selection in the current practice.
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Affiliation(s)
- Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milano, Italy
- Correspondence: ; Tel.: +39-02-64443962
| | - Gianni Rombolà
- Laboratory of Immunogenetics and Transplant Immunology, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
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9
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Crocchiolo R, Girgenti D, D'Amico F, Cornacchini G, Lando G, De Marco B, Magliano G, Grillo G, Rossini S. Potential selection of unrelated donor based on HLA-DPB1 T-cell epitope matching using data from a single-center analysis. Bone Marrow Transplant 2022; 57:1626-1628. [PMID: 35948665 DOI: 10.1038/s41409-022-01775-7] [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] [Received: 02/03/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Debora Girgenti
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Federico D'Amico
- SC Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.,Università degli Studi di Milano, Milano, Italy
| | - Giorgia Cornacchini
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giuliana Lando
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Beatrice De Marco
- Centro Trapianti Midollo, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Gabriele Magliano
- Centro Trapianti Midollo, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giovanni Grillo
- Centro Trapianti Midollo, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Silvano Rossini
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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10
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Crocchiolo R, Volpato E, Bellio L, Cuppari I, Magliano G, De Marco B, Grillo G, Rossini S. Is SARS-CoV-2 screening still necessary before hematopoietic stem cell donation? Observations from a single center and review of the literature. Transfus Apher Sci 2022; 61:103448. [PMID: 35422345 PMCID: PMC8994411 DOI: 10.1016/j.transci.2022.103448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Elisabetta Volpato
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Laura Bellio
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Irene Cuppari
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Gabriele Magliano
- Bone Marrow Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Beatrice De Marco
- Bone Marrow Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giovanni Grillo
- Bone Marrow Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Silvano Rossini
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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11
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Crocchiolo R, Gallina AM, Pani A, Campisi D, Cento V, Sacchi N, Miotti V, Gagliardi OM, D'Amico F, Vismara C, Cornacchini G, Lando G, Cuppari I, Scaglione F, Rossini S. Polymorphism of the HLA system and weak antibody response to BNT162b2 mRNA vaccine. HLA 2022; 99:183-191. [PMID: 35025131 DOI: 10.1111/tan.14546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/19/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Abstract
The polymorphism of the HLA system has been extensively studied in COVID-19 infection, however there are no data about the role of HLA on vaccine response. We report here the HLA-A, -B, -C, and DRB1 allelic frequencies of n = 111 individuals after BNT162b2 mRNA vaccine, selected on the basis of lower antibody levels (<5% percentile) after the second dose among a total of n = 2569 vaccinees, and compare them with the frequencies of a reference population. We found that differences in the frequencies of the alleles HLA-A*03:01, A*33:03, B*58:01 and at least one haplotype (HLA-A*24:02~C*07:01~B*18:01~DRB1*11:04) are associated with a weaker antibody response after vaccination, together with the age of vaccinees. Our results might suggest a role played by some HLA alleles or haplotypes in antibody production after the BNT162b2 mRNA vaccine, giving insights into the tracking of potentially susceptible individuals across populations. Further studies are needed to better define our exploratory findings and dissect the role of HLA polymorphism on response to anti-COVID-19 vaccines.
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Affiliation(s)
- Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Anna Maria Gallina
- Italian Bone Marrow Donor Registry, E. O. Ospedali Galliera, Genoa, Italy
| | - Arianna Pani
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniela Campisi
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valeria Cento
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicoletta Sacchi
- Italian Bone Marrow Donor Registry, E. O. Ospedali Galliera, Genoa, Italy
| | - Valeria Miotti
- Laboratory of Immunogenetics, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Oscar Matteo Gagliardi
- Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, Milan, Italy
| | - Federico D'Amico
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Vismara
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgia Cornacchini
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuliana Lando
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Irene Cuppari
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvano Rossini
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Valsecchi M, Lauterio A, Crocchiolo R, De Carlis R, Pugliano M, Centonze L, Ferla F, Zaniboni M, Veronese S, Podda GM, Belli L, Rossini S, De Carlis L, Fumagalli R. New-Onset Antibodies to Platelet Factor 4 Following Liver Transplantation From a Donor With Vaccine-Induced Thrombotic Thrombocytopenia. Liver Transpl 2022; 28:314-316. [PMID: 34416086 DOI: 10.1002/lt.26277] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Mila Valsecchi
- Department of Anesthesiology, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Lauterio
- Division of General Surgery and Transplantation, Department of Transplantation, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Crocchiolo
- Division of Immunohaematology and Transfusion Medicine, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo De Carlis
- Division of General Surgery and Transplantation, Department of Transplantation, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mariateresa Pugliano
- Division of Immunohaematology and Transfusion Medicine, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Leonardo Centonze
- Division of General Surgery and Transplantation, Department of Transplantation, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabio Ferla
- Division of General Surgery and Transplantation, Department of Transplantation, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Zaniboni
- Department of Anesthesiology, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvio Veronese
- Department of Laboratory Medicine, Division of Pathology, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gian Marco Podda
- Divisione di Medicina Generale II, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Luca Belli
- Hepatology and Gastroenterology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvano Rossini
- Division of Immunohaematology and Transfusion Medicine, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luciano De Carlis
- Division of General Surgery and Transplantation, Department of Transplantation, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milano-Bicocca, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesiology, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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13
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Crocchiolo R, Alfarano F, Volpato E, Pugliano M, Cuppari I, Mazza AM, Bellio L, Fanti D, Vismara C, Scaglione F, Sacchi N, Pollichieni S, Mele L, Diral E, Grillo G, Rossini S. SARS-COV-2 SCREENING IN ALLOGENEIC HEMATOPOIETIC STEM CELL DONORS: IMPLICATIONS FOR THE EVALUATION PROCESS AND ELIGIBILITY. Hematol Transfus Cell Ther 2021; 44:13-16. [PMID: 34901751 PMCID: PMC8648663 DOI: 10.1016/j.htct.2021.09.017] [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: 07/15/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Soon after the onset of the SARS-CoV-2 pandemic, viral screening by nasopharyngeal swab became mandatory for allogeneic hematopoietic stem cell (HSC) donor eligibility. Methods We described our monocenter experience with allogeneic HSC donors from February 1 to the October 31, 2020 to verify whether the introduction of SARS-CoV-2 screening altered the donor eligibility and/or entailed a prolongation of the evaluation process. Results A total of 21 allogeneic HSC donors were screened during the above-mentioned period upon request by the local transplant physicians or by the Italian Bone Marrow Donor Registry; among the HSC donors (n = 17) who completed the eligibility process and further received the nasopharyngeal swab, all but one were negative for the presence of SARS-CoV-2. The positive donor remained asymptomatic for the whole duration of the infection, which lasted six weeks. However, he was temporarily excluded from donation. The median duration of the evaluation process was not significantly different, compared to the same period of 2019 (p-value = 0.11). Conclusion The mandatory SARS-CoV-2 screening in allogeneic HSC donors allowed for the detection of 6% positivity in this monocenter series over a 9-month period. Despite the inconvenience of this unexpected non-eligibility, the exclusion of a SARS-CoV-2 positive donor represented an important safety measure for the donor, with respect to a new and still partially unknown virus. The screening did not alter the length of the donor evaluation and thus, did not cause a delay in the eligibility process.
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Affiliation(s)
| | | | | | | | - Irene Cuppari
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Laura Bellio
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Diana Fanti
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Chiara Vismara
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Nicoletta Sacchi
- Italian Bone Marrow Donor Registry, Ospedale Galliera, Genova, Italy
| | | | - Lia Mele
- HLA Laboratory, A.O. SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Elisa Diral
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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14
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Pani A, Cento V, Vismara C, Campisi D, Di Ruscio F, Romandini A, Senatore M, Schenardi PA, Gagliardi OM, Giroldi S, Zoppini L, Moreno M, Corradin M, Epis OM, Ughi N, Cuppari I, Crocchiolo R, Merli M, Bosio M, Rossini S, Puoti M, Scaglione F. Results of the RENAISSANCE Study: REsponse to BNT162b2 COVID-19 vacciNe-short- And long-term Immune reSponSe evAluatioN in health Care workErs. Mayo Clin Proc 2021; 96:2966-2979. [PMID: 34736776 PMCID: PMC8403667 DOI: 10.1016/j.mayocp.2021.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/01/2021] [Accepted: 08/18/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anti-spike (S) IgG antibody production after vaccination with BNT162b2 and the protection from symptomatic breakthrough infections in health care workers. METHODS This prospective observational study (RENAISSANCE) had as a primary end point the evaluation of serologic response to BNT162b2 14 days after a second dose. SARS-CoV-2 anti-S IgG antibodies were evaluated with LIAISON SARS-CoV-2 TrimericS IgG assay (DiaSorin S.p.A.), which is able to detect the presence of both binding and neutralizing antibodies for trimeric spike glycoprotein. Participants were recruited from February 1, 2021, to February 22, 2021. Occurrence of vaccine breakthrough infections was assessed by reverse transcription-polymerase chain reaction on symptomatic and contact cases up to June 6, 2021. RESULTS Of 2569 staff evaluated, only 4 were nonresponders (0.16%; 95% CI, 0.04% to 0.41%). All 4 nonresponders were severely immunosuppressed and receiving treatment with mycophenolate mofetil or mycophenolic acid. At 14 days after the second dose, 67.5% (1733) of staff had anti-S IgG titers of 2000 BAU/mL or higher; 19.2% (494), between 1500 and 2000 BAU/mL; 9.8% (251), between 1000 and 1500 BAU/mL; and 3.4% (87), 1000 BAU/mL or lower. Women had a higher probability of having higher titers than men (64.5% [1044/1618] vs 58.3% [410/703]; P=.005). This was confirmed after adjustment for age group (odds ratio, 1.275; 95% CI, 1.062 to 1.531; P=.009). Four months after the end of the vaccination program, only 13 participants (0.26%) had experienced a breakthrough SARS-CoV-2 infection, including 1 nonresponder. This was the only participant requiring hospitalization for severe COVID-19. CONCLUSION The vaccination campaign among health care workers at the ASST GOM Niguarda has resulted in a marked serologic response and reduction of incident COVID-19 cases. Yet, the lack of protection should not be overlooked in immunocompromised individuals.
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Affiliation(s)
- Arianna Pani
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Valeria Cento
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Vismara
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniela Campisi
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Di Ruscio
- Postgraduate School of Microbiology and Virology, Università degli Studi di Milano, Milan, Italy; Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Romandini
- Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, Milan, Italy
| | - Michele Senatore
- Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, Milan, Italy; Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Andrea Schenardi
- Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, Milan, Italy
| | - Oscar Matteo Gagliardi
- Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, Milan, Italy; Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Simona Giroldi
- Healthcare Management Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Zoppini
- Healthcare Management Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Moreno
- Healthcare Management Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Corradin
- Healthcare Management Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Nicola Ughi
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Irene Cuppari
- Division of Immunohaematology and Transfusion Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Crocchiolo
- Division of Immunohaematology and Transfusion Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Merli
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Bosio
- Healthcare Management Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvano Rossini
- Division of Immunohaematology and Transfusion Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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15
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Crocchiolo R, Mele L, Testi M, Scollo Chiara M, Murgia B, Rossi A, Vecchiato C, Grammatico P, Mininni D, Longhi E, Manfroi S, Giuliodori S, Castellani L, Carella G, Lai S, Azzaro Maria P, Mazzi B, Perotti L, Penta R, Lombardo C, Tognellini R, Andreani M, Albergoni Maria P, Nesci S, Cappuzzo V, Chiusolo P, Garino E, Cappucci G, Ceschini N, Bevilacqua E, Guizzardi E, Tagliaferri Cinzia M, Piazza A, Carcassi C, Miotti V. Use of DPB1 T-cell epitope algorithm among italian transplant centers: A survey on behalf of Associazione Italiana di Immunogenetica e Biologia dei Trapianti. HLA 2021; 98:114-121. [PMID: 34155826 DOI: 10.1111/tan.14347] [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: 04/05/2021] [Revised: 06/01/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
The HLA-DPB1 locus has been demonstrated to have a significant role on patients' outcome after allogeneic HSCT, and the so-called T-cell epitope (TCE) algorithm has been incorporated in international guidelines for the selection of unrelated donors. The purpose of the present study is to measure, through a national survey conducted on behalf of the Associazione Italiana di Immunogenetica e Biologia dei Trapianti (AIBT), the extent of awareness and use of HLA-DPB1 TCE-based algorithms during the donor search. 89% of the HLA laboratories answered to a short questionnaire and the results showed a progressive increase of the laboratories typing DPB1 in patients and their potential donors during the search (from 44% to 79% during the 2010-2019 period) as well as the application of a TCE-based algorithm for the donor choice whenever possible (from 24% to 65% during the same period). The DP-permissiveness status is detailed in the official HLA typing report by 12%, 32% and 50% of laboratories in 2010, 2015 and 2019, respectively. The present data indicate an encouraging raise in the awareness of the HLA-DPB1 role in unrelated donor selection; noteworthy, mentioning the TCE-based permissiveness status in the HLA typing report of each potential unrelated donor represents a notable mean to raise awareness among transplant physicians and to support them in their task of choosing the best donor. Nonetheless, despite the compelling evidence of the predictive ability of TCE-based algorithms, further efforts are still needed to extend its application to all transplant centers in Italy.
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Affiliation(s)
- Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lia Mele
- Laboratorio HLA e processazione cellule staminali ematopoietiche, Azienda Ospedaliera SS Antonio e Biagio e C Arrigo, Alessandria, Italy; Treasurer, Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Alessandria, Italy
| | - Manuela Testi
- Secretary, Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Bologna, Italy
| | | | - Barbara Murgia
- SC laboratorio di istocompatibilità, EO Ospedali Galliera, Genoa, Italy
| | - Angela Rossi
- UOSD Immunogenetica e Manipolazione cellule staminali emopoietiche, Ospedale ''Guglielmo da Saliceto'', Piacenza, Italy
| | - Cinzia Vecchiato
- Transfusion Service, San Maurizio Regional Hospital, Bolzano, Italy
| | - Paola Grammatico
- UOC Laboratorio di Genetica Medica, Ospedale San Camillo, Rome, Italy
| | - Donata Mininni
- Tissue Typing and Immunology of Transplants Unit, Department of Diagnostic Pathology, University of Bari, Bari, Italy
| | - Elena Longhi
- Laboratory of Transplant Immunology, IRCCS Ca ' Granda Foundation Maggiore Policlinico Hospital Milan, Milan, Italy
| | - Silvia Manfroi
- Immunohaematology and Transfusion Medicine Service, S. Orsola-Malpighi Polyclinic, Bologna, Italy
| | | | - Laura Castellani
- UOC immunoematologia e medicina trasfusionale, Laboratorio immunogenetica - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Graziella Carella
- Laboratorio di Istocompatibilità, ''Vittorio Mero'' Servizio di Immunoematologia e Medicina Trasfusionale, ASST Spedali Civili, Brescia, Italy
| | - Sara Lai
- SC Genetica Medica Cagliari - ATS Sardegna, Cagliari, Italy
| | - Pia Azzaro Maria
- Laboratorio di istocompatibilità, Centro Donatori di midollo Osseo (CD-CT02) dell'UOC di Ematologia con trapianto di Midollo Ossero - AOU Policlinico San Marco, Catania, Italy
| | - Benedetta Mazzi
- Immunogenetics laboratory, HLA & Chimerism - Dept. of ImmunoHematology & Blood Transfusion, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Laura Perotti
- Servizio di Immunoematologia e Trasfusionale, ASO Santa Croce e Carle, Cuneo, Italy
| | - Roberta Penta
- Laboratorio di istoconpatibilità, UOSD Criopreservazione e BaSCO, PO Pausilipon - AORN Santobono-Pausilipon, Naples, Italy
| | - Claudia Lombardo
- Laboratorio di Tipizzazione HLA, Servizio Di Immunoematologia e Medicina Trasfusionale, Fondazione IRCSS Istituto Tumori, Milan, Italy
| | - Rita Tognellini
- Laboratorio di immunogenetica e biologia dei trapianti, Servizio Immunoematologia e trasfusionale, Azienda Ospedaliera Perugia, Perugia, Italy
| | - Marco Andreani
- Transplantation Immunogenetics Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Sonia Nesci
- Settore di Immunogenetica e Biologia dei Trapianti, S.S.D. Diagnostica ad alta complessità - Dipartimento di Diagnostica Clinica, Azienda Ospedali Riuniti Marche Nord-, Pesaro, Italy
| | - Valentina Cappuzzo
- Laboratorio Regionale di Tipizzazione Tessutale ed Immunologia dei Trapianti, U.O.C. Medicina Trasfusionale e dei Trapianti - P.O. Cervello - A.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Elena Garino
- SC Immunogenetica e Biologia dei Trapianti, A.O.U. Città della Salute e della Scienza di Torino, Pavia, Italy
| | - Giuseppe Cappucci
- IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Nadia Ceschini
- Laboratorio di Tipizzazione Tissutale HLA, S.I.T., Ospedale Santa Chiara, Trento, Italy
| | - Elena Bevilacqua
- Laboratorio di Tipizzazione tissutale, Dipartimento di Medicina Trasfusionale, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste, Italy
| | | | | | - Antonina Piazza
- Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Bologna, Italy
| | - Carlo Carcassi
- Medical Genetics, Department of Medical Sciences and Public Health, University of Cagliari, Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Cagliari, Italy
| | - Valeria Miotti
- Laboratory of Immunogenetics, Santa Maria della Misericordia University Hospital, Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Udine, Italy
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Dubois V, Amokrane K, Crocchiolo R, Fort M, Guillaume N, Kennel A, Michiels S, Ralazamahaleo M, Rouzaire PO, Yakoub-Agha I, Faucher C. [Definition and standardization of histocompatibility requests depending on patient course and donor type: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) and the Francophone Society of Histocompatibility and Immunogenetics (SFHI)]. Bull Cancer 2021; 108:S45-S52. [PMID: 33966883 DOI: 10.1016/j.bulcan.2021.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 10/21/2022]
Abstract
Standardization of histocompatibility tests for allogeneic hematopoietic cell transplants, harmonization of information transmitted to clinicians are part of quality improvement and optimization of human and economic resources. New HLA typing technologies provide high-resolution information within a reasonable time frame. Knowledge of high-resolution HLA typing for the patient and their relatives is essential for a better interpretation of compatibilities. HLA-DPB1 typing must be considered in transplant field regardless of the donor type. The benefits of using search and match programs are considerable. It saves time and reduces additional typing costs by providing rapid information about the likelihood to identify a matched unrelated donor. A backup therapy considering alternative cell sources or treatment can therefore be quickly implemented. The importance of knowledge and consideration of patient immunization for donor choice was explored in previous workshops of the SFGM-TC (2018 and 2019). The published recommendations remain applicable. The routine follow-up protocol and in case of desensitization will be detailed here. This harmonization must be accompanied by the standardization of information to be returned to the clinician regarding the donor finding possibilities for the patient. This will guarantee a similar quality level in every center.
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Affiliation(s)
- Valérie Dubois
- Établissement Français du Sang, laboratoire Histocompatibilité, 69150 Décines, France.
| | - Kahina Amokrane
- Hôpital Saint Louis, laboratoire d'Immunologie Histocompatibilité, 75010 Paris, France
| | - Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italie
| | - Marylise Fort
- CHU de Toulouse, laboratoire d'Histocompatibilité, Hôpital de RANGUEIL, 31059 Toulouse, France
| | | | - Anne Kennel
- Établissement Français du Sang, laboratoire Histocompatibilité, 42000 Saint-Étienne, France
| | - Sandra Michiels
- Institut Jules Bordet, Département d'Hématologie, Université Libre de Bruxelles, 1000 Bruxelles, Belgique
| | - Mamy Ralazamahaleo
- CHU de Bordeaux, laboratoire d'Immunologie-Immunogénétique, 33076 Bordeaux
| | - Paul-Olivier Rouzaire
- CHU de Clermont-Ferrand, Service d'Histocompatibilité et d'Immunogénétique, Université Clermont Auvergne, EA 7453 CHELTER, 63003 Clermont-Ferrand
| | | | - Catherine Faucher
- Direction prélèvements et greffes de CSH, Direction médicale et scientifique, Agence de la biomédecine, 93212 St-Denis, La Plaine
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17
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Crocchiolo R, Cesana C, Girgenti D, Bertani G, Barba C, Liga G, Ferri U, Crucitti L, Grillo G, Rossini S, Cairoli R. Correction to: Tregs and GvHD prevention by extracorporeal photopheresis: observations from a clinical trial. Exp Hematol Oncol 2021; 10:22. [PMID: 33731200 PMCID: PMC7972182 DOI: 10.1186/s40164-021-00216-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Roberto Crocchiolo
- Servizio Di Immunoematologia E Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milano, Italy.
| | - Clara Cesana
- Servizio Di Immunoematologia E Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milano, Italy
| | - Debora Girgenti
- Servizio Di Immunoematologia E Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milano, Italy
| | | | - Claudia Barba
- Servizio Di Immunoematologia E Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milano, Italy
| | - Giuseppa Liga
- Servizio Di Immunoematologia E Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milano, Italy
| | - Ursula Ferri
- Servizio Di Immunoematologia E Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milano, Italy
| | - Lara Crucitti
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giovanni Grillo
- Servizio Di Immunoematologia E Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milano, Italy
| | - Silvano Rossini
- Servizio Di Immunoematologia E Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milano, Italy
| | - Roberto Cairoli
- Servizio Di Immunoematologia E Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milano, Italy
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18
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Castagna L, Valli V, Timofeeva I, Capizzuto R, Bramanti S, Mariotti J, De Philippis C, Sarina B, Mannina D, Giordano L, De Paoli F, van Beek JJP, Zaghi E, Calvi M, Vito CD, Mavilio D, Crocchiolo R, Lugli E. Feasibility and Efficacy of CD45RA+ Depleted Donor Lymphocytes Infusion After Haploidentical Transplantation With Post-Transplantation Cyclophosphamide in Patients With Hematological Malignancies. Transplant Cell Ther 2021; 27:478.e1-478.e5. [PMID: 33819481 DOI: 10.1016/j.jtct.2021.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/28/2022]
Abstract
Allogeneic stem cell transplantation from haploidentical donor using post-transplantation cyclophosphamide has been used to cure hematological diseases. Because of slow immunological reconstitution, there is an increased incidence of viral infection. The aim of our study was to prospectively evaluate the efficacy and the feasibility of a CD45RA+ depleted donor lymphocytes infusion (DLI) in terms of reduction of viral infection early after haploidentical transplantation. This a prospective single-center study. We enrolled 23 patients, of whom 19 were evaluable. Graft-versus-host disease (GVHD) prophylaxis was the same for all patients. The primary endpoint was 100-day cumulative incidence of viral infections. The primary endpoint was met, because the 100-day cumulative incidence of viral infection was 32%. The median time from transplantation to first CD45RA+ depleted DLI was 55 days (range, 46-63). 28% of patients had cytomegalovirus reactivation, no patients reactivated human herpesvirus-6; 1 patient developed BK virus related hemorrhagic cystitis. Most of the patients received the planned 3 infusions. Only 1 patient had development of grade 2 acute GVHD, and 2 patients had moderate chronic GVHD. All evaluable patients were off immunosuppressive therapy at last follow-up. The median follow-up was 12 months (range, 3-23), the 1-year overall survival and progression-free survival were 79% and 75%, respectively; the 100-day and 1-year non-relapse mortality were 5% and 12%, respectively. CD45RA+ depleted DLI are feasible in patients treated with haploidentical transplantation. The toxic profile is good with a low risk for development of both acute and chronic GVHD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Laura Giordano
- Biostatistic Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Federica De Paoli
- Laboratory of Translational Immunology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Jasper J P van Beek
- Laboratory of Translational Immunology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Elisa Zaghi
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Milan, Italy
| | - Michela Calvi
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Milan, Italy; Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | - Clara Di Vito
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Milan, Italy; Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Milan, Italy; Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | | | - Enrico Lugli
- Laboratory of Translational Immunology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
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19
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Milone G, Scirè P, Camuglia MG, Triolo A, Moschetti G, Scuderi MG, Cupri A, Milone GA, Bulla A, Giorgio MAD, Leotta V, Curtopelle A, Sciortino R, Parrinello L, Crocchiolo R, Leotta S. Low content of clonogenic progenitors on day+18 is associated with acute graft-versus-host disease and predicts transplant-related mortality. Exp Hematol 2021; 95:58-67.e4. [PMID: 33444663 DOI: 10.1016/j.exphem.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/18/2022]
Abstract
A marrow reaction associated with acute-graft-versus-host disease (a-GVHD) has been demonstrated in experimental models; its existence in human transplantation is controversial. The aim of the present study was to investigate whether clonogenic marrow precursors are an early marker for a-GVHD and transplant-related mortality (TRM). We prospectively studied 133 patients for colony-forming units-granulocyte-monocyte (CFU-GM) at day +18/+19 posttransplantation. CFU-GM frequency below the 25th percentile was predictive of an acute GVHD score I°-IV° when evaluated in multivariate logistic regression analysis (odds ratio = 13.551, 95% confidence interval [CI]: 1.583-116.031, p = 0.01). In the group with a clonogenic frequency below the 25th percentile, the cumulative incidence of GVHD grades II-IV was significantly more frequent with respect to the group with a frequency greater than the 25th percentile, 86% versus 54% (Gray test: p = 0.02). In multivariate Cox proportional analysis, a CFU-GM frequency below the 25th percentile at day +18 was associated with reduced overall survival (OS) (hazard ratio = 1.778, 95% CI: 1.022-3.093, p = 0.04). Patients with a frequency of CFU-GM greater than the 25th percentile had increased TRM with respect to patients with a clonogenic cell frequency greater than the 25th percentile (33.5% vs. 13.0%, p = 0.01). Patients were divided based on median content of viable CD34+ cells, and measurement of viable CD34+ cells was predictive for OS (p = 0.005) and TRM (p = 0.003). A weak correlation was observed between CFU-GM frequency in marrow at day +18 and levels of IL-2 receptor (IL-2R) in plasma (r = -0.226, p = 0.03). We conclude that marrow progenitor cell counts, on day +18 may be a useful marker for identifying patients at risk for severe a-GVHD, TRM, and inferior survival.
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Affiliation(s)
- Giuseppe Milone
- Istituto Oncologico del Mediterraneo, Bone Marrow Transplantation Unit, Viagrande, Italy; Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy.
| | - Paola Scirè
- Istituto Oncologico del Mediterraneo, Bone Marrow Transplantation Unit, Viagrande, Italy
| | - Maria Grazia Camuglia
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Anna Triolo
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Gaetano Moschetti
- Istituto Oncologico del Mediterraneo, Bone Marrow Transplantation Unit, Viagrande, Italy
| | - Maria Grazia Scuderi
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Alessandra Cupri
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Giulio Antonio Milone
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Anna Bulla
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Mary Ann Di Giorgio
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Valerio Leotta
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Angelo Curtopelle
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Roberta Sciortino
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Laura Parrinello
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Salvatore Leotta
- Department of Hematology and Bone Marrow Transplantation Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
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20
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Delbos F, Blouin L, Bruno B, Crocchiolo R, Desoutter J, Detrait M, Nguyen-Lejarre KT, Giannoli C, Lemarié C, Renac V, Yakoub-Agha I, Dubois V. [Relevance of antibodies in hematopoietic stem cell transplantation: Antibodies anti-HLA, anti-platelets, anti-granulocytes, anti-erythrocytes and anti-MICA. Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2020; 107:S159-S169. [PMID: 32540096 DOI: 10.1016/j.bulcan.2020.04.015] [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: 02/10/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
The presence of allo-antibodies in the serum of a recipient awaiting hematopoietic stem cell transplantation (HSCT) may have an impact on transfusion efficiency and/or donor choice, especially in the absence of an identical sibling donor. Prior to transplantation, donor specific anti-HLA (Human Leukocyte Antigen) antibodies (DSA) have a recognized effect on transplant outcome, correlated with the increasing MFI value and with the ability of such antibody to fix the complement fraction. Anti-platelet antibodies (anti-HLA class I and anti-HPA [Human Platelet Antigen]) are better involved in transfusion inefficiency and can be responsible for refractory status. ABO incompatibilities require a specific treatment of the graft in presence of high titer to avoid hemolytic adverse effects. Investigations of these antibodies should be carried out on a regular basis in order to establish appropriate transfusion recommendation, select an alternative donor when possible or adapt the source of cells. After transplantation, in case of delayed recovery or graft rejection, long term aplasia, persistent mixed chimerism or late release, and after elimination of the main clinical causes, a biological assessment targeted on the different type of antibodies will have to be performed in order to orient towards the cause or the appropriate therapy. Further studies should be carried out to determine the impact of anti-MICA antibodies and recipient specific anti-HLA antibodies, on the outcome of the transplantation.
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Affiliation(s)
- Florent Delbos
- EFS Centre Pays de la Loire, laboratoire HLA, 34, rue Jean-Monnet, 44000 Nantes, France
| | - Laura Blouin
- CHU Pellegrin, laboratoire immunologie et immunogénétique, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | | | - Roberto Crocchiolo
- ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano, Italie
| | - Judith Desoutter
- CHU Amiens Picardie, service d'hématologie biologique, secteur d'histocompatibilité, 80054 Amiens cedex 1, France
| | - Marie Detrait
- Service d'hématologie et de transplantation médullaire, CHRU de Nancy, institut Louis-Mathieu, hôpitaux de Brabois, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - Khan Tien Nguyen-Lejarre
- EFS Bourgogne Franche-Comté, laboratoire d'immunogénétique, 8, rue du Dr-JFX-Girod, 25020 Besançon cedex, France
| | - Catherine Giannoli
- EFS Auvergne Rhône Alpes, laboratoire HLA/HPA, 111, rue Elisée-Reclus, 69150 Décines, France
| | - Claude Lemarié
- Institut Paoli-Calmettes, département de biologie du cancer, Marseille, France; Inserm CBT1409 centre d'investigations cliniques en biothérapie, Marseille, France
| | - Virginie Renac
- EFS Bretagne, laboratoire d'immunogénétique et histocompatibilité immunologie plaquettaire, rue Pierre-Jean-Gineste, 35000 Rennes, France
| | | | - Valérie Dubois
- EFS Auvergne Rhône Alpes, laboratoire HLA/HPA, 111, rue Elisée-Reclus, 69150 Décines, France.
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Crocchiolo R, Cornacchini G, Lando G, Coviello A, Cuppari I, Volpato E, Pugliano MT, Grillo G, Zucchetti E, Rossini S. The number of HLA confirmatory tests during unrelated donor search as a driver for the evaluation of back-up haploidentical donor(s). Transfus Apher Sci 2020; 59:102766. [PMID: 32276862 DOI: 10.1016/j.transci.2020.102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/01/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION the identification of a suitable donor in an appropriate timing represents a crucial step in the preparation of allogeneic stem cell transplantation (HSCT). At our Institution, for patients lacking an HLA-identical sibling, a haploidentical donor is considered in the absence of a 10/10-matched or a one-locus HLA-mismatched unrelated donor (UD), but the optimal timing of work-up of potential familiar haploidentical donor(s) by the Apheresis Team is actually unknown. PATIENTS & METHODS we analyzed here n = 167 UD searches launched at our Hospital between July 2013 and July 2018 and looked for any correlation between the number of HLA confirmatory tests received and the final type of donor selected for HSCT, in an attempt to identify those situations where prompt evaluation of haploidentical donor(s) is warranted. RESULTS a total of n = 117 transplants were performed and haploidentical HSCTs were n = 16 (14 %). In n = 93 cases (56 %) the number of HLA confirmatory tests received were two; they were one, zero and three for n = 52, n = 14 and n = 8 patients, respectively. Only 5 % of haploidentical donors were used when two confirmation test samples were received whereas this percentage rises to 17 % when only one sample reached the HLA lab. When no confirmation tests were available, haploidentical transplant occurred in 100 % of cases. CONCLUSIONS besides the situations with no HLA confirmation tests, the evaluation of any haploidentical donor(s) should be promptly started also when only one HLA confirmatory test is received, in order to optimise the potential work-up process and avoid delay in transplantation.
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Affiliation(s)
- Roberto Crocchiolo
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy.
| | - Giorgia Cornacchini
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy
| | - Giuliana Lando
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy
| | - Arianna Coviello
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy
| | - Irene Cuppari
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy
| | - Elisabetta Volpato
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy
| | - Maria Teresa Pugliano
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy
| | - Giovanni Grillo
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy
| | - Elisa Zucchetti
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy
| | - Silvano Rossini
- ASST Grande Ospedale Metropolitano Niguarda, Milano. Piazza Dell'Ospedale Maggiore 3, 20162, Milano, Italy
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22
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Leotta S, Sapienza G, Camuglia MG, Avola G, Marco AD, Moschetti G, Curto Pelle A, Markovic U, Milone GA, Cupri A, Bianco O, Frontini V, Spadaro A, Marchese AE, Crocchiolo R, Milone G. Preliminary Results of a Combined Score Based on sIL2-Rα and TIM-3 Levels Assayed Early After Hematopoietic Transplantation. Front Immunol 2020; 10:3158. [PMID: 32117211 PMCID: PMC7020780 DOI: 10.3389/fimmu.2019.03158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022] Open
Abstract
Assays of cytokines in the plasma at the onset of graft-vs. -host disease (GVHD) can predict disease severity and treatment-related mortality (TRM); however, the optimal time during which cytokines should be tested and the specific panel of cytokines with the highest predictive ability remain unknown. We chose a predefined time point, 18 days after hematopoietic stem cell transplantation (HSCT), to measure the levels of six cytokines in the plasma: soluble interleukin-2 receptor alpha (sIL2-Rα), T-cell immunoglobulin domain and mucin domain-3 (TIM-3), suppression of tumorigenicity-2 (ST-2), intercellular adhesion molecule (ICAM-1), interferon-gamma (IFN-γ), and interleukin-6 (IL-6). The study included 95 patients, who underwent allogeneic hematopoietic transplantation at our institution. Plasma levels of sIL2-Rα and TIM-3, measured as continuous data, had predictive value for overall survival (sIL2-Rα, p = 0.002; TIM-3, p = 0.0007), while TRM could be predicted by sIL2-Rα (p = 0.0005), IFN-gamma (p = 0.01), and IL-6 (p = 0.0001). No cytokine was associated with the risk of relapse. Patients were categorized into groups, according to cytokine thresholds determined by receiver operating characteristic curve analysis (sIL2-Rα ≤ or > 8,100 pg/ml; TIM-3 ≤ or > 950 pg/ml) and multivariate analysis was conducted. High levels of both TIM-3 and sIL2-Rα were significant predictors of poor survival [TIM-3 > 950 pg/ml: hazard ratio (HR) = 6.214 (95% CI 1.939–19.910), p = 0.002 and sIL2-Rα > 8.100 pg/ml: HR = 2.644 (95% CI 1.308–5.347), p = 0.006]. Using these cutoff thresholds, we constructed a composite scoring system that could distinguish three different groups of patients with varying rates of TRM: high risk, 41.7%; intermediate risk, 10.8%; and low risk, 7.1% (Gray's test: p = 0.001). If confirmed in a validation cohort, this composite scoring system could be used to guide the modulation of post-transplant immune suppressive therapy.
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Affiliation(s)
- Salvatore Leotta
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Giuseppe Sapienza
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Maria Grazia Camuglia
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Giuseppe Avola
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Annalia Di Marco
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Gaetano Moschetti
- Unità Operativa di Oncoematologia e BMT Unit, Istituto Oncologico del Mediterraneo, Catania, Italy
| | - Angelo Curto Pelle
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Uros Markovic
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Giulio Antonio Milone
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Alessandra Cupri
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Oriana Bianco
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Viviana Frontini
- First Department of Laboratory Medicine, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Andre Spadaro
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Anna Elisa Marchese
- First Department of Laboratory Medicine, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Giuseppe Milone
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
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23
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Peccatori J, Mastaglio S, Giglio F, Greco R, Crocchiolo R, Patriarca F, Forno B, Deola S, Assanelli A, Lupo Stanghellini MT, Marcatti M, Zecca M, Cortelazzo S, Fanin R, Fagioli F, Locatelli F, Ciceri F. Clofarabine and Treosulfan as Conditioning for Matched Related and Unrelated Hematopoietic Stem Cell Transplantation: Results from the Clo3o Phase II Trial. Biol Blood Marrow Transplant 2019; 26:316-322. [PMID: 31605823 DOI: 10.1016/j.bbmt.2019.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be curative for patients with hematologic malignancies. The ideal conditioning regimen before allo-HSCT has not been established. We conducted a Phase II study to evaluate the tolerability and efficacy of clofarabine and treosulfan as conditioning regimen before allo-HSCT. The primary objective was to evaluate the cumulative incidence of nonrelapse mortality (NRM) on day +100. Forty-four patients (36 with acute myelogenous leukemia, 5 with acute lymphoblastic leukemia, 3 with myelodysplastic syndromes) were enrolled. The median patient age was 47 years, and the median duration of follow-up was 27 months. The conditioning regimen was based on clofarabine 40 mg/m2 (days -6 to -2) and treosulfan 14 g/m2 (days -6 to -4). Allogeneic hematopoietic stem cells were derived from a sibling (n = 22) or a well-matched unrelated donor (n = 22). Graft-versus-host disease (GVHD) prophylaxis consisted of antithymocyte globulin, rituximab, cyclosporine, and a short-course of methotrexate. The regimen allowed for rapid engraftment and a 100-day NRM of 18%, due mainly to bacterial infections. The incidences of grade II-IV acute GVHD and chronic GVHD were 16% and 19%, respectively. The rates of overall survival (OS), progression-free survival, and relapse at 2 years were 51%, 31%, and 50%, respectively. Significantly different outcomes were observed between patients with low-intermediate and patients with high-very high Disease Risk Index (DRI) scores (1-year OS, 78% and 24%, respectively). Our findings show that the use of treosulfan and clofarabine as a conditioning regimen for allo-HSCT is feasible, with a 78% 1-year OS in patients with a low-intermediate DRI score. However, 1-year NRM was 18%, and despite the intensified conditioning regimen, relapse incidence remains a major issue in patients with poor prognostic risk factors.
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Affiliation(s)
- Jacopo Peccatori
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Mastaglio
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Giglio
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Greco
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesca Patriarca
- Carlo Melzi Hematology and Cellular Therapy Unit, Azienda Sanitaria Universitaria Integrata di Udine, Undine, Italy
| | - Barbara Forno
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Deola
- Department of Hematology, Ospedale Regionale, Bolzano, Italy
| | - Andrea Assanelli
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Magda Marcatti
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Renato Fanin
- Carlo Melzi Hematology and Cellular Therapy Unit, Azienda Sanitaria Universitaria Integrata di Udine, Undine, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, University of Torino, Torino, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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24
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Ward KN, Hill JA, Hubacek P, de la Camara R, Crocchiolo R, Einsele H, Navarro D, Robin C, Cordonnier C, Ljungman P. Guidelines from the 2017 European Conference on Infections in Leukaemia for management of HHV-6 infection in patients with hematologic malignancies and after hematopoietic stem cell transplantation. Haematologica 2019; 104:2155-2163. [PMID: 31467131 PMCID: PMC6821622 DOI: 10.3324/haematol.2019.223073] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/27/2019] [Indexed: 01/15/2023] Open
Abstract
Of the two human herpesvirus 6 (HHV-6) species, human herpesvirus 6B (HHV-6B) encephalitis is an important cause of morbidity and mortality after allogeneic hematopoietic stem cell transplant. Guidelines for the management of HHV-6 infections in patients with hematologic malignancies or post-transplant were prepared a decade ago but there have been no other guidelines since then despite significant advances in the understanding of HHV-6 encephalitis, its therapy, and other aspects of HHV-6 disease in this patient population. Revised guidelines prepared at the 2017 European Conference on Infections in Leukaemia covering diagnosis, preventative strategies and management of HHV-6 disease are now presented.
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Affiliation(s)
- Katherine N Ward
- Division of Infection and Immunity, University College London, London, UK
| | - Joshua A Hill
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Petr Hubacek
- Department of Medical Microbiology and Department of Paediatric Haematology and Oncology 2 Medical Faculty of Charles University and Motol University Hospital, Prague, Czech Republic
| | | | | | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Julius Maximilians Universität, Würzburg, Germany
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA and Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Christine Robin
- Department of Haematology, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Université Paris-Est Créteil, Créteil, France
| | - Catherine Cordonnier
- Department of Haematology, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Université Paris-Est Créteil, Créteil, France
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Ljungman P, de la Camara R, Robin C, Crocchiolo R, Einsele H, Hill JA, Hubacek P, Navarro D, Cordonnier C, Ward KN. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis 2019; 19:e260-e272. [PMID: 31153807 DOI: 10.1016/s1473-3099(19)30107-0] [Citation(s) in RCA: 244] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 01/05/2019] [Accepted: 03/05/2019] [Indexed: 12/11/2022]
Abstract
Cytomegalovirus is one of the most important infections to occur after allogeneic haematopoietic stem cell transplantation (HSCT), and an increasing number of reports indicate that cytomegalovirus is also a potentially important pathogen in patients treated with recently introduced drugs for hematological malignancies. Expert recommendations have been produced by the 2017 European Conference on Infections in Leukaemia (ECIL 7) after a review of the literature on the diagnosis and management of cytomegalovirus in patients after HSCT and in patients receiving other types of therapy for haematological malignancies. These recommendations cover diagnosis, preventive strategies such as prophylaxis and pre-emptive therapy, and management of cytomegalovirus disease. Antiviral drugs including maribavir and letermovir are in development and prospective clinical trials have recently been completed. However, management of patients with resistant or refractory cytomegalovirus infection or cytomegalovirus disease is a challenge. In this Review we summarise the reviewed literature and the recommendations of the ECIL 7 for management of cytomegalovirus in patients with haematological malignancies.
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Affiliation(s)
- Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, and Division of Hematology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | | | - Christine Robin
- Assistance Publique-Hopitaux de Paris, Department of Hematology, Henri Mondor Hospital and Université Paris-Est Créteil, Créteil, France
| | - Roberto Crocchiolo
- Servizio Immunoematologia e Medicina Trasfusionale, Azienda Socio Sanitaria Territoriale di Bergamo Ovest, Treviglio, Italy
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Julius Maximilians Universitaet, Würzburg, Germany
| | - Joshua A Hill
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Petr Hubacek
- Department of Medical Microbiology and Department of Paediatric Haematology and Oncology, Second Faculty of Medicine of Motol University Hospital and Charles University, Prague, Czech Republic
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain; Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Catherine Cordonnier
- Assistance Publique-Hopitaux de Paris, Department of Hematology, Henri Mondor Hospital and Université Paris-Est Créteil, Créteil, France
| | - Katherine N Ward
- Division of Infection and Immunity, University College London, London, UK
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Fontana R, Raccosta L, Rovati L, Steffensen KR, Paniccia A, Jakobsson T, Melloni G, Bandiera A, Mangili G, Bergamini A, Maggioni D, Doglioni C, Crocchiolo R, Cella M, Mattioli M, Battaglia C, Colonna M, Russo V. Nuclear receptor ligands induce TREM-1 expression on dendritic cells: analysis of their role in tumors. Oncoimmunology 2018; 8:1554967. [PMID: 30723587 DOI: 10.1080/2162402x.2018.1554967] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 11/02/2018] [Accepted: 11/26/2018] [Indexed: 12/13/2022] Open
Abstract
Dendritic cells (DCs) initiate adaptive immune responses after their migration to secondary lymphoid organs. The LXR ligands/oxysterols and the RXR ligand 9-cis Retinoic Acid (9-cis RA) were shown to dampen DC migration to lymphoid organs through the inhibition of CCR7 expression. We performed transcriptomics of DCs undergoing maturation in the presence of the LXR ligand 22R-Hydroxycholesterol (22R-HC). The analysis highlighted more than 1500 genes modulated by 22R-HC treatment, including the triggering receptor expressed on myeloid cells (TREM)-1, which was found markedly up-regulated. We tested the effect of other nuclear receptor ligands (NRL) and we reported the induction of TREM-1 following RXR, RAR and VDR activation. From a functional point of view, triggering of TREM-1 induced by retinoids increased TNFα and IL-1β release, suggesting an active role of NRL-activated TREM-1+ DCs in inflammation-driven diseases, including cancer. Consistently with this hypothesis we detected DCs expressing TREM-1 in pleural effusions and ascites of cancer patients, an observation validated by the induction of TREM-1, LXR and RAR target genes when monocyte-DCs were activated in the presence of tumor-conditioned fluids. Finally, we observed a better control of LLC tumor growth in Trem-1-/- bone marrow chimera mice as compared to wild type chimera mice. Future studies will be necessary to shed light on the mechanism of TREM-1 induction by distinct NRL, and to characterize the role of TREM-1+ DCs in tumor growth.
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Affiliation(s)
- Raffaella Fontana
- Immuno-Biotherapy of Melanoma and Solid Tumors Unit, Division of Experimental Oncology, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Laura Raccosta
- Immuno-Biotherapy of Melanoma and Solid Tumors Unit, Division of Experimental Oncology, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Lucrezia Rovati
- Immuno-Biotherapy of Melanoma and Solid Tumors Unit, Division of Experimental Oncology, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Knut R Steffensen
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
| | - Aida Paniccia
- Immuno-Biotherapy of Melanoma and Solid Tumors Unit, Division of Experimental Oncology, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Tomas Jakobsson
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
| | - Giulio Melloni
- Thoracic Surgery Unit, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Alessandro Bandiera
- Thoracic Surgery Unit, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Giorgia Mangili
- Gynecologic Unit, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Alice Bergamini
- Gynecologic Unit, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Daniela Maggioni
- Immuno-Biotherapy of Melanoma and Solid Tumors Unit, Division of Experimental Oncology, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Claudio Doglioni
- Department of Pathology, IRCCS Scientific Institute San Raffaele, Milan, Italy.,Department of Pathology, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Marina Cella
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Michela Mattioli
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Segrate, Italy
| | - Cristina Battaglia
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Segrate, Italy
| | - Marco Colonna
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Vincenzo Russo
- Immuno-Biotherapy of Melanoma and Solid Tumors Unit, Division of Experimental Oncology, IRCCS Scientific Institute San Raffaele, Milan, Italy
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Sarina B, Mariotti J, Bramanti S, Morabito L, Crocchiolo R, Rimondo A, Tordato F, Pocaterra D, Casari E, De Philippis C, Carlo-Stella C, Santoro A, Castagna L. A reduced dose of fluconazole as primary antifungal prophylaxis is not associated with increased risk of invasive fungal infections after allogeneic stem cell transplantation from a HLA identical sibling. Transpl Infect Dis 2018; 20:e12906. [PMID: 29668124 DOI: 10.1111/tid.12906] [Citation(s) in RCA: 2] [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: 07/01/2017] [Revised: 12/16/2017] [Accepted: 12/24/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Invasive fungal infections (IFI) represent a common side effect of allogeneic hematopoietic stem cell transplant (allo-SCT), resulting in increased non relapse mortality (NRM) and reduced overall survival (OS) rates. Seventy-five days of Fluconazole 400 mg/d represents the standard primary antifungal prophylaxis (PAP) after allo-SCT, especially for low-risk transplants. However, the ideal dosage of fluconazole has never been tested. METHODS Here, we report the experience of our institution on 113 consecutive patients receiving an allo-SCT from a HLA identical sibling between 1999 and 2015, where PAP consisted of fluconazole 100 mg/d only during the pre-engraftment phase. At the time of transplant, all patients were considered at low-risk for mold infection according to ECIL-5 guidelines. RESULTS Cumulative incidence of possible-probable-proven IFI was 11.7%, while proven-probable (PP-IFI) occurred in 5.5% of patients by day 100 post transplant. Of note, only 1 patient developed invasive Candidiasis due to a non-albicans strain and stool-screening tests were negative for colonization by Candida albicans species. The incidence of 1-year acute and 2-year chronic graft-versus-host-disease (GVHD) was 30% and 45%, respectively. Three-year OS and 1-year NRM were 53% and 11.3%, respectively. CONCLUSION In summary, fungal prophylaxis with fluconazole 100 mg/d results in very low incidence of PP-IFI, GVHD and NRM in low-risk allo-SCT.
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Affiliation(s)
- Barbara Sarina
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Jacopo Mariotti
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Stefania Bramanti
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Lucio Morabito
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Roberto Crocchiolo
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Andrea Rimondo
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Federica Tordato
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Daria Pocaterra
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Erminia Casari
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Chiara De Philippis
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Carmelo Carlo-Stella
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Armando Santoro
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Luca Castagna
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
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Castagna L, Boubdallah R, Furst S, Coso D, El Cheikh J, Faucher C, Crocchiolo R, Granata A, Chabannon C, Lemarié C, Calmels B, Boher JM, Mohty M, Blaise D. Correction: Corrigendum: Disease status is a more reliable predictive factor than histology in lymphoma patients after reduced-intensity conditioning regimen and allo-SCT. Bone Marrow Transplant 2018; 53:234. [DOI: 10.1038/bmt.2018.1] [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: 11/09/2022]
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Cesaro S, Crocchiolo R, Tridello G, Knelange N, Van Lint MT, Koc Y, Ciceri F, Gülbas Z, Tischer J, Afanasyev B, Bruno B, Castagna L, Blaise D, Mohty M, Irrera G, Diez-Martin JL, Pierelli L, Pioltelli P, Arat M, Delia M, Fagioli F, Ehninger G, Aljurf M, Carella AM, Ozdogu H, Mikulska M, Ljungman P, Nagler A, Styczynski J. Comparable survival using a CMV-matched or a mismatched donor for CMV+ patients undergoing T-replete haplo-HSCT with PT-Cy for acute leukemia: a study of behalf of the infectious diseases and acute leukemia working parties of the EBMT. Bone Marrow Transplant 2018; 53:422-430. [PMID: 29330396 DOI: 10.1038/s41409-017-0016-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/13/2017] [Accepted: 10/21/2017] [Indexed: 12/19/2022]
Abstract
The role of donor CMV serostatus in the setting of non T-cell depleted haplo-HSCT with post-transplant cyclophosphamide (PT-Cy) has not been specifically addressed so far. Here we analyzed the impact of the donor CMV serological status on the outcome of 983 CMV seropositive (CMV+), acute leukemia patients receiving a first, non T-cell depleted haplo-HSCT registered in the EBMT database. The 1-year NRM was 21.3% (95% CI: 18.4-24.8) and 18.8% (95% CI: 13.8-25.5) in the CMV D+/R+ and D-/R+ pairs, respectively (p = 0.40). Similarly, 1-year OS was 55.1% (95% CI: 50.1-58.0) and 55.7% (95% CI: 48.0-62.8) in the same groups (p = 0.50). The other main outcomes were comparable. No difference in NRM nor OS was observed after stratification for the intensity of conditioning and multivariate anaysis confirmed the lack of significant association with NRM or OS. In conclusion, the choice of a CMV-seronegative donor did not impair early survival of CMV-seropositive patients with acute leukemia after a first, non T-cell depleted haploidentical HSCT and PT-Cy among this series of 983 consecutive patients. Future research may focus on the assessment of the hierarchy of all the donor variables.
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Affiliation(s)
- Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Gloria Tridello
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Yener Koc
- Medical Park Hospitals, Antalya, Turkey
| | | | - Zafer Gülbas
- Anadolu Medical Center Hospital, Kocaeli, Turkey
| | | | - Boris Afanasyev
- First State Pavlov Medical University of St., Petersburg, Russia
| | | | | | | | | | - Giuseppe Irrera
- Azienda Ospedaliera Bianchi-Melacrino-Morelli di Reggio Calabria, Reggio Calabria, Italy
| | - J L Diez-Martin
- Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | - Mutlu Arat
- Florence Nightingale Sisli Hospital, Istanbul, Turkey
| | | | | | | | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Hakan Ozdogu
- Baskent University Hospital, Yuregir Adana, Turkey
| | | | - Per Ljungman
- Karolinska University Hospital, Stockholm, Sweden
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel and Acute Leukemia Working Party Paris Office, Hopital Saint-Antoine, Université Pierre & Marie Curie, Paris, France
| | - Jan Styczynski
- University Hospital Collegium Medicum UMK, Bydgoszcz, Poland
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30
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Renda G, Rocca B, Crocchiolo R, De Cristofaro R, Landolfi R. Effect of fibrinogen concentration and platelet count on the inhibitory effect of abciximab and tirofiban. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryGlycoprotein (Gp) IIb/IIIa blockers are powerful antithrombotic agents, but display a wide variability of their effect using weight-adjusted dosing. We investigated whether some hemostatic variables affected in vitro platelet inhibition exerted by the antibody abciximab and the peptidomimetic tirofiban. High fibrinogen concentrations reduced platelet inhibition by tirofiban, assessed in whole blood (r = –0.85, n = 10, p <0.01) and in platelet rich plasma (r = –0.89, n = 10, p <0.01) through PFA 100 and Born’s aggregometry assay, respectively. Both drugs were unaffected by von Willebrand factor levels, while platelet count was inversely related to their inhibitory effect (tirofiban: r = –0.9, n = 7, p <0.01; abciximab: r = –0.81, n = 9, p <0.01). Analysis of GpIIb-IIIa blockade showed that receptor occupancy at a fixed abciximab dose was inversely related to platelet counts. These experimental data were in agreement with the classical model of receptor saturation by a tight binding inhibitor.A role for fibrinogen and/or platelet count in influencing the antithrombotic properties of platelet GpIIb-IIIa antagonists can be hypothesized.
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31
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Crocchiolo R, Dubois V, Nicolini FE, Sobh M, Ducastelle-Lepretre S, Labussiere H, Lebras L, Auxenfans C, Mojallal A, Damour O, Braye F, Michallet M. Skin allograft for severe chronic GvHD. Bone Marrow Transplant 2017; 52:1060-1062. [DOI: 10.1038/bmt.2017.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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32
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Castagna L, Sarina B, Crocchiolo R, Bramanti S, Furst S, Devillier R, Coso D, Bouabdallah R, Mokart D, Morabito L, Harbi S, Giordano L, Rimondo A, Jean Weiller P, Carlo-Stella C, Santoro A, Chabannon C, Blaise D. Outcomes of Hodgkin lymphoma patients who relapse after allogeneic stem cell transplantation. Bone Marrow Transplant 2016; 51:1644-1646. [PMID: 27748737 DOI: 10.1038/bmt.2016.257] [Citation(s) in RCA: 3] [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] [Indexed: 12/13/2022]
Affiliation(s)
- L Castagna
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - B Sarina
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - R Crocchiolo
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - S Bramanti
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - S Furst
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - R Devillier
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - D Coso
- Hematology Department, Lymphoma Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - R Bouabdallah
- Hematology Department, Lymphoma Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - D Mokart
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - L Morabito
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - S Harbi
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - L Giordano
- Biostatistical Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - A Rimondo
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - P Jean Weiller
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - C Carlo-Stella
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milano, Milano, Italy
| | - A Santoro
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy.,Humanitas University, Rozzano, Italy
| | - C Chabannon
- Cell Therapy Unit, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille Université, Marseille, France.,Centre de Recherche en Cancérologie de Marseille, Inserm, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - D Blaise
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy.,Hematology Department, Lymphoma Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy.,Aix-Marseille Université, Marseille, France.,Centre de Recherche en Cancérologie de Marseille, Inserm, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
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Bramanti S, Nocco A, Mauro E, Milone G, Morabito L, Sarina B, Crocchiolo R, Timofeeva I, Capizzuto R, Carlo-Stella C, Santoro A, Castagna L. Desensitization with plasma exchange in a patient with human leukocyte antigen donor-specific antibodies before T-cell-replete haploidentical transplantation. Transfusion 2016; 56:1096-1100. [PMID: 27021516 DOI: 10.1111/trf.13523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The presence of human leukocyte antigen donor-specific antibodies (DSAs) increases the risk of graft failure in T-cell-replete haploidentical hematopoietic stem cell transplantation (haplo-HSCT) CASE REPORT: A 49-year-old female with high-risk acute myeloid leukemia in first complete remission received a haplo-HSCT from her daughter. Pretransplant recipient screening examination showed high DSAs levels against unshared class I leukocyte antigens. RESULTS The patient underwent a desensitization program consisting of plasma exchange (PEX), polyvalent intravenous (IV) immunoglobulins, and IV tacrolimus and mycophenolate mofetil (MMF). This protocol resulted in the disappearance of the DSA anti HLA B41. Engraftment was prompt with stable full donor chimerism. CONCLUSIONS This case report suggests that the adopted scheme is safe for reducing DSA levels and facilitating donor engraftment in patients scheduled for haplo-HSCT.
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Affiliation(s)
- Stefania Bramanti
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Angela Nocco
- Immuno-Hematology Laboratory, IRCCS Ospedale Maggiore, Milano, Italy
| | - Elisa Mauro
- Transplant Unit Ospedale Ferrarotto, Catania, Italy
| | | | - Lucio Morabito
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Barbara Sarina
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Roberto Crocchiolo
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Inna Timofeeva
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Rossana Capizzuto
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Carmelo Carlo-Stella
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Armando Santoro
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Luca Castagna
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
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Crocchiolo R, Castagna L, Furst S, Devillier R, Sarina B, Bramanti S, El-Cheikh J, Granata A, Harbi S, Morabito L, Faucher C, Rimondo A, Girardi D, Mohty B, Calmels B, Carlo-Stella C, Chabannon C, Bouabdallah R, Santoro A, Vey N, Weiller PJ, Blaise D. The patient’s CMV serological status affects clinical outcome after T-cell replete haplo-HSCT and post-transplant cyclophosphamide. Bone Marrow Transplant 2016; 51:1134-6. [DOI: 10.1038/bmt.2016.69] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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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35
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Devillier R, Bramanti S, Fürst S, Sarina B, EL-Cheikh J, Crocchiolo R, Granata A, Chabannon C, Morabito L, Harbi S, Faucher C, Santoro A, Weiller PJ, Vey N, Stella CC, Castagna L, Blaise D. T-Replete Haploidentical Allogeneic Transplantation Using Post-Transplantation Cyclophosphamide in Advanced Acute Myeloid Leukemia and Myelodysplastic Syndromes. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.877] [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: 10/22/2022]
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36
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Rimondo A, Bramanti S, Crocchiolo R, Giordano L, Sarina B, Morabito L, Perotti C, Timofeeva I, Capizzuto R, Santoro A, Castagna L. Bone marrow donor-related variables associated with harvest outcome in HLA-haploidentical transplantation with postinfusion cyclophosphamide. Vox Sang 2016; 111:93-100. [DOI: 10.1111/vox.12385] [Citation(s) in RCA: 3] [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: 09/24/2015] [Revised: 12/17/2015] [Accepted: 01/10/2016] [Indexed: 12/18/2022]
Affiliation(s)
- A. Rimondo
- Hematology Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
| | - S. Bramanti
- Hematology Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
| | - R. Crocchiolo
- Hematology Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
| | - L. Giordano
- Biostatistics Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
| | - B. Sarina
- Hematology Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
| | - L. Morabito
- Hematology Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
| | - C. Perotti
- Immunohaematology and Transfusion Service; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - I. Timofeeva
- Hematology Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
| | - R. Capizzuto
- Hematology Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
| | - A. Santoro
- Hematology Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
| | - L. Castagna
- Hematology Unit; Humanitas Cancer Center; Rozzano (Milan) Italy
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37
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Wanquet A, Crocchiolo R, Furst S, Granata A, Faucher C, Devillier R, Harbi S, Lemarie C, Calmels B, Vey N, Weiller PJ, Chabannon C, Castagna L, Blaise D, El-Cheikh J. The efficacy and safety of a new reduced-toxicity conditioning with 4 days of once-daily 100 mg/m(2) intravenous busulfan associated with fludarabine and antithymocyte globulins prior to allogeneic stem cell transplantation in patients with high-risk myelodysplastic syndrome or acute leukemia. Leuk Lymphoma 2016; 57:2315-20. [PMID: 26885686 DOI: 10.3109/10428194.2016.1146948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The optimal intensity of myeloablation associated with a reduced-toxicity conditioning (RTC) regimen in order to decrease the relapse rate without increasing non-relapse mortality (NRM), is not well established yet. This retrospective analysis was done on 30 patients with hematological malignancies. The aim was to assess the safety of a RTC regimen based on the busulfan at a dose of 100 mg/m(2)/d intravenously for 4 d, fludarabine at a dose of 30 mg/m(2)/d for 5 d, and anti-thymoglobulins at a dose of 2.5 mg/kg/d for 2 d. The cumulative incidences of grade 2-4 acute graft-versus-host disease (GVHD) and all grades chronic GVHD were 37% and 42%, respectively. Median 1-year overall survival and disease-free survival were 66% and 50%, respectively. At 1 year, the cumulative incidence of relapse/disease progression was 33%. NRM was 3% and 17% at day 100 and 1 year, respectively. This RTC conditioning regimen can lead to a long-term disease control. Moreover, it appears to be safe with a low NRM rate among high-risk patients.
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Affiliation(s)
- Anne Wanquet
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Roberto Crocchiolo
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Sabine Furst
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Angela Granata
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Catherine Faucher
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Raynier Devillier
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Samia Harbi
- c Centre de Thérapie Cellulaire , Institut Paoli-Calmettes , Marseille , France
| | - Claude Lemarie
- c Centre de Thérapie Cellulaire , Institut Paoli-Calmettes , Marseille , France
| | - Boris Calmels
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Norbert Vey
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Pierre Jean Weiller
- c Centre de Thérapie Cellulaire , Institut Paoli-Calmettes , Marseille , France
| | - Christian Chabannon
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Luca Castagna
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Didier Blaise
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Jean El-Cheikh
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
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38
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Blaise D, Fürst S, Crocchiolo R, El-Cheikh J, Granata A, Harbi S, Bouabdallah R, Devillier R, Bramanti S, Lemarie C, Picard C, Chabannon C, Weiller PJ, Faucher C, Mohty B, Vey N, Castagna L. Haploidentical T Cell–Replete Transplantation with Post-Transplantation Cyclophosphamide for Patients in or above the Sixth Decade of Age Compared with Allogeneic Hematopoietic Stem Cell Transplantation from an Human Leukocyte Antigen–Matched Related or Unrelated Donor. Biol Blood Marrow Transplant 2016; 22:119-24. [DOI: 10.1016/j.bbmt.2015.08.029] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/20/2015] [Indexed: 11/26/2022]
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39
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Crocchiolo R, Bramanti S, Vai A, Sarina B, Mineri R, Casari E, Tordato F, Mauro E, Timofeeva I, Lugli E, Mavilio D, Carlo-Stella C, Santoro A, Castagna L. Infections after T-replete haploidentical transplantation and high-dose cyclophosphamide as graft-versus-host disease prophylaxis. Transpl Infect Dis 2015; 17:242-9. [PMID: 25648539 PMCID: PMC7169814 DOI: 10.1111/tid.12365] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [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: 09/23/2014] [Revised: 11/24/2014] [Accepted: 01/18/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, a platform of T-cell replete haploidentical hematopoietic stem cell transplantation (haplo-HSCT) using post-transplant cyclophosphamide (Cy) has shown high reproducibility and acceptable safety profile. METHOD This prospective cohort analysis allowed us to collect data on infections among 70 consecutive recipients of haplo-HSCT affected by various hematologic malignancies. RESULTS After a median follow-up of 23 months, cumulative incidence of viral infections was 70% (95% confidence interval [CI] 59-81) at 100 days and 77% (95% CI 67-87) at 1 year; 35 of 65 patients at risk had CMV reactivation (54%) and the rate of polyomavirus-virus-associated cystitis was 19% (13/70). Cumulative incidence of bacterial and fungal infections at 1 year were 63% (95% CI 51-75) and 12% (95% CI 4-19), respectively. Of note, only 1 invasive fungal infection occurred beyond 1 year after transplant (day +739). CONCLUSION In conclusion, despite a high rate of viral infections in the early period, present data suggest a satisfactory infectious profile after T-cell replete haplo-HSCT using post-transplant Cy. These results may help clinicians to improve both prophylactic and therapeutic antimicrobial strategies in this emerging haploidentical setting.
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Affiliation(s)
- R Crocchiolo
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milan, Italy
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40
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Castagna L, Bramanti S, Furst S, Giordano L, Sarina B, Crocchiolo R, El-Cheikh J, Cheikh JE, Granata A, Morabito L, Mauro E, Faucher C, Mohty B, Harbi S, Devillier R, Chabannon C, Carlo-Stella C, Santoro A, Blaise D. Tacrolimus compared with cyclosporine A after haploidentical T-cell replete transplantation with post-infusion cyclophosphamide. Bone Marrow Transplant 2015; 51:462-5. [PMID: 26595078 DOI: 10.1038/bmt.2015.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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)
- L Castagna
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - S Bramanti
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - S Furst
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - L Giordano
- Statistic Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - B Sarina
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - R Crocchiolo
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | | | - J El Cheikh
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - A Granata
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - L Morabito
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - E Mauro
- Department of Hematology, Ospedale Ferrarotto, Catania, Italy
| | - C Faucher
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - B Mohty
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - S Harbi
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - R Devillier
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - C Chabannon
- Cell Therapy Unit Institut Paoli Calmettes, Marseille, France.,Aix-Marseille Université, Marseille, France.,Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
| | - C Carlo-Stella
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - A Santoro
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - D Blaise
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France.,Aix-Marseille Université, Marseille, France.,Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
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41
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Devillier R, Bramanti S, Fürst S, Sarina B, El-Cheikh J, Crocchiolo R, Granata A, Chabannon C, Morabito L, Harbi S, Faucher C, Santoro A, Weiller PJ, Vey N, Carlo-Stella C, Castagna L, Blaise D. T-replete haploidentical allogeneic transplantation using post-transplantation cyclophosphamide in advanced AML and myelodysplastic syndromes. Bone Marrow Transplant 2015; 51:194-8. [PMID: 26551778 DOI: 10.1038/bmt.2015.270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/24/2015] [Accepted: 09/29/2015] [Indexed: 11/12/2022]
Abstract
Unmanipulated haploidentical transplantation (Haplo-SCT) using post-transplantation cyclophosphamide (PT-Cy) represents an alternative for patients with high-risk diseases lacking HLA-identical donor. Although it provides low incidences of GVHD, the efficacy of Haplo-SCT is still questioned, especially for patients with myeloid malignancies. Thus, we analyzed 60 consecutive patients with refractory (n=30) or high-risk CR (n=30) AML or myelodysplastic syndromes (MDSs) who underwent PT-Cy Haplo-SCT. The median age was 57 years (22-73 years), hematopoietic cell transplantation comorbidity index was ⩾3 in 38 patients (63%) and Haplo-SCT was the second allogeneic transplantation for 10 patients (17%). Although most of patients received PBSC as graft source (n=48, 80%), we found low incidences of grade 3-4 acute (2%) and severe chronic GVHD (4%). Among patients with high-risk CR diseases, 1-year non-relapse mortality, cumulative incidence of relapse, progression-free and overall survivals were 20%, 32%, 47% and 62%, respectively. In patients with refractory disease, corresponding results were 34%, 35%, 32% and 37%, respectively. We conclude that PT-Cy Haplo-SCT could provide promising anti-leukemic effect even in the setting of very advanced diseases. Thus, it represents a viable alternative for high-risk AML/MDS patients without HLA-identical donor.
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Affiliation(s)
- R Devillier
- Department of Hematology, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Medicine Faculty, Marseille, France
| | - S Bramanti
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - S Fürst
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - B Sarina
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - J El-Cheikh
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - R Crocchiolo
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - A Granata
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - C Chabannon
- Aix-Marseille University, Medicine Faculty, Marseille, France.,Cell Therapy Facility, Institut Paoli Calmettes, Marseille, France
| | - L Morabito
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - S Harbi
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - C Faucher
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - A Santoro
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - P-J Weiller
- Department of Hematology, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Medicine Faculty, Marseille, France
| | - N Vey
- Department of Hematology, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Medicine Faculty, Marseille, France
| | - C Carlo-Stella
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - L Castagna
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - D Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Medicine Faculty, Marseille, France
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42
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Crocchiolo R, Castagna L, Garciaz S, Fürst S, El Cheikh J, Sarina B, Bramanti S, Granata A, Vai A, Harbi S, Morabito L, Mohty B, Giordano L, Devillier R, Coso D, Balzarotti M, Chabannon C, Carlo-Stella C, Santoro A, Bouabdallah R, Blaise D. Tandem autologous-allogeneic stem cell transplantation as a feasible and effective procedure in high-risk lymphoma patients. Haematologica 2015. [PMID: 26206800 DOI: 10.3324/haematol.2015.129452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Luca Castagna
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Sylvain Garciaz
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Sabine Fürst
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Jean El Cheikh
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Barbara Sarina
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Stefania Bramanti
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Angela Granata
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Andrea Vai
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Samia Harbi
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Lucio Morabito
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Bilal Mohty
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Laura Giordano
- Biostatistic Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Diane Coso
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Monica Balzarotti
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | - Armando Santoro
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Reda Bouabdallah
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Didier Blaise
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
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43
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Noviello M, Forcina A, Veronica V, Crocchiolo R, Stanghellini MTL, Carrabba M, Greco R, Vago L, Giglio F, Assanelli A, Carbone MR, Magnani Z, Crippa F, Corti C, Bernardi M, Peccatori J, Bordignon C, Ciceri F, Bonini C, Bondanza A. Early recovery of CMV immunity after HLA-haploidentical hematopoietic stem cell transplantation as a surrogate biomarker for a reduced risk of severe infections overall. Bone Marrow Transplant 2015; 50:1262-4. [PMID: 26076126 DOI: 10.1038/bmt.2015.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M Noviello
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - A Forcina
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - R Crocchiolo
- Department of Hematology, Humanitas Clinical Institute, Milan, Italy
| | - M T L Stanghellini
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - M Carrabba
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - R Greco
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - L Vago
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy.,Unit of Molecular and Functional Immunogenetics, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - F Giglio
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - A Assanelli
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - M R Carbone
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Z Magnani
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - F Crippa
- Infectious Disease Unit, San Paolo Hospital, University of Milan, Milan, Italy
| | - C Corti
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - M Bernardi
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - J Peccatori
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - C Bordignon
- Vita-Salute San Raffaele University, Milan, Italy.,MolMed S.p.a, Milan, Italy
| | - F Ciceri
- Hematology and Bone Marrow Transplantation Unit, Division of Regenerative Medicine, Stem Cell and Gene Therapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - C Bonini
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - A Bondanza
- Vita-Salute San Raffaele University, Milan, Italy.,Innovative Immunotherapies Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Hospital Scientific Institute, Milan, Italy
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44
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Garciaz S, Castagna L, Bouabdallah R, Fürst S, Bramanti S, Coso D, Crocchiolo R, El-Cheikh J, Broussais F, Chabannon C, Santoro A, Blaise D. Erratum: Familial haploidentical challenging unrelated donor Allo-SCT in advanced non-Hodgkin lymphomas when matched related donor is not available. Bone Marrow Transplant 2015; 50:880. [DOI: 10.1038/bmt.2015.79] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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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45
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Roberto A, Castagna L, Zanon V, Bramanti S, Crocchiolo R, McLaren JE, Gandolfi S, Tentorio P, Sarina B, Timofeeva I, Santoro A, Carlo-Stella C, Bruno B, Carniti C, Corradini P, Gostick E, Ladell K, Price DA, Roederer M, Mavilio D, Lugli E. Role of naive-derived T memory stem cells in T-cell reconstitution following allogeneic transplantation. Blood 2015; 125:2855-64. [PMID: 25742699 PMCID: PMC4424633 DOI: 10.1182/blood-2014-11-608406] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [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: 10/31/2014] [Accepted: 02/28/2015] [Indexed: 12/31/2022] Open
Abstract
Early T-cell reconstitution following allogeneic transplantation depends on the persistence and function of T cells that are adoptively transferred with the graft. Posttransplant cyclophosphamide (pt-Cy) effectively prevents alloreactive responses from unmanipulated grafts, but its effect on subsequent immune reconstitution remains undetermined. Here, we show that T memory stem cells (TSCM), which demonstrated superior reconstitution capacity in preclinical models, are the most abundant circulating T-cell population in the early days following haploidentical transplantation combined with pt-Cy and precede the expansion of effector cells. Transferred naive, but not TSCM or conventional memory cells preferentially survive cyclophosphamide, thus suggesting that posttransplant TSCM originate from naive precursors. Moreover, donor naive T cells specific for exogenous and self/tumor antigens persist in the host and contribute to peripheral reconstitution by differentiating into effectors. Similarly, pathogen-specific memory T cells generate detectable recall responses, but only in the presence of the cognate antigen. We thus define the cellular basis of T-cell reconstitution following pt-Cy at the antigen-specific level and propose to explore naive-derived TSCM in the clinical setting to overcome immunodeficiency. These trials were registered at www.clinicaltrials.gov as #NCT02049424 and #NCT02049580.
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Affiliation(s)
- Alessandra Roberto
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Luca Castagna
- Hematology and Bone Marrow Transplant Unit, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Veronica Zanon
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Stefania Bramanti
- Hematology and Bone Marrow Transplant Unit, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Roberto Crocchiolo
- Hematology and Bone Marrow Transplant Unit, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - James E McLaren
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sara Gandolfi
- Hematology and Bone Marrow Transplant Unit, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Paolo Tentorio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Barbara Sarina
- Hematology and Bone Marrow Transplant Unit, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Inna Timofeeva
- Hematology and Bone Marrow Transplant Unit, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Armando Santoro
- Hematology and Bone Marrow Transplant Unit, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Carmelo Carlo-Stella
- Hematology and Bone Marrow Transplant Unit, Humanitas Cancer Center, Rozzano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Cristiana Carniti
- Department of Haematology and Pediatric Onco-Haematology, Istituto Nazionale Tumori, Milan, Italy; and
| | - Paolo Corradini
- Department of Haematology and Pediatric Onco-Haematology, Istituto Nazionale Tumori, Milan, Italy; and
| | - Emma Gostick
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Kristin Ladell
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - David A Price
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Mario Roederer
- ImmunoTechnology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan, Italy
| | - Enrico Lugli
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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46
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Garciaz S, Castagna L, Bouabdallah R, Fürst S, Bramanti S, Coso D, Crocchiolo R, El-Cheikh J, Broussais F, Chabannon C, Santoro A, Blaise D. Familial haploidentical challenging unrelated donor Allo-SCT in advanced non-Hodgkin lymphomas when matched related donor is not available. Bone Marrow Transplant 2015; 50:865-7. [PMID: 25730187 DOI: 10.1038/bmt.2015.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- S Garciaz
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - L Castagna
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - R Bouabdallah
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - S Fürst
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - S Bramanti
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - D Coso
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - R Crocchiolo
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - J El-Cheikh
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - F Broussais
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - C Chabannon
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - A Santoro
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - D Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
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47
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El-Cheikh J, Crocchiolo R, Furst S, Bramanti S, Sarina B, Granata A, Vai A, Lemarie C, Faucher C, Mohty B, Harbi S, Bouabdallah R, Vey N, Santoro A, Chabannon C, Castagna L, Blaise D. Unrelated cord blood compared with haploidentical grafts in patients with hematological malignancies. Cancer 2015; 121:1809-16. [PMID: 25649994 DOI: 10.1002/cncr.29271] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/28/2014] [Accepted: 12/11/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alternative donors, such as unrelated umbilical cord blood (UCB) and related haploidentical (haplo) donors, are more and more frequently searched for and used for patients who are candidates for allogeneic hematopoietic stem cell transplantation but are without a suitable related or unrelated donor. The aim of the current retrospective study was to compare the outcome of patients after haplo and UCB grafts prepared using a nonmyeloablative conditioning regimen. METHODS A total of 150 adult patients with high-risk hematologic diseases who underwent allogeneic hematopoietic stem cell transplantation from alternative donors at 2 centers (Paoli-Calmettes Institute [Marseille, France] and Humanitas Cancer Center [Milan, Italy]) were analyzed. Sixty-nine patients had haplo donors and 81 patients had UCB donors. RESULTS The cumulative incidence of nonrecurrence mortality at 1 year was 23% in the UCB group versus 17% in the haplo group (P = .39). The incidence of grade 2 to 4 acute graft-versus-host disease and extensive chronic graft-versus-host disease in the UCB group versus the haplo group was 52% versus 29% (P = .05) and 12% versus 6% (P<.0001), respectively. The overall survival rate at 2 years was 45% in the UCB group (95% confidence interval [95% CI], 34%-56%) versus 69% in the haplo group (95% CI, 58%-80%) (P = .10). The progression-free survival rate at 2 years was 36% in the UCB group (95% CI, 25%-47%) versus 65% in the haplo group (95% CI, 53%-77%) (P = .01). CONCLUSIONS The results of the current study suggest that for patients with high-risk hematological diseases without a related or unrelated donor, haploidentical transplants are a promising alternative option that deserves further investigation.
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Affiliation(s)
- Jean El-Cheikh
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | | | - Sabine Furst
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | | | | | - Angela Granata
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | | | - Claude Lemarie
- Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France.,Cellular Therapy Center, Paoli-Calmettes Institute, Marseille, France
| | - Catherine Faucher
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Bilal Mohty
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Samia Harbi
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Reda Bouabdallah
- Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Norbert Vey
- Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France.,Aix-Marseille University, Marseille, France.,Cancer Research Center of Marseille, Marseille, France
| | | | - Christian Chabannon
- Cellular Therapy Center, Paoli-Calmettes Institute, Marseille, France.,Aix-Marseille University, Marseille, France.,Cancer Research Center of Marseille, Marseille, France
| | - Luca Castagna
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Humanitas Cancer Center, Milan, Italy
| | - Didier Blaise
- Transplantation and Cellular Therapy Unit (U2T), Paoli-Calmettes Institute, Marseille, France.,Department of Hematology and Medical Oncology, Paoli-Calmettes Institute, Marseille, France.,Aix-Marseille University, Marseille, France.,Cancer Research Center of Marseille, Marseille, France
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48
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Blaise D, Furst S, El Cheikh J, Crocchiolo R, Devillier R, Bramanti S, Granata A, Harbi S, Bouabdallah R, Mohty B, Lemarie C, Chabannon C, Faucher C, Vey N, Castagna L. Comparison of Haploidentical T-Replete HSCT Followed with Post-Transplant High Dose Cyclophosphamide (PT-HDCy) with Matched Related (MRD) or Unrelated (UD) HSCT in Patients in or after the 6TH Decade. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.433] [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: 10/24/2022]
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49
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Castagna L, Crocchiolo R, Giordano L, Bramanti S, Carlo-Stella C, Sarina B, Chiti A, Mauro E, Gandolfi S, Todisco E, Balzarotti M, Anastasia A, Magagnoli M, Brusamolino E, Santoro A. High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant. Bone Marrow Transplant 2015; 50:499-504. [PMID: 25621797 DOI: 10.1038/bmt.2014.304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/27/2014] [Accepted: 10/31/2014] [Indexed: 11/09/2022]
Abstract
Persistence of disease after salvage therapy among relapsed or refractory Hodgkin lymphoma (HL) patients predicts poor outcome. Here, we report on 41 HL patients with active disease after salvage therapy and who received high-dose melphalan (HD-PAM) and auto-SCT as a bridge to a second autologous or an allogeneic transplantation between 2002 and 2013 at our center. Disease response was based on 18-fluoro-deoxyglucose-positron emission tomography results in all patients. Overall response rate after HD-PAM was 78% and it did not differ among PR or stable/progressive disease patients (P=1.00). Response was associated with better OS: hazard ratio=0.32 (95% confidence interval: 0.13-0.77, P=0.01) irrespective of disease status before HD-PAM. Thirty-three patients (80%) were able to complete the planned treatment, intended as tandem autologous or auto-allo transplant. Hematological and extrahematological toxicity of HD-PAM was manageable, without any treatment-related death. In conclusion, HD-PAM is a valuable therapeutic option in relapsed/refractory HL patients with active disease after salvage therapy, with an impressive 78% overall response rate and 80% rate of proceeding to further transplantation. The present data may be integrated with the growing literature on new drugs in the field of relapsed/refractory HL.
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Affiliation(s)
- L Castagna
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - R Crocchiolo
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - L Giordano
- Statistic Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - S Bramanti
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - C Carlo-Stella
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - B Sarina
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Chiti
- Nuclear Medicine Department, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Mauro
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - S Gandolfi
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Todisco
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Balzarotti
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Anastasia
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Magagnoli
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Brusamolino
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Santoro
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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50
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Pical-Izard C, Crocchiolo R, Granjeaud S, Kochbati E, Just-Landi S, Chabannon C, Frassati C, Picard C, Blaise D, Olive D, Fauriat C. Reconstitution of natural killer cells in HLA-matched HSCT after reduced-intensity conditioning: impact on clinical outcome. Biol Blood Marrow Transplant 2015; 21:429-39. [PMID: 25579888 DOI: 10.1016/j.bbmt.2014.11.681] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
Recent advances in the development of reduced-intensity conditioning (RIC) have allowed a broader range of patients to access allogeneic hematopoietic stem cell transplantation (HSCT). Reconstitution of an effective immune system post-transplant, including natural killer (NK) cells, is critical for both tumor control and infectious disease control or prevention. The development and functions of NK cells in such settings remain elusive. Here we analyzed NK cell development in HLA-matched HSCT from related or unrelated donors, after RIC that included antithymocyte globulin (N = 45 patients). Our data reveal that NK cells quickly recover after RIC-HSCT, irrespective of donor type. Rapidly re-emerging NK cells, however, remain immature for more than 6 months. Effector functions resemble that of immature NK cells because they poorly produce IFN-γ and TNF-α in response to target cell stimulation, despite a rapid acquisition of degranulation ability and MIP-1β production. Strikingly, rapid reconstitution of cytokine production correlates with a lower relapse incidence (P = .01) and a better survival rate (P < .0001) at 1 year post-transplant, whereas degranulation capacity was associated with less relapse (P = .05). Our study demonstrates rapid quantitative reconstitution of the NK cell compartment despite administration of potent immune suppressive drugs as part of the conditioning regimen and after transplantation. However, there is a prolonged persistence of functional defects, the correction of which positively correlates with clinical outcome.
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Affiliation(s)
- Caroline Pical-Izard
- Inserm, U1068, Centre Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, CNRS, UMR7258, Aix-Marseille University, Marseille, France
| | - Roberto Crocchiolo
- Bone Marrow Transplantation Unit, Onco-Hematology Department, Institut Paoli-Calmettes, Marseille, France; Istituto Clinico Humanitas, Rozzano, Italy
| | - Samuel Granjeaud
- Inserm, U1068, Centre Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, CNRS, UMR7258, Aix-Marseille University, Marseille, France
| | - Eloise Kochbati
- Inserm, U1068, Centre Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, CNRS, UMR7258, Aix-Marseille University, Marseille, France
| | - Sylvaine Just-Landi
- Inserm, U1068, Centre Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, CNRS, UMR7258, Aix-Marseille University, Marseille, France
| | - Christian Chabannon
- Inserm, U1068, Centre Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, CNRS, UMR7258, Aix-Marseille University, Marseille, France; Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France; Inserm CIC-1049, Centre d'Investigations Cliniques en Biothérapie, Marseille, France
| | - Coralie Frassati
- Histocompatibility Laboratory, UMR 7268 ADÉS, Aix-Marseille Université/EFS/CNRS, Marseille, France
| | - Christophe Picard
- Histocompatibility Laboratory, UMR 7268 ADÉS, Aix-Marseille Université/EFS/CNRS, Marseille, France
| | - Didier Blaise
- Inserm, U1068, Centre Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, CNRS, UMR7258, Aix-Marseille University, Marseille, France; Istituto Clinico Humanitas, Rozzano, Italy
| | - Daniel Olive
- Inserm, U1068, Centre Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, CNRS, UMR7258, Aix-Marseille University, Marseille, France
| | - Cyril Fauriat
- Inserm, U1068, Centre Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, CNRS, UMR7258, Aix-Marseille University, Marseille, France.
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