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Fonseca-Santos M, Bailen R, Lopez-Godino O, Herruzo-Delgado B, Bermudez MA, García-Cadenas I, Huguet-Mas M, Ferra-Coll C, Esquirol A, Cortés-Rodriguez M, Yañez-Sansegundo L, Pascual-Cascon MJ, Heras I, Kwon M, Lopez-Corral L. Characterization of Chronic Graft-versus-host Disease After Haploidentical Stem Cell Transplantation With Posttransplant Cyclophosphamide: A Study on Behalf of GETH-TC. Transplantation 2024:00007890-990000000-00740. [PMID: 38685204 DOI: 10.1097/tp.0000000000005034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Chronic graft-versus-host disease (cGVHD) is a cause of late morbidity and nonrelapse mortality (NRM) after allogenic hematopoietic stem cell transplantation (allo-HSCT). Although studies evaluating haploidentical allo-HSCT (haplo-HSCT) using posttransplant cyclophosphamide (PTCy) demonstrate lower cGVHD rates, comprehensive data describing the clinical profile, risk factors, or outcomes of cGVHD within this platform are scarce. METHODS We conducted a retrospective multicenter analysis of 389 consecutive patients who underwent haplo-HSCT PTCy in 7 transplant centers of the Spanish Group Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH-TC) between 2008 and 2020 describing incidence, clinical profile, risk factors, and cGVHD outcomes. RESULTS Ninety-five patients of 389 developed cGVHD. Our data revealed that the incidence and severity of cGVHD are lower than those reported for HLA-identical transplantation with conventional prophylaxis and that the strongest predictor for cGVHD was previous acute GVHD (P = 0.031). Also, recipient age ≥60 y (P = 0.044) was protective against cGVHD. Moreover, patients with moderate cGVHD had longer event-free survival at 3 y than other patients (P = 0.016) and a lower relapse rate at 3 y (P = 0.036). CONCLUSIONS Our results support the fact that the incidence and severity of cGVHD are lower than those reported for HLA-identical transplantation with conventional prophylaxis. In this series, patients who develop moderate cGVHD after haplo-HSCT PTCy had a higher overall survival and event-free survival, and lower relapse, suggesting higher graft-versus-leukemia effect. Although this is the largest series focused on characterizing cGVHD in haplo-HSCT PTCy, further prospective studies are needed to confirm the findings.
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Affiliation(s)
- Marta Fonseca-Santos
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Rebeca Bailen
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Oriana Lopez-Godino
- Hematology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | | | - Maria Aranzazu Bermudez
- Servicio de Hematologia y Hemoterapia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - María Huguet-Mas
- Hematology Department, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - María Cortés-Rodriguez
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
- Statistical Department, Universidad de Salamanca, Salamanca, Spain
| | - Lucrecia Yañez-Sansegundo
- Servicio de Hematologia y Hemoterapia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Inmaculada Heras
- Hematology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Mi Kwon
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lucía Lopez-Corral
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
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Esquirol A, Cadenas IG, Novelli S, Garrido A, Caballero AC, Oñate G, Lopez J, Redondo S, Argüello M, Saavedra S, Moreno C, Briones J, Sierra J, Martino R. Outcome improvement over time in reduced intensity conditioning hematopoietic transplantation: a 20-year experience. Ann Hematol 2024; 103:321-334. [PMID: 37971549 DOI: 10.1007/s00277-023-05530-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
The current study includes all consecutive patients (N = 484) who received a reduced-intensity conditioning regimen (RIC) allogeneic hematopoietic stem cell transplantation in our center from 1999 to 2020. Conditioning regimens were based on fludarabine with melphalan or busulfan, with low-dose thiotepa and pharmacological GVHD prophylaxis consisted of cyclosporine A (CsA)-methotrexate (MTX)/mofetil (MMF) (n = 271), tacrolimus-sirolimus (n = 145), and post-transplantation cyclophosphamide (PTCy)-tacrolimus (n = 68). The median time of overall follow-up in survivors was 8 years (1-22 years) and was at least 3 years in all three GVHD prophylaxis groups. Thirty-three percent had a high or very high disease risk index, 56% ≥ 4 European bone marrow transplantation risk, and 65% ≥ 3 hematopoietic stem cell transplantation comorbidity index score-age score. Neutrophil and platelet engraftment was longer for PTCy-tacro (p 0.0001). Cumulative incidence of grade III-IV aGVHD was 17% at 200 days, and that of moderate-severe cGvHD was 36% at 8 years. GVHD prophylaxis was the only prognostic factor in the multivariable analyses for the development of aGVHD and moderate-severe cGVHD (p 0.0001). NRM and relapse incidences were 29% and 30% at 8 years, while OS and PFS rates were 43% and 39% at 8 years. At 3 years, OS was highest in the PTCy-tacro group (68%) than in the tacro-siro (61%) and CsA-MTX/MMF (49%) cohorts (p < 0.01). In the three groups, respectively, the 200-day incidence of grade III-IV aGvHD (6% vs. 12% vs. 23%) and 3-year moderate-severe cGVHD (8% vs. 40% vs. 38%) were lower in the PTCy cohort. These better outcomes were confirmed in multivariable analyses. Based on our recent results, the PTCy could be considered as a real GvHD prophylaxis in the RIC setting due to improve best 3-year GvHD and survival outcomes.
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Affiliation(s)
- Albert Esquirol
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain.
| | - Irene Garcia Cadenas
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Ana Garrido
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Ana Carolina Caballero
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Guadalupe Oñate
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Jordi Lopez
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Sara Redondo
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Miguel Argüello
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Silvana Saavedra
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Carolina Moreno
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Mas Casanovas, 90, 08041, Barcelona, Spain
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Rampotas A, Sockel K, Panitsas F, Theuser C, Bornhauser M, Hernani R, Hernandez-Boluda JC, Esquirol A, Avenoso D, Tsirigotis P, Robin M, Czerw T, Helbig G, Roddie C, Lambert J, McLornan DP. Adoptive Immunotherapy via Donor Lymphocyte Infusions following Allogeneic Hematopoietic Stem Cell Transplantation for Myelofibrosis: A Real-World, Retrospective Multicenter Study. Transplant Cell Ther 2023; 29:687.e1-687.e7. [PMID: 37633414 DOI: 10.1016/j.jtct.2023.08.020] [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: 04/06/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) remains the sole curative option for myelofibrosis (MF). Relapse remains a significant problem, however, occurring in up to 20% to 30% of cases. Donor lymphocyte infusion (DLI) represents a potentially effective strategy for relapse prevention and management, but the optimal timing based on measurable residual disease/chimerism analyses and the choice of regimen remain undetermined. We performed a retrospective real-world analysis of a multicenter cohort of MF allo-HCT recipients from 8 European transplantation centers who received DLI between 2005 and 2022. Response was assessed using International Working Group-Myeloproliferative Neoplasms Research and Treatment-defined response criteria, and survival endpoints were estimated using the Kaplan-Meier estimator and log-rank test. The study included 28 patients with a median age of 58 years and a Karnofsky Performance Status of >80. The majority of patients had Dynamic International Prognostic Scoring System-plus intermediate-2 or high-risk disease at the time of allo-HCT. In vivo T cell depletion was used in 20 patients (71.2%), with 19 of the 20 receiving antithymocyte globulin. The indication for DLI was either "preemptive" (n = 15), due to a decrease in recipient chimerism (n = 13) or molecular relapse (n = 2), or "therapeutic" (n = 13) for clinician-defined hematologic/clinical relapse. No patient received DLI prophylactically. The median time of DLI administration was 23.4 months post allo-HCT. Of the 16 patients receiving multiple DLIs, 12 were part of a planned escalating dose regimen. The median follow-up from the time of first DLI was 55.4 months. The responses to DLI were complete response in 9 patients, partial response in 1 patient, and clinical improvement in 6 patients. Chimerism levels improved in 16 patients, and stable disease was reported in 5 patients. No response or progression was reported in 7 patients. DLI-induced acute graft-versus-host disease (aGVHD) was reported in 11 patients (39%), with grade III-IV aGVHD in 7 (25%). The median overall survival from the time of first DLI was 62.6 months, and the cumulative incidence of relapse/progression after first DLI was 30.8% at 6 months. This study highlights that good response rates can be achieved with DLI even after frank relapse in some patients in a cohort in which other treatment options are very limited. More prospective studies are warranted to identify the optimal DLI regimen and timing to improve patient outcomes.
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Affiliation(s)
- Alexandros Rampotas
- Department of Haematology and Cell Therapy, University College London Hospital NHS Foundation Trust, London, United Kingdom.
| | - Katja Sockel
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Germany
| | - Fotios Panitsas
- Department of Haematology, Laikon University Hospital, Athens, Greece
| | - Catrin Theuser
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Germany
| | - Martin Bornhauser
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Germany
| | - Rafael Hernani
- Haematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Albert Esquirol
- Department of Haematology, Hospital de la Santa creu i Sant Pau and Universitat Autonoma de Barcelona, Spain
| | - Daniele Avenoso
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Marie Robin
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, APHP, Université de Paris Cité, Paris, France
| | - Tomasz Czerw
- Department of Haematology and Bone Marrow Transplantation, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - Claire Roddie
- Department of Haematology and Cell Therapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Jonathan Lambert
- Department of Haematology and Cell Therapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Donal P McLornan
- Department of Haematology and Cell Therapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
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Arguello-Tomas M, Albiol N, Jara P, Garcia-Cadenas I, Redondo S, Esquirol A, Novelli S, Saavedra S, Martino R, Nomdedeu J, Sierra J, Mora A, Moreno C. Evolution in the frontline treatment of patients with chronic lymphocytic leukemia: experience from one European center. Leuk Lymphoma 2023; 64:1655-1661. [PMID: 37452739 DOI: 10.1080/10428194.2023.2232489] [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: 03/24/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
Treatment of chronic lymphocytic leukemia (CLL) has dramatically evolved over the last decades thanks to the introduction of targeted therapies. We aimed to describe retrospectively the evolution in the frontline prescription in the CLL patients from our institution. As a secondary objective, the impact of frontline therapy on the time-to-next-treatment (TTNT) and overall survival (OS). After a median of 6.4 years (0.1-36.4) of follow-up from diagnosis, 323 of 780 CLL patients (41.4%) required therapy. Alkylating agents in monotherapy (chlorambucil) were the most used until 2012, and from then, chemoimmunotherapy. Since 2018, targeted therapies were the most common therapeutic strategy (74.1%). Patients who received targeted therapies had significantly longer TTNT compared to other regimens. In the multivariable analyses, mutated IGHV genes targeted therapies and chemoimmunotherapy regimens were related to longer TTNT, and sex female, age younger than 65, and mutated IGHV genes were associated with better OS.
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Affiliation(s)
- Miguel Arguello-Tomas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Nil Albiol
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Hematology Department, Catalan Institute of Oncology (ICO), Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Paola Jara
- Josep Carreras Leukemia Research Institute, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Irene Garcia-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Sara Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Silvana Saavedra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Josep Nomdedeu
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Jordi Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Alba Mora
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - Carol Moreno
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Josep Carreras Leukemia Research Institute, Barcelona
- Medicine department, Universitat Autònoma de Barcelona, Barcelona
- Sant Pau Institute for Biomedical Research, Barcelona, Spain
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Albiol N, Lynton-Pons E, Aso O, Moga E, Vidal S, Gómez-Pérez L, Santiago JA, Triquell M, Roch N, Lázaro E, González I, López-Contreras J, Esquirol A, Sierra J, Martino R, García-Cadenas I. mRNA-1273 SARS-CoV-2 vaccine in recently transplanted allogeneic hematopoietic cell transplant recipients: Dynamics of cellular and humoral immune responses and booster effect. Leuk Res 2023; 132:107347. [PMID: 37356281 PMCID: PMC10284722 DOI: 10.1016/j.leukres.2023.107347] [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: 03/09/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
Allogeneic hematopoietic stem cell transplant (HCT) recipients are at high risk of severe COVID-19 despite vaccination. Little is known about cellular response to SARS-CoV-2 vaccine in this population, especially in recently transplanted patients (RTP). In this single-center study we examined cellular and humoral response to the mRNA-1273 (Spikevax®) vaccine in recently transplanted patients (RTP, n = 49), and compared them to long-term transplanted patients (LTTP, n = 19) and healthy controls (n = 20) at three different timepoints: one and three months after the second dose (T1 and T2, respectively, 28 days apart), and one month after the third dose (T3). Controls did not receive a third dose. RTPs showed lower IgG anti-S1 titers than healthy controls at both T1 (mean 0.50 vs 0.94 arbitrary units -AU-, p < 0.0001) and T2 (0.37 vs 0.79 AU, p < 0.0001). They also presented lower titers than LTTPs at T1 (0.50 vs 0.66, p = 0.01), but no differences at T2 (0.37 vs 0.40 AU, p = 0.55). The rate of positive T-cell responses was lower in RTPs than in controls at both T1 and T2 (61.2 % vs 95 %, p = 0.007; 59.2 % vs 100 %, p = 0.001, respectively), but without statistically significant differences between transplanted groups. At T3 no differences were seen between RTPs and LTTPs as well, neither in IgG antibodies (p = 0.82) nor in cellular responses (p = 0.15), although a third dose increased the rate of positive cellular and humoral responses in approximately 50 % of recently transplanted patients. However, active immunosuppressive treatment severely diminished their chances to produce an adequate response.
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Affiliation(s)
- Nil Albiol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Catalan Institute of Oncology (ICO), Hospital Universitari Doctor Josep Trueta, 17007 Girona, Spain.
| | - Elionor Lynton-Pons
- Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Olga Aso
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Esther Moga
- Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Silvia Vidal
- Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Lucía Gómez-Pérez
- Hematology Department, Hospital del Mar - Parc de Salut Mar, Passeig Marítim de la Barceloneta 25-29, 08003 Barcelona, Spain
| | - Jose Alejandre Santiago
- Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Mercè Triquell
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Nerea Roch
- Division of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Elisabeth Lázaro
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Iria González
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Joaquín López-Contreras
- Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; Division of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Carrer del Mas Casanovas 90, 08041 Barcelona, Spain; Josep Carreras Leukaemia Research Institute, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Institut d'Investigació Biomèdica (IIB) Sant Pau, Carrer de Sant Quintí 77-79, 08041 Barcelona, Spain; Autonomous University of Barcelona, Carrer de Sant Antoni Maria Claret 167, 08025 Barcelona, Spain.
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Fernandez-Sojo J, Valdivia E, Esquirol A, Portos JM, Rovira M, Suarez M, Diaz-de-Heredia C, Uría ML, Ortí G, Ferra C, Mussetti A, Paviglianiti A, Marsal J, Badell I, Lozano M, Gomez D, Azqueta C, Martorell L, Rubio N, Garcia-Buendia A, Villa J, Carreras E, Querol S. Development of an in-house bone marrow collection kit: The Catalan bone marrow transplantation group experience. Vox Sang 2023; 118:783-789. [PMID: 37533171 DOI: 10.1111/vox.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/28/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Bone marrow (BM) harvesting is one of the essential sources of stem cells for haematopoietic stem cell transplantation. In 2019, commercial BM collection kits became unavailable in Europe. Consequently, we created an in-house BM collection kit as an alternative. MATERIALS AND METHODS We compared two groups of BM collections. The first collections were taken using an in-house kit from June 2022 through February 2023 and the second with a commercial kit from February 2021 through May 2022. These all took place at seven collection centres (CC). We analysed the harvest quality (cell blood count, CD34+ cells, viability, potency and sterility), the incidents occurring with each kit and the time to neutrophil and platelet engraftment in recipients. RESULTS A total of 23 donors underwent BM harvesting with the in-house kit and 23 with the commercial one. Both cohorts were comparable regarding donor characteristics, CC and time to procedure. No statistical differences were found in harvest quality between the in-house and commercial kits. A new transfusion set was required in three BM harvests (13%) with the in-house kit because of filter clogging. The median time to neutrophil and platelet engraftment was 21 days for both cohorts and 29 days (in-house) and 33 days (commercial), p = 0.284, respectively. CONCLUSION The in-house BM collection kit offers a real approach to solve the diminished supply of commercial kits. A higher risk of filter clogging was observed compared with commercial kits due to the lack of 850 and 500 μm filters.
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Affiliation(s)
- Jesus Fernandez-Sojo
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
- Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Elena Valdivia
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Albert Esquirol
- Adult Haematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose-Manuel Portos
- Adult Haematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montse Rovira
- BMT Unit, Haematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Maria Suarez
- BMT Unit, Haematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Cristina Diaz-de-Heredia
- Paediatric Oncology and Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Maria-Luz Uría
- Paediatric Oncology and Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Guillermo Ortí
- Adult Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Christelle Ferra
- Adult Haematology Department, Institut Català d'Oncologia-Badalona, Barcelona, Spain
| | - Alberto Mussetti
- Adult Haematology Department, Institut Catala d'Oncologia-Hospitalet, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Annalisa Paviglianiti
- Adult Haematology Department, Institut Catala d'Oncologia-Hospitalet, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Julia Marsal
- Paediatric SCT Unit, Haematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Isabel Badell
- Paediatric Haematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Haemotherapy and Haemostasis ICMHO, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - David Gomez
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Carmen Azqueta
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Lluis Martorell
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Nuria Rubio
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Ana Garcia-Buendia
- Statistical Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Juliana Villa
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Enric Carreras
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Sergio Querol
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
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Regalado-Artamendi I, García-Fasanella M, Medina L, Fernandez-Sojo J, Esquirol A, García-Cadenas I, Martino R, Briones J, Sierra J, Novelli S. Age, CD34+ cell dose, conditioning and pre-transplant cytopenias can help predict transfusion support in lymphoma patients undergoing autologous stem cell transplantation. Vox Sang 2023; 118:681-689. [PMID: 37356813 DOI: 10.1111/vox.13486] [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: 11/29/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Autologous stem cell transplant (ASCT) is a widely used therapy for lymphoma patients and can nowadays be performed on an outpatient basis. This study aimed to describe transfusion support in lymphoma patients undergoing ASCT and identify increased or prolonged transfusion requirement predictors. MATERIALS AND METHODS A retrospective study of all consecutive lymphoma patients undergoing ASCT between 2010 and 2020. RESULTS Out of 226 patients, 145 (64%) received red blood cell (RBC) transfusions, whereas all 226 (100%) required platelet transfusion (PT). Transfusions between Day +1 and +30 were higher in patients over 60 (2 [1-4] vs. 2 [0-2] RBC; p = 0.001 and 4 [2-8] vs. 3 [2-4] PT; p < 0.001); patients with pre-transplant anaemia (4 [2.5-6] vs. 2 [0-2] RBC; p < 0.001 and 5 [3-9] vs. 3 [2-4] PT; p = 0.001); pre-transplant thrombocytopenia (2 [1-4] vs. 2 [0-2] RBC; p < 0.001 and 4 [3-8.5] vs. 2 [1-3] PT; p < 0.001) or CD34+ cell dose <4 × 106 /kg (2 [0-4] vs. 2 [0-2] RBC; p = 0.024 and 4 [2-6] vs. 2 [1-3.5] PT; p < 0.001). RBC transfusion independence was reached later in patients receiving carmustine, cytarabine, etoposide and melphalan (BEAM) (hazard ratio [HR] 1.6; confidence interval [CI] 1.1-2.3) and those requiring RBC before infusion and/or with pre-transplant anaemia (HR 2.2; CI 1.4-3.4). Age above 60 (HR 1.4; CI 1.0-1.9), BEAM conditioning (HR 1.4; CI 1.0-2.0) and pre-transplant thrombocytopenia and/or requiring PT before infusion (HR 1.8; CI 1.4-2.5) entailed longer time until PT independence. CONCLUSION These four factors (age ≥60 years; BEAM conditioning, CD34+ dose <4 × 106 /kg and pre-transplant cytopenia and/or Day -10 to 0 transfusion) allowed dividing patients into three groups with significant differences between them regarding the time until transfusion independence.
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Affiliation(s)
- Isabel Regalado-Artamendi
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Laura Medina
- Banc de Sang i Teixits de Catalunya, Barcelona, Spain
| | | | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
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8
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Bailén R, Alenda R, Herruzo-Delgado B, Acosta-Fleitas C, Vallés A, Esquirol A, Fonseca M, Solán L, Sánchez-Vadillo I, Bautista G, Bento L, López-Godino O, Pérez-Martínez A, Torrent A, Zanabili J, Calbacho M, Moreno MÁ, Pascual-Cascón MJ, Guerra-Domínguez L, Chinea A, García-Cadenas I, López-Corral L, Boix-Giner F, López Lorenzo JL, Humala K, Duarte R, Sampol A, Heras I, Vicario JL, Balas A, Oarbeascoa G, Fernández-Caldas P, Anguita J, Kwon M. Results of haploidentical transplant in patients with donor-specific antibodies: a survey on behalf of the Spanish Group of Hematopoietic Transplant and Cell Therapy. Front Immunol 2023; 14:1165759. [PMID: 37304258 PMCID: PMC10250708 DOI: 10.3389/fimmu.2023.1165759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Background Donor-specific antibodies (DSAs) are IgG allo-antibodies against mismatched donor HLA molecules and can cause graft failure (GF) in the setting of haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Our aim was to report the experience of the Spanish Group of Hematopoietic Transplant (GETH-TC) in DSA-positive patients who had undergone haplo-HSCT. Methods We conducted a survey of patients who underwent haplo-HSCT in GETH-TC centers between 2012 and 2021. Data were collected on the DSA assay used, monitoring strategy, complement fixation, criteria for desensitization, desensitization strategies and transplant outcomes. Results Fifteen centers from the GETH-TC responded to the survey. During the study period, 1,454 patients underwent haplo-HSCT. Seventy of the transplants were performed in 69 DSA-positive patients, all of whom lacked a suitable alternative donor; 61 (88%) patients were female (90% with prior pregnancies). All patients received post-transplant cyclophosphamide-based graft-versus-host disease prophylaxis. Regarding baseline DSA intensity, 46 (67%) patients presented mean fluorescence intensity (MFI) >5,000, including 21 (30%) with MFI >10,000 and three (4%) with MFI >20,000. Six patients did not receive desensitization treatment, four of them with MFI <5,000. Of 63 patients receiving desensitization treatment, 48 (76%) were tested after desensitization therapy, and a reduction in intensity was confirmed in 45 (71%). Three patients (5%) experienced an increase in MFI after desensitization, two of whom experienced primary GF. Cumulative incidence of neutrophil engraftment at day 28 was 74% in a median of 18 days (IQR, 15─20); six patients died before engraftment due to toxicity or infection and eight patients had primary GF despite desensitization in seven of them. After a median follow-up of 30 months, two-year overall and event-free survival were 46.5% and 39%, respectively. The two-year cumulative incidence of relapse was 16% and non-relapse mortality (NRM) was 43%. Infection was the most frequent cause of NRM, followed by endothelial toxicity. Multivariate analysis identified baseline MFI >20,000 as an independent risk factor for survival and an increase in titers after infusion as an independent risk factor for GF. Conclusions Haplo-HSCT is feasible in DSA-positive patients, with high rates of engraftment after desensitization guided by DSA intensity. Baseline MFI >20,000 and increased intensity after infusion are risk factors for survival and GF.
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Affiliation(s)
- Rebeca Bailén
- Department of Hematology and Hemotherapy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Translational Oncology Section, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Raquel Alenda
- Department of Histocompatibility, Centro de Transfusión de la Comunidad de Madrid, Madrid, Spain
| | - Beatriz Herruzo-Delgado
- Department of Hematology and Hemotherapy, Hospital Universitario Regional de Málaga, Málaga, Spain
| | - Cynthia Acosta-Fleitas
- Department of Hematology and Hemotherapy, Hospital Universitario Doctor Negrín, Gran Canaria, Spain
| | - Ana Vallés
- Department of Hematology and Hemotherapy, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Health Research Institute and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Marta Fonseca
- Department of Hematology and Hemotherapy, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Laura Solán
- Department of Hematology and Hemotherapy, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Irene Sánchez-Vadillo
- Department of Hematology and Hemotherapy, Hospital Universitario La Paz, Madrid, Spain
| | - Guiomar Bautista
- Department of Hematology and Hemotherapy, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Leyre Bento
- Department of Hematology and Hemotherapy, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Oriana López-Godino
- Department of Hematology and Hemotherapy, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Ariadna Pérez-Martínez
- Department of Hematology and Hemotherapy, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Anna Torrent
- Department of Hematology and Hemotherapy, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Joud Zanabili
- Department of Hematology and Hemotherapy, Hospital Universitario Central de Asturias, Asturias, Spain
| | - María Calbacho
- Department of Hematology and Hemotherapy, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Miguel Ángel Moreno
- Department of Histocompatibility, Centro de Transfusión de la Comunidad de Madrid, Madrid, Spain
| | | | - Luisa Guerra-Domínguez
- Department of Hematology and Hemotherapy, Hospital Universitario Doctor Negrín, Gran Canaria, Spain
| | - Anabelle Chinea
- Department of Hematology and Hemotherapy, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Health Research Institute and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Lucía López-Corral
- Department of Hematology and Hemotherapy, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Francisco Boix-Giner
- Department of Hematology and Hemotherapy, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
- CIBERONC and Centro de Investigación del Cáncer-Instituto de Biología Molecular y Celular del Cáncer (Universidad de Salamanca - CSIC), Salamanca, Spain
| | - José Luis López Lorenzo
- Department of Hematology and Hemotherapy, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Karem Humala
- Department of Hematology and Hemotherapy, Hospital Universitario La Paz, Madrid, Spain
| | - Rafael Duarte
- Department of Hematology and Hemotherapy, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Antonia Sampol
- Department of Hematology and Hemotherapy, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Inmaculada Heras
- Department of Hematology and Hemotherapy, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - José Luis Vicario
- Department of Histocompatibility, Centro de Transfusión de la Comunidad de Madrid, Madrid, Spain
| | - Antonio Balas
- Department of Histocompatibility, Centro de Transfusión de la Comunidad de Madrid, Madrid, Spain
| | - Gillen Oarbeascoa
- Department of Hematology and Hemotherapy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Translational Oncology Section, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Paula Fernández-Caldas
- Department of Hematology and Hemotherapy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Anguita
- Department of Hematology and Hemotherapy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Translational Oncology Section, Gregorio Marañón Health Research Institute, Madrid, Spain
- Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Mi Kwon
- Department of Hematology and Hemotherapy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Translational Oncology Section, Gregorio Marañón Health Research Institute, Madrid, Spain
- Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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9
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García-Cadenas I, Redondo S, Esquirol A, Portos JM, Novelli S, Saavedra S, Moreno C, Garrido A, Oñate G, López J, Ana-Carolina C, Miqueleiz S, Arguello-Tomas M, Briones J, Sierra J, Martino R. Successful Outcome in Patients with Myelofibrosis Undergoing Allogeneic Donor Hematopoietic Cell Transplantation Using Reduced-Doses of Post-Transplant Cyclophosphamide: challenges and review of the literature. Transplant Cell Ther 2023:S2666-6367(23)01239-3. [PMID: 37086849 DOI: 10.1016/j.jtct.2023.04.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Engraftment and non-relapse mortality (NRM) greatly depend upon the transplant platform in patients with Myelofibrosis (MF). OBJECTIVE We report outcomes of 14 consecutive MF patients who received reduced doses of post-transplant Cyclophosphamide (PTCy) (60 mg/kg total dose) and tacrolimus as graft versus host disease (GVHD) prophylaxis as part of a new standardized allogeneic hematopoietic-cell transplantation (allo-HCT) protocol. STUDY DESIGN Median age at HCT was 59 years (range: 41-67), and median interval from diagnosis to HCT was 19 months (range: 2-114). All cases received ruxolitinib before HCT and 71% had no response. Most patients (78%) had symptomatic splenomegaly at HCT. Eighty-six percent received reduced-intensity conditioning (RIC) and most of them (64%) from an unrelated donor. RESULTS There were not graft failures and neutrophil and platelet recovery occurred at a median of 21 and 31 days. The cumulative incidence of grade II-IV and III-IV acute GVHD was 28.6% and 7%. The 2-year incidence of overall and moderate-severe chronic GVHD was 36% and 14%. Only 1 patient relapsed after transplant, and NRM at 100 days and 2-years was 7% and 14%. GVHD-free/relapse-free and immunosuppression free incidence at 1 year was 41%. With a median follow-up for survivors of 28 months (range:8-55), the 2-year overall survival and progression-free survival are 86% and 69%. CONCLUSION Reduced doses of PTCy as GVHD prophylaxis for high risk MF patients shows promising results by reducing GVHD incidence without cases of graft failure.
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Affiliation(s)
- Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Sara Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain..
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - J M Portos
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Silvana Saavedra
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Carol Moreno
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Ana Garrido
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Guadalupe Oñate
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Jordi López
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Caballero Ana-Carolina
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Sara Miqueleiz
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Miguel Arguello-Tomas
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universidad Autónoma de Barcelona, Spain
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10
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Redondo S, García-Cadenas I, Vila A, Esquirol A, Portos JM, Novelli S, Saavedra S, Moreno C, Garrido A, Arguello-Tomas M, Oñate G, López-Pardo J, Caballero AC, Miqueleiz S, Briones J, Sierra J, Sancho G, Martino R. Sequence matters: Total body irradiation (TBI)-based myeloablative conditioning with post-transplant cyclophosphamide may reduce the early nonrelapse mortality compared with pretransplant cyclophosphamide plus TBI. Eur J Haematol 2023. [PMID: 37058419 DOI: 10.1111/ejh.13978] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES High-dose total body irradiation (TBI) is considered a cornerstone of myeloablative conditioning for allogeneic stem cell transplantation (allo-SCT). We retrospectively compared the main outcomes of an HLA matched or 1-allele mismatched related or unrelated allo-SCT in adult patients affected by acute leukemia (AL) or myelodysplastic syndromes (MDS). METHODS Fifty-nine patients received cyclophosphamide (Cy)-TBI (13.5 Gy) and graft-versus-host disease (GVHD) prophylaxis with a calcineurin-inhibitor plus methrotrexate (CyTBI group) and 28 patients received fludarabine-TBI (8.8-13.5 Gy) and GVHD prophylaxis with PTCy and tacrolimus (FluTBI-PTCy group). RESULTS Median follow-up for survivors was 82 and 22 months. The 12-month probability of overall survival and progression-free survival were similar (p = .18, p = .7). The incidence of Grades 2-4 and 3-4 acute GVHD, and the incidence of moderate-to-severe chronic GVHD were higher in the CyTBI group (p = .02, p < .01and p = .03). Nonrelapse mortality (NRM) at 12 months posttransplant was higher in the CyTBI group (p = 0.05), while the incidence of relapse was similar in both groups (p = 0.7). The number of GVHD-free and relapse-free patients without systemic immunosuppression (GRFS) at 1-year posttransplant was higher in the FluTBI-PTCy group (p = 0.01). CONCLUSIONS The study confirms the safety and efficacy of a novel FluTBI-PTCy platform with reduced incidence of severe acute and chronic GVHD, and early improvement of NRM.
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Affiliation(s)
- Sara Redondo
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonio Vila
- Radiotherapy Oncology Department, Hospital de la Sant Creu i Sant Pau, Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J M Portos
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Silvana Saavedra
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Carol Moreno
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ana Garrido
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Miguel Arguello-Tomas
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Guadalupe Oñate
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jordi López-Pardo
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ana-Carolina Caballero
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Sara Miqueleiz
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Gemma Sancho
- Radiotherapy Oncology Department, Hospital de la Sant Creu i Sant Pau, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Sant Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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11
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Redondo S, De Dios A, Gomis-Pastor M, Esquirol A, Aso O, Triquell M, Moreno ME, Riba M, Ruiz J, Blasco A, Tobajas E, González I, Sierra J, Martino R, García-Cadenas I. Feasibility of a new model of care for allogeneic stem cell transplantation recipients facilitated by eHealth: The MY-Medula pilot study. Transplant Cell Ther 2023:S2666-6367(23)01175-2. [PMID: 36948273 DOI: 10.1016/j.jtct.2023.03.016] [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: 02/03/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The use of allogeneic stem cell transplantation (allo-SCT) for the treatment of hematologic diseases is steadily increasing. However, allo-SCT has the downside of causing considerable treatment-related morbidity and mortality. Mobile technology applied to healthcare (mHealth) has proven to be a cost-effective strategy to improve care and offer new services to people with multimorbidity, but there are few data on its usefulness in allo-SCT recipients. OBJECTIVE The aim of this report was to describe a new integrated healthcare model facilitated by an mHealth platform, named EMMASalud-MY-Medula, and to report the results of a le. STUDY DESIGN The MY-Medula platform development approach consisted of 4 phases. Firstly, patient and healthcare professional needs were identified and technological development and pre-testing tests were conducted (phases 1-3, January 2016-March 2021). Then, a non-randomized, prospective, observational, single-center pilot study was conducted (October 2021-January 2022) at the adult Stem Cell Transplant Unit of a tertiary university hospital. RESULTS Twenty-eight volunteer allo-SCT recipients were included in the pilot study. Fifty percent were outpatients in the first-year post-SCT and the remaining 50% were affected by steroid-dependent graft-versus-host disease (SR-GVHD). All patients used MY-Medula application during the two-month follow-up period with a median number of visits to the application of 143 (range 6-477). A total of 2067 self-monitoring records were made, and 205 text messages were received, most of them related to symptoms description (47%) and doubts about medication (21%). In 3.4% of the cases drug dose adjustments were performed by the pharmacist because of dosing errors or interactions. At the end of the study, a 6-question Likert-type questionnaire for patients and a 22-question test for healthcare professionals showed a high degree of satisfaction (95% and 100% respectively) with the new healthcare pathway. CONCLUSIONS Re-engineering allo-SCT recipients follow-up into an integrated, multidisciplinary model of care facilitated by mHealth tools is feasible and has been associated with a high usability and degree of satisfaction by patients and healthcare professionals. A randomized trial aiming to determine the cost-effectiveness of MY-Medula-based follow-up post-SCT is currently enrolling participants.
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Affiliation(s)
- S Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain.
| | - A De Dios
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau.; Digital Health Department, Hospital de la Santa Creu i Sant Pau
| | - M Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau.; Digital Health Department, Hospital de la Santa Creu i Sant Pau
| | - A Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - O Aso
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - M Triquell
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - M E Moreno
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau
| | - M Riba
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau
| | - J Ruiz
- Nutrition and Dietetics Department, Hospital de la Santa Creu i Sant Pau
| | - A Blasco
- Nutrition and Dietetics Department, Hospital de la Santa Creu i Sant Pau
| | - E Tobajas
- Psycho-Oncology Department, Hospital de la Santa Creu i Sant Pau
| | - I González
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau
| | - J Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - R Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
| | - I García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Departamento de Medicina, Universitat Autónoma de Barcelona, Spain
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12
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Albiol N, Aso O, Gómez-Pérez L, Triquell M, Roch N, Lázaro E, Esquirol A, González I, López-Contreras J, Sierra J, Martino R, García-Cadenas I. Correction to: mRNA-1273 SARS-CoV-2 vaccine safety and COVID-19 risk perception in recently transplanted allogeneic hematopoietic stem cell transplant recipients. Support Care Cancer 2022; 30:9691. [DOI: 10.1007/s00520-022-07452-1] [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: 11/21/2022]
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13
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Albiol N, Barata A, Aso O, Gómez-Pérez L, Triquell M, Roch N, Lázaro E, Esquirol A, González I, López-Contreras J, Sierra J, Martino R, García-Cadenas I. mRNA-1273 SARS-CoV-2 vaccine safety and COVID-19 risk perception in recently transplanted allogeneic hematopoietic stem cell transplant recipients. Support Care Cancer 2022; 30:9687-9690. [PMID: 36169731 PMCID: PMC9517991 DOI: 10.1007/s00520-022-07376-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2022]
Abstract
Purpose This study aims to describe the incidence and severity of adverse events (AEs) following the mRNA-1273 SARS-CoV-2 vaccine and explore the risk perception of COVID-19 in allogeneic hematopoietic stem cell transplant (HCT) recipients. Methods We performed a single-center prospective study including recently transplanted (< 2 years post-infusion) allogeneic HCT recipients. AEs were assessed through phone calls and graded from 0 to 4, while COVID-19 risk perception was measured using the Brief Illness Perception Questionnaire (BIP-Q5). Results Fifty-four HCT recipients were evaluated. Incidence and grades of AE (94.4% and 85.2% after the first and second dose, respectively) were similar to those described in the general population. The most common AE was pain at the site of injection. Three patients (5.6%) developed a grade ≥ 3 AE. Vaccine-related cytopenias and graft-versus-host disease flares were not observed. Female sex (OR 3.94, 95% CI 1.14–13.58, p = 0.03) and time since HCT (per month since HCT: OR 1.09, 95% CI 1.01–1.18, p = 0.04) were associated with the occurrence of any AE. The patients’ risk perception level of COVID-19 decreased over time (p < 0.05). Conclusion Our study confirms that the mRNA-1273 SARS-CoV-2 vaccine is safe in recent HCT recipients and suggests that the perceived risk of COVID-19 decreases over time.
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Affiliation(s)
- Nil Albiol
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain. .,Autonomous University of Barcelona, Barcelona, Spain. .,Josep Carreras Leukaemia Research Institute, Barcelona, Spain.
| | - Anna Barata
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Olga Aso
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Lucía Gómez-Pérez
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Mercè Triquell
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Nerea Roch
- Infectious Diseases Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Elisabeth Lázaro
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Iria González
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Joaquín López-Contreras
- Autonomous University of Barcelona, Barcelona, Spain.,Infectious Diseases Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB) Sant Pau, Barcelona, Spain. .,Autonomous University of Barcelona, Barcelona, Spain. .,Josep Carreras Leukaemia Research Institute, Barcelona, Spain.
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14
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Redondo S, Esquirol A, Novelli S, Caballero AC, Garrido A, Oñate G, López J, Moreno C, Saavedra SD, Granell M, Briones J, Sierra J, Martino R, García-Cadenas I. Efficacy and Safety of Ruxolitinib in Steroid-Refractory/Dependent Chronic Graft-versus-Host Disease: Real-World Data and Challenges. Transplant Cell Ther 2022; 28:43.e1-43.e5. [PMID: 34757054 DOI: 10.1016/j.jtct.2021.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/24/2021] [Accepted: 10/24/2021] [Indexed: 01/31/2023]
Abstract
Steroid-refractory (SR) chronic graft-versus-host disease (cGVHD) is a major obstacle in recipients of allogeneic stem cell transplantation (HCT). Ruxolitinib is the first agent to demonstrate superior efficacy to the best available therapy, but real-life data are still lacking. Here we describe the results of ruxolitinib compassionate use for the treatment of SR/steroid-dependent cGVHD in a tertiary care university hospital. In this retrospective single-center study, we evaluated the outcomes of 48 patients diagnosed with SR-cGVHD who were treated with ruxolitinib. Forty-seven (98%) had moderate-severe disease, and 27 (56%) had received ≥2 lines of prior therapy (excluding steroids). Results were analyzed using SPSS version 26.0.01 and R version 3.4.3. The overall response rate was 77% (37 of 48), with 15% (7 of 37) in complete remission. The median time to response was 2 months (range, 0.5 to 8 months). Steroid tapering was achieved in 26 patients (54%) and definitive discontinuation was achieved in 10 patients (21%) after a median of 20 months (range, 1.5 to 60 months). Toxicity was predominantly hematologic, including a 33% rate of anemia and a 17% rate of thrombocytopenia. Overall survival at 2 years was significantly higher in responders compared with nonresponders (88% [95% confidence interval (CI), 65% to 96%] versus 49% [95% CI, 12% to 78%]; P = .01). At last follow-up, tapering of ruxolitinib had been started in 8 of 37 responders (22%). Our experience supports the efficacy of ruxolitinib in the treatment of SR-cGVHD, along with its steroid-sparing effect and manageable toxicity. Gradual tapering of ruxolitinib seems feasible without cases of GVHD flare. More studies and longer follow-up are needed to confirm these data, as well as to identify the ideal dose adjustments in cases of toxicity.
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Affiliation(s)
- Sara Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ana Carolina Caballero
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ana Garrido
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Guadalupe Oñate
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jordi López
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Carol Moreno
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Silvanna-Daniela Saavedra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Miquel Granell
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and José Carreras Leukemia Research Institutes, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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15
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Esquirol A, Pascual MJ, Kwon M, Pérez A, Parody R, Ferra C, Garcia Cadenas I, Herruzo B, Dorado N, Hernani R, Sanchez-Ortega I, Torrent A, Sierra J, Martino R. Severe infections and infection-related mortality in a large series of haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant 2021; 56:2432-2444. [PMID: 34059802 PMCID: PMC8165955 DOI: 10.1038/s41409-021-01328-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/10/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
Severe infections and their attributable mortality are major complications in recipients of allogeneic hematopoietic stem cell transplantation (alloSCT). We herein report 236 adult patients who received haploSCT with PTCy. The median follow-up for survivors was 37 months. The overall incidence of bloodstream infections by gram-positive and gram-negative bacteria at 37 months was 51% and 46%, respectively. The incidence of cytomegalovirus infection was 69%, while Epstein Barr virus infections occurred in 10% of patients and hemorrhagic cystitis in 35% of cases. Invasive fungal infections occurred in 11% at 17 months. The 3-year incidence of infection-related mortality was 19%. The median interval from transplant to IRM was 3 months (range 1–30), 53% of IRM occurred >100 days post-haploSCT. Risk factors for IRM included age >50 years, lymphoid malignancy, and developing grade III-IV acute GvHD. Bacterial infections were the most common causes of IRM (51%), mainly due to gram-negative bacilli BSI. In conclusion, severe infections are the most common causes of NRM after haploSCT with PTCy, with a reemergence of gram-negative bacilli as the most lethal pathogens. More studies focusing on the severe infections after haploSCT with PTCy and differences with other types of alloSCT in adults are clearly warranted.
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Affiliation(s)
- Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain.
| | | | - Mi Kwon
- Hematology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Rocio Parody
- Hematology Department, Hospital de Bellvitge, Barcelona, Spain
| | - Christelle Ferra
- Hematology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Irene Garcia Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Beatriz Herruzo
- Hematology Department, Hospital Regional Universitario, Malaga, Spain
| | - Nieves Dorado
- Hematology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Rafael Hernani
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | | | - Anna Torrent
- Hematology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
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16
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Bueno F, Solano C, Vázquez L, Giménez E, de la Cámara R, Albert E, Rovira M, Espigado I, Martín Calvo C, López-Jiménez J, Suárez-Lledó M, Chinea A, Esquirol A, Pérez A, Bermúdez A, Saldaña R, Heras I, González-Huerta AJ, Torrado T, Batlle M, Jiménez S, Vallejo C, Barba P, Cuesta MÁ, Duarte R, Piñana JL, Navarro D. Assessment of the association between cytomegalovirus DNAemia and subsequent acute graft-versus-host disease in allogeneic peripheral blood stem cell transplantation: A multicenter study from the Spanish hematopoietic transplantation and cell therapy group. Transpl Infect Dis 2021; 23:e13627. [PMID: 33908148 DOI: 10.1111/tid.13627] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 12/01/2022]
Abstract
The potential role of active CMV infection in promoting acute Graft-versus-Host Disease (aGvHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a matter of debate. We further addressed this issue conducting a retrospective, observational, multicenter study of 632 patients subjected to allogeneic peripheral blood HSCT at 20 Spanish centers. Monitoring of CMV DNA load in plasma or whole blood was performed by real-time PCR assays. Cumulative incidence of CMV DNAemia was 48.9% (95% CI, 45%-52.9%), of any grade aGvHD, 45.6; 95% (CI, 41.3%-50.1%), and of grade II-IV aGvHD, 30.7 (95% CI, 24.9%-36.4%). Overall, development of CMV DNAemia at any level resulted in an increased risk of subsequent all grade (HR, 1.38; 95% CI, 1.08 - 1.76; P = .009) or grade II-IV (HR, 1.58; 95% CI, 1.22 - 2.06; P = .001) aGvHD. The increased risk of aGvHD linked to prior occurrence of CMV DNAemia was similar to the above when only clinically significant episodes were considered for the analyses (HR for all grade aGvHD, 1.48; 95% CI, 1.13 - 1.91; P = .041, and HR for grade II-IV aGvHD, 1.53; 95% CI. 1.13-1.81; P = .04). The CMV DNA doubling time in blood was comparable overall in episodes of CMV DNAemia whether followed by aGvHD or not. Whether CMV replication is a surrogate risk marker of aGvHD or it is causally involved is an important question to be addressed in future experimental research.
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Affiliation(s)
- Felipe Bueno
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Lourdes Vázquez
- Hematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Estela Giménez
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | | | - Eliseo Albert
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Montserrat Rovira
- Hematology Department, Hospital Clinic Institute of Hematology & Oncology, Barcelona, Spain
| | | | | | | | - María Suárez-Lledó
- Hematology Department, Hospital Clinic Institute of Hematology & Oncology, Barcelona, Spain
| | - Anabella Chinea
- Hematology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Albert Esquirol
- Hematology Department, Hospital Sant Creu i Sant Pau, Barcelona, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Aránzazu Bermúdez
- Department of Hematology, Hospital Marques de Valdecilla, Santander, Spain
| | - Raquel Saldaña
- Hematology Department, Hospital Universitario de Jerez, Spain
| | - Inmaculada Heras
- Hematology Department, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, IMIB, Universidad de Murcia, Spain
| | - Ana Julia González-Huerta
- Hematology-Stem cell Transplantation Unit, Hospital Universitario Central de Asturias, Oviedo IISPA. IUOPA, Oviedo, Spain
| | - Tamara Torrado
- Hematology Department, Complejo Hospitalario Universitario, Vigo, Spain
| | - Montserrat Batlle
- Hematology Department, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Santiago Jiménez
- Hematology Department, Hospital Universitario Doctor Negrín de Gran Canaria, Las Palmas, Spain
| | - Carlos Vallejo
- Hematology Department, Hospital Universitario Donostia-Aránzazu, San Sebastián, Spain
| | - Pere Barba
- Hematology Department Hospital, Universitario Vall de Hebrón, Barcelona, Spain
| | | | - Rafael Duarte
- Hematology Department, Hospital Puerta de Hierro, Madrid, Spain
| | - José Luis Piñana
- Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain.,Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain.,Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
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17
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González Vicent M, Díaz de Heredia C, González de Pablo J, Molina B, Regueiro A, Pérez Martinez A, Palomo P, López Corral L, García E, Fernández JM, Pérez A, Jiménez MJ, Guerreiro M, Vallejo C, Gallardo AI, López O, Benito A, Marsal J, Duarte M, Bento L, Badell I, Pedraza A, Jiménez Ubieto A, González P, Gómez Centurión I, Costilla L, Beléndez C, Esquirol A, Espigado I, Lavilla E, Díaz MÁ. Defibrotide in hematopoietic stem cell transplantation: A multicenter survey study of the Spanish Hematopoietic Stem Cell Transplantation Group (GETH). Eur J Haematol 2021; 106:842-850. [PMID: 33713387 DOI: 10.1111/ejh.13618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Defibrotide is approved in European Union for the treatment of severe sinusoidal obstruction syndrome (SOS) after HSCT. However, it has also been used for SOS prophylaxis, moderate SOS and in other complications such as transplant-associated thrombotic microangiopathy (TAM). The objective of this study was to evaluate current uses, effectiveness and safety of defibrotide in patients with HSCT. METHODS This multicenter, retrospective study included patients treated with defibrotide for any indication at 28 HSCT centers of the Grupo Español de Trasplante Hematopoyetico (GETH) including the pediatric subgroup Grupo Español de Trasplante de Medula en Niños (GETMON). RESULTS Three hundred and eighty eight patients treated with defibrotide between January 2011 and December 2018 were included. 253 patients were children, and 135 patients were adults. In total, 332 transplants were allogeneic, and the remainder were autologous. Main indications for defibrotide use were severe/very severe SOS in 173 patients, SOS prophylaxis in 135 patients, moderate SOS in 41 patients, TAM in six patients and suspected SOS in 33 patients. Overall survival (OS) at day +100 in the SOS prophylaxis group was 89% (95% CI, 87%-91%). In the group of patients with moderate and severe/very severe SOS, the OS at day +100 was 80% (95% CI, 74%-86%) and 62% (95% CI, 59%-65%), respectively (P = .0015). With a longer follow-up, median of 2 years (4 months-7 years), OS was 63% (95% CI, 59%-67%) in the SOS prophylaxis patients. OS for patients with moderate and severe/very severe SOS groups was 53% (95% CI, 47%-61%) and 26% (95% CI, 22%-30%), respectively (P = .006). 191 patients died, and SOS was the main cause of death in 23 patients (12%). CONCLUSIONS Defibrotide has an acceptable safety profile with an improved response in severe/very severe SOS compared with historical controls, mainly in pediatric patients. Use of defibrotide for prophylaxis may improve prognosis of patients at high risk of complications due to endothelial damage such as those who receive a second transplant. SOS has an important impact on the HSCT long-term survival, as can be concluded from our study.
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Affiliation(s)
| | | | | | | | | | | | - Pilar Palomo
- BMT Unit, Hospital Central de Asturias, Oviedo, Spain
| | | | | | | | | | | | | | - Carlos Vallejo
- BMT Unit, Hospital Universitario de Donosti, San Sebastián, Spain
| | | | - Oriana López
- BMT Unit, Hospital Morales Meseguer, Murcia, Spain
| | - Ana Benito
- BMT Unit, Hospital Regional de Málaga, Málaga, Spain
| | - Julia Marsal
- BMT Unit, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Mónica Duarte
- BMT Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | - Leyre Bento
- BMT Unit, Hospital Son Espases, Mallorca, Spain
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18
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Esquirol A, Pascual MJ, Garcia-Cadenas I, Herruzo B, Ferrà C, Pérez A, Torio A, Torrent A, Cuesta M, Martino R, Sierra J. Combining Three Different Pretransplantation Scores Improves Predictive Value in Patients after Haploidentical Stem Cell Transplantation with Thiotepa, Busulfan, and Fludarabine Conditioning and Post-Transplantation Cyclophosphamide. Transplant Cell Ther 2021; 27:614.e1-614.e8. [PMID: 33775908 DOI: 10.1016/j.jtct.2021.03.021] [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: 12/09/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
One hundred and sixty-one patients underwent haploidentical stem cell transplantation (haploSCT) with thiotepa, busulfan, and fludarabine conditioning followed by post-transplantation cyclophosphamide (PTCy) (on days +3 and +4) and tacrolimus as graft-versus-host disease prophylaxis. Forty-two percent of patients had a high or very high revised Disease Risk Index (rDRI), 55% had an European Society for Blood and Marrow Transplantation risk score (EBMT-RS) ≥4, and 36% had an age-adjusted Hematopoietic Cell Transplant Comorbidity Index (HCT-CI-age) score ≥3. Each of these was considered an unfavorable score. Using the pretransplantation unfavorable scores that had an independent impact on each transplantation outcome studied in multivariate analysis allowed for better stratification of patient outcomes. Thus, the 3-year overall survival (OS) in patients with 0, 1, 2, and 3 unfavorable scores was 86%, 56%, 36%, and 24%, respectively. Nonrelapse mortality (NRM) was negatively impacted by the EBMT-RS and the HCT-CI-age score (3-year NRM in patients with 0, 1, and 2 unfavorable scores was 12%, 33%, and 43%, respectively), whereas the EBMT-RS and the rDRI had an impact on the 3-year relapse incidence (8%, 18%, and 41% in patients with 0, 1, and 2 unfavorable scores, respectively). In conclusion, our study shows that combining 2 or 3 of these well-defined pretransplantation scores improves the ability to predict transplantation outcomes in the setting of haploSCT with PTCy.
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Affiliation(s)
- Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain.
| | | | - Irene Garcia-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Beatriz Herruzo
- Hematology Department, Hospital Regional Universitario, Malaga, Spain
| | - Christelle Ferrà
- Hematology Department, Institut Català d'Oncologia Hospital Germans Trias i Pujol, Badalona, Spain and Universitat de Vic-Universitat Central de Catalunya, Catalonia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Alberto Torio
- Immunology Department, Hospital Regional Universitario, Malaga, Spain
| | - Anna Torrent
- Hematology Department, Institut Català d'Oncologia Hospital Germans Trias i Pujol, Badalona, Spain and Universitat de Vic-Universitat Central de Catalunya, Catalonia, Spain
| | - Marian Cuesta
- Hematology Department, Hospital Regional Universitario, Malaga, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autonoma of Barcelona, Barcelona, Spain
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19
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Novelli S, Bento L, Garcia I, Prieto L, López L, Gutierrez G, Hernani R, Pérez A, Esquirol A, Solano C, Bastos M, Dorado N, Rodríguez N, Rodríguez G, Piñana JL, Montoro J, Herrera P, Luna A, Parody R, Martín C, García E, López O, Heras I, Zanabili J, Moraleda JM, Yañez L, Gutierrez A, Zudaire T, Córdoba R, Varela R, Ferra C, Martínez J, Martínez C, Gonzalez-Barca E, Martino R, Caballero D. Allogeneic Stem Cell Transplantation in Mature T Cell and Natural Killer/T Neoplasias: A Registry Study from Spanish GETH/GELTAMO Centers. Transplant Cell Ther 2021; 27:493.e1-493.e8. [PMID: 33857447 DOI: 10.1016/j.jtct.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Despite advances in understanding the biology of mature T and natural killer (NK)/T cell neoplasia, current therapies, even the most innovative ones, are still far from ensuring its cure. The only treatment to date that has been shown to control aggressive T cell neoplasms in the long term is allogeneic stem cell transplantation (alloSCT). We aim to report the results of alloSCT for advanced mature T and NK/T neoplasias performed in centers from our national GELTAMO/GETH (Grupo Español de Linfoma y Trasplante de Médula Ósea/Grupo Español de Trasplante Hematopoyético y Terapia Celular) over the past 25 years. As a secondary objective, we analyzed the results of alloSCT from haploidentical donors. We performed a retrospective analysis of all patients who received an alloSCT in Spanish centers (n = 201) from September 1995 to August 2018. The 2-year overall survival (OS) and disease-free survival (DFS) were 65.5% and 58.2%, respectively. The univariate for OS and DFS showed statistically different hazard ratios for conditioning intensity, response pre-alloSCT, comorbidity index, donor/receptor cytomegalovirus status and Eastern Cooperative Oncology Group (ECOG) pre-alloSCT, but only a better ECOG pre-alloSCT remained significant in the multivariate analysis. There was an increased incidence of relapse in those patients who did not develop chronic graft-versus-host disease (GVHD) and an increased risk of death in those developing moderate to severe acute GVHD. The 1-year nonrelapse mortality was 21.9% and was mainly due to GVHD (30%) and bacterial infections (17%). When comparing unrelated donors with haploidentical donors, we found similar results in terms of OS and DFS. There was, however, a reduction of acute GVHD in the haploidentical group (P = .04) and trend to a reduction of chronic GVHD. In conclusion, alloSCT is the only curative option for most aggressive T cell neoplasias. Haploidentical donors offer similar results to related donors in terms of survival with a reduction of acute GVHD.
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Affiliation(s)
- Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain.
| | - Leyre Bento
- Hematology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Irene Garcia
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain
| | - Laura Prieto
- Hematology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Lucía López
- Hematology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Rafael Hernani
- Hematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain
| | - Carlos Solano
- Hematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | - Mariana Bastos
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nieves Dorado
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nancy Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Guillermo Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Jose L Piñana
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Herrera
- Hematology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alejandro Luna
- Hematology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rocío Parody
- Hematology Department, Institut Catala d'Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | - Carmen Martín
- Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Estefanía García
- Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Oriana López
- Hematology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Inmaculada Heras
- Hematology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Joud Zanabili
- Hematology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jose M Moraleda
- Hematology Department, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Lucrecia Yañez
- Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Antonio Gutierrez
- Hematology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Teresa Zudaire
- Hematology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Raúl Córdoba
- Hematology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Rosario Varela
- Hematology Department, Hospital Universitario de A Coruña, A Coruña, Spain
| | - Christelle Ferra
- Hematology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Joaquin Martínez
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Martínez
- Hematology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Eva Gonzalez-Barca
- Hematology Department, Institut Catala d'Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain
| | - Dolores Caballero
- Hematology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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20
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Cid J, Monsalvo S, Castillo C, Pascual C, Moreno-Jiménez G, López-Parra M, Andón C, Guerra L, Esquirol A, Sánchez-Ortega I, Ortega S, Zalba S, Martínez C, Rovira M, Marín P, Lozano M. Addition of plerixafor to G-CSF in poor mobilizing healthy related donors overcame mobilization failure: An observational case series on behalf of the Grupo Español de Trasplante Hematopoyético (GETH). Transfus Apher Sci 2021; 60:103052. [PMID: 33483284 DOI: 10.1016/j.transci.2021.103052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/07/2020] [Accepted: 01/06/2021] [Indexed: 12/23/2022]
Abstract
Plerixafor (Mozobil, Sanofi) is approved for using in patients with lymphoma and multiple myeloma when steady-state mobilization strategies fail. Although off-label use of plerixafor in healthy related donors (HRD) is known, limited data are available and no recommendations exist to guide its use in this setting. With the aim of collecting data from HRDs who received plerixafor in our country, we designed an observational case series study within the Spanish Group of Hematopoietic Transplant and Cell Therapy (GETH). Plerixafor was administered subcutaneously to 30 HRDs at a median dose of 0.24 mg/Kg (interquartile range (IQR): 0.23-0.25) because mobilization failure after using mobilization with G-CSF (mobilization failure was defined as collection of <4.0 × 106 CD34+ cells/Kg recipient). All HRDs received G-CSF at a median dose of 11 μg/Kg/day (IQR: 10-12) for 4-5 days. Leukocytapheresis after G-CSF mobilization was performed in 23 (77 %) HRDs collecting a median of 1.6 × 106 CD34+ cells/Kg recipient weight (IQR: 0.9-2.5). Addition of plerixafor allowed the collection of a higher median number of CD34 cells (4.98 × 106 CD34+ cells/Kg recipient weight (IQR: 3.5-5.8)) when compared with the collection of CD34+ cells with G-CSF alone (p < 0.01). The final median total number of CD34+ cells collected was 6.1 × 106/Kg recipient weight (IQR: 4.8-7.3). Mild adverse events related with plerixafor administration were reported in 8 (27 %) donors. In conclusion, addition of plerixafor after G-CSF mobilization failure in HRDs allowed collecting higher number of CD34+ cells in comparison with steady-state mobilization.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain.
| | | | - Carlos Castillo
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain
| | | | | | | | | | - Luisa Guerra
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | - Saioa Zalba
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Carmen Martínez
- BMT Unit, Department of Hematology, ICMHO, Hospital Clínic, IDIBAPS, UB, Josep Carreras Leukemia Research Foundation, Barcelona, Spain
| | - Montserrat Rovira
- BMT Unit, Department of Hematology, ICMHO, Hospital Clínic, IDIBAPS, UB, Josep Carreras Leukemia Research Foundation, Barcelona, Spain
| | - Pedro Marín
- BMT Unit, Department of Hematology, ICMHO, Hospital Clínic, IDIBAPS, UB, Josep Carreras Leukemia Research Foundation, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain
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21
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Solano C, Vázquez L, Giménez E, de la Cámara R, Albert E, Rovira M, Espigado I, Calvo CM, López-Jiménez J, Suárez-Lledó M, Chinea A, Esquirol A, Pérez A, Bermúdez A, Saldaña R, Heras I, González-Huerta AJ, Torrado T, Bautista G, Batlle M, Jiménez S, Vallejo C, Barba P, Cuesta MÁ, Piñana JL, Navarro D. Cytomegalovirus DNAemia and risk of mortality in allogeneic hematopoietic stem cell transplantation: Analysis from the Spanish Hematopoietic Transplantation and Cell Therapy Group. Am J Transplant 2021; 21:258-271. [PMID: 32812351 DOI: 10.1111/ajt.16147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/07/2020] [Accepted: 06/11/2020] [Indexed: 01/25/2023]
Abstract
The net impact of cytomegalovirus (CMV) DNAemia on overall mortality (OM) and nonrelapse mortality (NRM) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a matter of debate. This was a retrospective, multicenter, noninterventional study finally including 749 patients. CMV DNA monitoring was conducted by real-time polymerase chain reaction (PCR) assays. Clinical outcomes of interest were OM and NRM through day 365 after allo-HSCT. The cumulative incidence of CMV DNAemia in this cohort was 52.6%. A total of 306 out of 382 patients with CMV DNAemia received preemptive antiviral therapy (PET). PET use for CMV DNAemia, but not the occurrence of CMV DNAemia, taken as a qualitative variable, was associated with increased OM and NRM in univariate but not in adjusted models. A subcohort analysis including patients monitored by the COBAS Ampliprep/COBAS Taqman CMV Test showed that OM and NRM were comparable in patients in whom either low or high plasma CMV DNA threshold (<500 vs ≥500 IU/mL) was used for PET initiation. In conclusion, CMV DNAemia was not associated with increased OM and NRM in allo-HSCT recipients. The potential impact of PET use on mortality was not proven but merits further research.
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Affiliation(s)
- Carlos Solano
- Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Lourdes Vázquez
- Hematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Estela Giménez
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | | | - Eliseo Albert
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Montserrat Rovira
- Hematology Department, Hospital Clinic Institute of Hematology & Oncology, Barcelona, Spain
| | | | - Carmen M Calvo
- Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - María Suárez-Lledó
- Hematology Department, Hospital Clinic Institute of Hematology & Oncology, Barcelona, Spain
| | - Anabella Chinea
- Hematology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Albert Esquirol
- Hematology Department, Hospital Sant Creu i Sant Pau, Barcelona, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Aránzazu Bermúdez
- Department of Hematology, Hospital Marques de Valdecilla, Santander, Spain
| | - Raquel Saldaña
- Hematology Department, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
| | - Inmaculada Heras
- Hematology Department, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, IMIB, Universidad de Murcia, Murcia, Spain
| | - Ana J González-Huerta
- Hematology-Stem cell Transplantation Unit, Hospital Universitario Central de Asturias, Oviedo IISPA. IUOPA, Oviedo, Spain
| | - Tamara Torrado
- Hematology Department, Complejo Hospitalario Universitario, Vigo, Spain
| | - Guiomar Bautista
- Hematology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Montserrat Batlle
- Hematology Department, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Santiago Jiménez
- Hematology Department, Hospital Universitario Doctor Negrín de Gran Canaria, Las Palmas, Spain
| | - Carlos Vallejo
- Hematology Department Hospital Universitario Donostia-Aránzazu, San Sebastián, Spain
| | - Pere Barba
- Hematology Department Hospital, Universitario Vall de Hebrón, Barcelona, Spain
| | - María Á Cuesta
- Hematology Department, Hospital Regional Universitario, Málaga, Spain
| | - José L Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain.,Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
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22
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Fox ML, García-Cadenas I, Pérez AM, Villacampa G, Piñana JL, Ortí G, Montoro J, Roldán E, Bosch Vilaseca A, Martino R, Salamero O, Saavedra S, Hernandez-Boluda JC, Esquirol A, Sierra J, Sanz J, Solano C, Bosch F, Barba P, Valcarcel D. Feasibility of thiotepa addition to the fludarabine-busulfan conditioning with tacrolimus/sirolimus as graft vs host disease prophylaxis. Leuk Lymphoma 2020; 61:1823-1832. [PMID: 32654570 DOI: 10.1080/10428194.2020.1788015] [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] [Indexed: 10/23/2022]
Abstract
In classical reduced-intensity conditioning (RIC) regimens, including the fludarabine and busulphan (BF) combination, sirolimus and tacrolimus (SIR-TAC) as graft vs host disease (GVHD) prophylaxis has shown acceptable results. The outcomes of SIR-TAC in a more intense RIC regimen as Thiotepa-fludarabine-busulfan (TBF) have been hardly investigated. This retrospective study included all consecutive patients receiving an allogeneic hematopoietic stem cell transplantation for myeloid malignancies (January 2009-2017) conditioned with either TBF or BF and receiving SIR-TAC. Patients receiving TBF presented higher non-relapse mortality (31.6 vs 12.3%, p = .01), along with shorter overall survival (51.8% vs 77.8%, p < .01) at 2 years than patients treated with BF. There were no significant differences in the cumulative incidence of grade II-IV acute GVHD or moderate-severe chronic GVHD or relapse between both groups. These results suggest that TBF does not seem to improve the traditional RIC BF regimen, at least when associated with SIR-TAC prophylaxis.
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Affiliation(s)
- María Laura Fox
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Irene García-Cadenas
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Ariadna Martínez Pérez
- Department of Hematology, Hospital Clínico Universitario- INCLIVA. University of Valencia, Valencia, Spain
| | - Guillermo Villacampa
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - José Luis Piñana
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain - CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Guillermo Ortí
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juan Montoro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain - CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Elisa Roldán
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anna Bosch Vilaseca
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Rodrigo Martino
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Olga Salamero
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Silvana Saavedra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | | | - Albert Esquirol
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Jordi Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Jaime Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain - CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Carlos Solano
- Department of Hematology, Hospital Clínico Universitario- INCLIVA. University of Valencia, Valencia, Spain
| | - Francesc Bosch
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pere Barba
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Valcarcel
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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23
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Martino R, Garrido A, Santaliestra M, García-Cadenas I, Novelli S, Saavedra SD, Esquirol A, Granell M, Briones J, Moreno C, Brunet S, Giménez A, Hidalgo A, Sánchez F, Sierra J. Low Rate of Invasive Fungal Infections During Induction and Consolidation Chemotherapy for Adults with De Novo Acute Myeloid Leukemia Without Anti-mold Prophylaxis: Single-Center 2002-2018 Empirical/Pre-emptive Approach. Mycopathologia 2020; 185:639-652. [PMID: 32564177 DOI: 10.1007/s11046-020-00461-w] [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: 04/04/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Broad-spectrum antifungal prophylaxis is currently considered the standard of care for adults with de novo AML for the prevention of invasive fungal infections (IFIs), especially invasive pulmonary aspergillosis (IPA). Because fluconazole has been used in our center as anti-yeast prophylaxis, we sought to analyze in detail the incidence of IFIs over a 17-year period, as well as their impact on outcome. A standardized protocol of patient management, including serum galactomannan screening and thoracic CT-guided diagnostic-driven antifungal therapy, was used in all patients. A total of 214 consecutive adults with de novo AML who were treated in 3 CETLAM (Grupo Cooperativo para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias) protocols from 2002 to 2018 were included. The 90-day incidence of any IFI (including possible cases) was 11% (95% CI 4-15%), most cases occurred during induction chemotherapy (8%, 95% CI 4-12%), and most cases were probable/proven IPA (8%, 95% CI 3-13%). Developing an IFI during induction and consolidation had no impact on 1-year survival. A case-control study with 23 cases of IPA and 69 controls identified induction/re-induction chemotherapy, chronic pulmonary disease and age > 60 years/poor baseline performance status as potential pretreatment risk factors. The current study proves that inpatient induction and consolidation chemotherapy for de novo AML can be given in areas with "a priori" high-burden of airborne molds with fluconazole prophylaxis, while the selective use of anti-mold prophylaxis in patients at very high risk may further reduce the incidence of IFI in this specific clinical scenario.
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Affiliation(s)
- Rodrigo Martino
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain.
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Ana Garrido
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Marta Santaliestra
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Irene García-Cadenas
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Silvana Novelli
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Silvanna Daniella Saavedra
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Albert Esquirol
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Miquel Granell
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Javier Briones
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Carolina Moreno
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Salut Brunet
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ana Giménez
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Alberto Hidalgo
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Fernando Sánchez
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
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24
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García-Cadenas I, Awol R, Esquirol A, Saavedra S, Bosch-Vilaseca A, Novelli S, Garrido A, López J, Granell M, Moreno C, Briones J, Brunet S, Sierra J, Martino R. Incorporating posttransplant cyclophosphamide-based prophylaxis as standard-of-care outside the haploidentical setting: challenges and review of the literature. Bone Marrow Transplant 2019; 55:1041-1049. [PMID: 31822813 DOI: 10.1038/s41409-019-0771-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/21/2019] [Accepted: 11/29/2019] [Indexed: 11/09/2022]
Abstract
Posttransplant high-dose cyclophosphamide (PTCy) effectively prevents GvHD after haploidentical SCT. However, its use in HLA-matched SCT has been less explored. Fifty-six consecutive patients who underwent allo-SCT for hematological malignancies have been included in this prospective single-center protocol. Donors have been HLA-identical siblings, fully-matched unrelated or 1-allele-mismatched unrelated donors in 30%, 32%, and 37% of cases, respectively. Nine patients have received a TBI-containing MAC regimen, while the remaining (84%) received RIC platforms based on Fludarabine plus Busulfan/Melphalan. Due to the high graft failure (GF) rate (21%) in a preliminary analysis in the allo-RIC cohort (n = 29), protocol amendments have been implemented, with no further cases of GF after the introduction of mini-thiotepa (0/18). The overall incidence of grade II-IV acute GvHD is 24% (95% CI: 17-31%) with four steroid-refractory cases. Severe chronic GvHD has occurred in only 1 of 43 evaluable cases. The 1-year NRM and relapse are 18% (95% CI: 12-26%) and 30% (18-42%) and the OS and DFS are 78% and 64%, respectively. These outcomes support the feasibility of using PTCy as a SOC outside the haplo-setting, albeit mini-thiotepa (3 mg/kg) was incorporated in the standard allo-RIC platforms to prevent GF. Despite the limitations of a single-center experience and the short follow-up, these protocols show promising results with particular benefit in reducing the occurrence of moderate-to-severe GvHD.
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Affiliation(s)
- I García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain.
| | - R Awol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - A Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - S Saavedra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - A Bosch-Vilaseca
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - S Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - A Garrido
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - J López
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - M Granell
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - C Moreno
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - J Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - S Brunet
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - J Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - R Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
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25
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Santaliestra M, Garrido A, Carricondo M, Bussaglia E, Pratcorona M, Blanco ML, Gich I, Hoyos M, Esquirol A, García‐Cadenas I, Brunet S, Martino R, Sierra J, Nomdedéu JF. Bone marrow WT1 levels in patients with myeloid neoplasms treated with 5‐azacytidine: Identification of responding patients. Eur J Haematol 2019; 103:208-214. [DOI: 10.1111/ejh.13275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Marta Santaliestra
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - Ana Garrido
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Maite Carricondo
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - Elena Bussaglia
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - Marta Pratcorona
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Maria L. Blanco
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Ignasi Gich
- Epidemiology Department Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Montserrat Hoyos
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Irene García‐Cadenas
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Salut Brunet
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
| | - Josep F. Nomdedéu
- Hematology Department, Hospital de la Santa Creu I Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
- IIB Sant Pau and Josep Carreras Leukemia Foundation Barcelona Spain
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26
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Guglieri-Lopez B, Perez-Pitarch A, Garcia-Cadenas I, Gimenez E, Barba P, Rabella N, Hernandez-Boluda JC, Fox L, Valcarcel D, Esquirol A, Ferriols-Lisart R, Sierra J, Solano C, Navarro D, Martino R, Piñana JL. Effect of Sirolimus Exposure on the Need for Preemptive Antiviral Therapy for Cytomeglovirus Infection after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1022-1030. [DOI: 10.1016/j.bbmt.2019.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/04/2019] [Indexed: 11/16/2022]
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27
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Hübel K, Re A, Boumendil A, Finel H, Hentrich M, Robinson S, Wyen C, Michieli M, Kanfer E, Diez-Martin JL, Balsalobre P, Vincent L, Schroyens W, Santasusana JMR, Kröger N, Schiel X, Cwynarski K, Esquirol A, Sousa AB, Cattaneo C, Montoto S, Dreger P. Autologous stem cell transplantation for HIV-associated lymphoma in the antiretroviral and rituximab era: a retrospective study by the EBMT Lymphoma Working Party. Bone Marrow Transplant 2019; 54:1625-1631. [PMID: 30804486 DOI: 10.1038/s41409-019-0480-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/18/2019] [Accepted: 02/08/2019] [Indexed: 01/25/2023]
Abstract
The present study aimed at describing the outcome of patients with HIV-associated lymphomas following autologous hematopoietic stem cell transplantation (autoHCT) in the rituximab and combined antiretroviral therapy (cART) era. Eligible for this retrospective study were HIV-positive patients with lymphoma who received autoHCT between 2007 and 2013. A total of 118 patients were included with a median age of 45 years (range 24-66). Underlying diagnoses were diffuse large B cell lymphoma in 47%, Hodgkin lymphoma in 24%, Burkitt lymphoma in 18%, and plasmablastic lymphoma in 7% of patients. Disease status at autoHCT was complete remission in 44%, partial remission (PR) in 38%, and less than PR in 18% of the patients. With a median follow-up of 4 years, 3-year non-relapse mortality, incidence of relapse, progression-free survival (PFS) and overall survival (OS) were 10%, 27%, 63% and 66%, respectively. By multivariate analysis, disease status less than PR but not CD4+ cell count at the time of autoHCT was a significant predictor of unfavorable PFS and OS. In conclusion, in the era of cART and chemoimmunotherapy, the outcome of autoHCT for HIV-related lymphoma is driven by lymphoma-dependent risk factors rather than by characteristics of the HIV infection.
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Affiliation(s)
- Kai Hübel
- University Hospital of Cologne, Cologne, Germany.
| | - Alessandro Re
- Hematology, Spedali Civili di Brescia, Brescia, Italy
| | | | - Herve Finel
- Hopital Saint-Antoine, EBMT Paris Study Office, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Silvia Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Peter Dreger
- University Hospital of Heidelberg, Heidelberg, Germany
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28
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Bazarbachi A, Boumendil A, Finel H, Mohty M, Castagna L, Blaise D, Peggs KS, Afanasyev B, Diez-Martin J, Corradini P, Michonneau D, Robinson S, Gutiérrez García G, Bonifazi F, Yakoub-Agha I, Gülbas Z, Bloor A, Delage J, Esquirol A, Malladi R, Scheid C, El-Cheikh J, Ghesquières H, Montoto S, Dreger P, Sureda A. Brentuximab vedotin for recurrent Hodgkin lymphoma after allogeneic hematopoietic stem cell transplantation: A report from the EBMT Lymphoma Working Party. Cancer 2018; 125:90-98. [DOI: 10.1002/cncr.31755] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/26/2018] [Accepted: 08/13/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Ali Bazarbachi
- Department of Internal Medicine; American University of Beirut; Beirut Lebanon
| | - Ariane Boumendil
- European Society for Blood and Marrow Transplantation Lymphoma Working Party Paris Office; Saint-Antoine Hospital; Paris France
| | - Hervé Finel
- European Society for Blood and Marrow Transplantation Lymphoma Working Party Paris Office; Saint-Antoine Hospital; Paris France
| | - Mohamad Mohty
- Department of Hematology and Cell Therapy; Saint Antoine Hospital, Sorbonne University; Paris France
| | - Luca Castagna
- Department of Hematology and Oncology; Humanitas Clinic Institute; Rozzano Milan Italy
| | - Didier Blaise
- Department of Hematology; Paoli Calmettes Institute; Marseille France
| | - Karl S. Peggs
- Department of Hematology; University College London Hospital; London United Kingdom
| | - Boris Afanasyev
- Department of Hematology; First State Pavlov Medical University of St. Petersburg; St. Petersburg Russia
| | - J.L. Diez-Martin
- Department of Hematology; Gregorio Maranon Hospital; Madrid Spain
| | - Paolo Corradini
- Department of Hematology; IRCCS National Cancer Institute, University of Milan; Milan Italy
| | - David Michonneau
- Department of Hematology and Stem Cell Transplant; St. Louis Hospital; Paris France
| | - Stephen Robinson
- Department of Hematology and Oncology; University Hospital Bristol; Bristol United Kingdom
| | | | - Francesca Bonifazi
- Department of Hematology and Medical Oncology; Hematology Department “Seragnoli,” S. Orsola-Malpighi University Hospital; Bologna Italy
| | - Ibrahim Yakoub-Agha
- Department of Hematology, Lille Regional Hospital Center; LIRIC INSERM U995, Lille University; Lille France
| | - Zafer Gülbas
- Department of Hematologic Oncology and Bone Marrow Transplantation; Anadolu Medical Center Hospital; Kocaeli Turkey
| | - Adrian Bloor
- Department of Hematology and Stem Cell Transplant; Christie NHS Foundation Trust; Manchester United Kingdom
| | - Jeremy Delage
- Department of Clinical Hematology; Lapeyronie Regional Hospital Center; Montpellier France
| | - Albert Esquirol
- Department of Hematology; Santa Creu i Sant Pau Hospital; Barcelona Spain
| | - Ram Malladi
- Department of Hematology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Christof Scheid
- Department of Internal Medicine; University of Cologne; Cologne Germany
| | - Jean El-Cheikh
- Department of Internal Medicine; American University of Beirut; Beirut Lebanon
| | | | - Silvia Montoto
- Department of Haemato-oncology, St Bartholomew’s Hospital; Barts Health NHS Trust; London United Kingdom
| | - Peter Dreger
- Department of Medicine V; University of Heidelberg; Heidelberg Germany
| | - Anna Sureda
- Department of Haematology; Catala Oncology Institute; Barcelona Spain
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29
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Bosch-Vilaseca A, García-Cadenas I, Roldán E, Novelli S, Barba P, Esquirol A, Valcárcel D, Martino R, Sierra J. Usefulness of thrombopoietin receptor agonists for persistent clinically relevant thrombocytopenia after allogeneic stem cell transplantation. Eur J Haematol 2018; 101:407-414. [DOI: 10.1111/ejh.13132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Anna Bosch-Vilaseca
- Hematology Department; Hospital de la Santa Creu i Sant Pau; Biomedical Research Institute (IIB Sant-Pau) and José Carreras Leukemia Research Institute; Autonomous University of Barcelona (UAB); Barcelona Spain
| | - Irene García-Cadenas
- Hematology Department; Hospital de la Santa Creu i Sant Pau; Biomedical Research Institute (IIB Sant-Pau) and José Carreras Leukemia Research Institute; Autonomous University of Barcelona (UAB); Barcelona Spain
| | - Elisa Roldán
- Hematology Department; Hospital Vall d'Hebron; Experimental Hematology Unit; Vall d’ Hebron Institute of Oncology (VHIO); Autonomous University of Barcelona (UAB); Barcelona Spain
| | - Silvana Novelli
- Hematology Department; Hospital de la Santa Creu i Sant Pau; Biomedical Research Institute (IIB Sant-Pau) and José Carreras Leukemia Research Institute; Autonomous University of Barcelona (UAB); Barcelona Spain
| | - Pere Barba
- Hematology Department; Hospital Vall d'Hebron; Experimental Hematology Unit; Vall d’ Hebron Institute of Oncology (VHIO); Autonomous University of Barcelona (UAB); Barcelona Spain
| | - Albert Esquirol
- Hematology Department; Hospital de la Santa Creu i Sant Pau; Biomedical Research Institute (IIB Sant-Pau) and José Carreras Leukemia Research Institute; Autonomous University of Barcelona (UAB); Barcelona Spain
| | - David Valcárcel
- Hematology Department; Hospital Vall d'Hebron; Experimental Hematology Unit; Vall d’ Hebron Institute of Oncology (VHIO); Autonomous University of Barcelona (UAB); Barcelona Spain
| | - Rodrigo Martino
- Hematology Department; Hospital de la Santa Creu i Sant Pau; Biomedical Research Institute (IIB Sant-Pau) and José Carreras Leukemia Research Institute; Autonomous University of Barcelona (UAB); Barcelona Spain
| | - Jorge Sierra
- Hematology Department; Hospital de la Santa Creu i Sant Pau; Biomedical Research Institute (IIB Sant-Pau) and José Carreras Leukemia Research Institute; Autonomous University of Barcelona (UAB); Barcelona Spain
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30
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Paviglianiti A, Tozatto Maio K, Rocha V, Gehlkopf E, Milpied N, Esquirol A, Chevallier P, Blaise D, Gac AC, Leblond V, Cahn JY, Abecasis M, Zuckerman T, Schouten H, Gurman G, Rubio MT, Beguin Y, Corral LL, Nagler A, Snowden JA, Koc Y, Mordini N, Bonifazi F, Volt F, Kenzey C, Robinson SP, Montoto S, Gluckman E, Ruggeri A. Outcomes of Advanced Hodgkin Lymphoma after Umbilical Cord Blood Transplantation: A Eurocord and EBMT Lymphoma and Cellular Therapy & Immunobiology Working Party Study. Biol Blood Marrow Transplant 2018; 24:2265-2270. [PMID: 30031070 DOI: 10.1016/j.bbmt.2018.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023]
Abstract
Allogeneic stem cell transplantation is an alternative for patients with relapsed or refractory Hodgkin lymphoma (HL), but only limited data on unrelated umbilical cord blood transplantation (UCBT) are available. We analyzed 131 adults with HL who underwent UCBT in European Society for Blood and Marrow Transplantation centers from 2003 to 2015. Disease status at UCBT was complete remission (CR) in 59 patients (47%), and almost all patients had received a previous autologous stem cell transplantation. The 4-year progression-free survival (PFS) and overall survival (OS) were 26% (95% confidence interval [CI], 19% to 34%) and 46% (95% CI, 37% to 55%), respectively. Relapse incidence was 44% (95% CI, 36% to 54%), and nonrelapse mortality (NRM) was 31% (95% CI, 23% to 40%) at 4 years. In multivariate analysis refractory/relapsed disease status at UCBT was associated with increased relapse incidence (hazard ratio [HR], 3.14 [95% CI, 1.41 to 7.00], P = .005) and NRM (HR, 3.61 [95% CI, 1.58 to 8.27], P = .002) and lower PFS (HR, 3.45 [95% CI, 1.95 to 6.10], P < .001) and OS (HR, 3.10 [95% CI, 1.60 to 5.99], P = .001). Conditioning regimen with cyclophosphamide + fludarabine + 2 Gy total body irradiation (Cy+Flu+2GyTBI) was associated with decreased risk of NRM (HR, .26 [95% CI, .10 to .64], P = .004). Moreover, Cy+Flu+2GyTBI conditioning regimen was associated with a better OS (HR, .25 [95% CI, .12 to .50], P < .001) and PFS (HR, .51 [95% CI, .27 to .96], P = .04). UCBT is feasible in heavily pretreated patients with HL. The reduced-intensity conditioning regimen with Cy+Flu+2GyTBI is associated with a better OS and NRM. However, outcomes are poor in patients not in CR at UCBT.
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Affiliation(s)
- Annalisa Paviglianiti
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Karina Tozatto Maio
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco; Department of Haematology, Hospital Sao Paulo, San Paulo, Brazil
| | - Eve Gehlkopf
- Service d'Hématologie, CHU Lapeyronie, Montpellier, France
| | - Noel Milpied
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Haut-leveque, CHU Bordeaux, Pessac, France
| | - Albert Esquirol
- Clinical Hematology Service, Hospital de la Santa Creu i Sant Pau, Jose Carreras Leukaemia Research Institute, Barcelona, Spain
| | | | - Didier Blaise
- Service d'Hématologie et thérapie cellulaire, Institute Paoli Calmettes, Marseille, France
| | | | | | - Jean Yves Cahn
- Hématologie Clinique, CHU Grenoble Alpes, Grenoble, France
| | | | - Tsila Zuckerman
- Department of Hematology and BMT, Rambam Medical Center, Haifa, Israel
| | - Harry Schouten
- Department of Internal Medicine, Hematology and Oncology, University Hospital Maastricht, Maastricht, Netherlands
| | - Gunhan Gurman
- Department of Hematology Adult Stem Cell Transplantation Unit, Ankara University, Ankara, Turkey
| | - Marie Thérèse Rubio
- Service d'Hematologie et Therapie Cellulaire, Hôpitaux des Brabois, Nancy, France
| | - Yves Beguin
- Department of Hematology, CHU of Liège and University of Liege, Liege, Belgium
| | - Lucia Lopez Corral
- Hematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Centro de Investigacion del Cancer-IBMCC, Salamanca, Spain
| | - Arnon Nagler
- Department of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Yener Koc
- Stem Cell Transplant Unit Medical Park Hospitals, Antalya, Turkey
| | - Nicola Mordini
- Division of Hematology, Az. Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Francesca Bonifazi
- Institute of Hematology, "Seragnoli" University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Fernanda Volt
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Chantal Kenzey
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | | | - Silvia Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, EBMT Lymphoma Working Party, London, United Kingdom
| | - Eliane Gluckman
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Annalisa Ruggeri
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco; Hematology Department, Ospedale Pediatrico Bambin Gesù, Dipartimento di Oncoematologia e Terapia Cellulare e Genica, Rome, Italy.
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Vicente EP, Cuellar-García C, Martinez M, Soler A, Mora A, Bosch R, Brunet S, Briones J, García I, Esquirol A, Granell M, Saavedra S, Nomdedeu J, Sierra J, Martino R, Moreno C. Chronic Lymphocytic Leukemia: Clinical Stages Maintain Their Prognostic Significance Over the Course of the Disease and Are Surrogates for Response to Therapy. Clin Lymphoma Myeloma Leuk 2018; 18:737-742. [PMID: 30017595 DOI: 10.1016/j.clml.2018.06.023] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/11/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND To determine whether in patients with chronic lymphocytic leukemia (CLL), the clinical stage maintains prognostic significance over time and can be considered as a surrogate for the response to therapy. PATIENTS AND METHODS The data from 229 CLL patients were retrospectively evaluated. The main aims of the study were to describe the changes in clinical stage during the course of CLL as a result of the response to treatment and to determine the time to next therapy (TTNT) and overall survival (OS) according to those changes, in particular, among the heterogeneous International Workshop on CLL (IWCLL) partial response (PR) category. RESULTS Among the patients in the IWCLL PR category, differences were found in TTNT and OS according to the clinical stage at the response evaluation. With a median follow-up period of 91 months (range, 2-390 months), patients with a PR- Binet A at the response evaluation had significantly longer TTNT and OS compared with those with PR-Binet B/C (median TTNT, 26 vs. 11 months; P = .00; median OS, 63 vs. 43 months; P = .047). CONCLUSION The results of the present study have shown that for patients with CLL, the Binet clinical stages are good outcome predictors throughout the disease course and also suggest that changes in Binet clinical stage could be useful as response surrogates and to divide the IWCLL PR category into different prognostic subgroups.
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Affiliation(s)
- Eva Puy Vicente
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain; Laboratory of Oncology/Hematology and Transplantation, Institute of Biomedical Research, IIB Sant Pau, Barcelona, Spain
| | - Carolina Cuellar-García
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Montserrat Martinez
- Department of Hematology, Hospital Parc Taulí, Parc del Taulí, Sabadell, Spain
| | - Alfons Soler
- Department of Hematology, Hospital Parc Taulí, Parc del Taulí, Sabadell, Spain
| | - Alba Mora
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain; Laboratory of Oncology/Hematology and Transplantation, Institute of Biomedical Research, IIB Sant Pau, Barcelona, Spain
| | - Rosa Bosch
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain; Laboratory of Oncology/Hematology and Transplantation, Institute of Biomedical Research, IIB Sant Pau, Barcelona, Spain
| | - Salut Brunet
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Javier Briones
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Irene García
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Albert Esquirol
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Miquel Granell
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Silvana Saavedra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Nomdedeu
- Laboratory of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Rodrigo Martino
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Carol Moreno
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain; Laboratory of Oncology/Hematology and Transplantation, Institute of Biomedical Research, IIB Sant Pau, Barcelona, Spain.
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32
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Afram G, Simón JAP, Remberger M, Caballero-Velázquez T, Martino R, Piñana JL, Ringden O, Esquirol A, Lopez-Corral L, Garcia I, López-Godino O, Sierra J, Caballero D, Ljungman P, Vazquez L, Hägglund H. Reduced intensity conditioning increases risk of severe cGVHD: identification of risk factors for cGVHD in a multicenter setting. Med Oncol 2018; 35:79. [PMID: 29696461 PMCID: PMC5918523 DOI: 10.1007/s12032-018-1127-2] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/05/2018] [Indexed: 01/09/2023]
Abstract
Chronic graft-versus-host disease (cGVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Aim is to identify risk factors for the development of cGVHD in a multicenter setting. Patients transplanted between 2000 and 2006 were analyzed (n = 820). Donors were HLA-identical siblings (57%), matched unrelated donors (30%), and HLA-A, B or DR antigen mismatched (13%). Reduced intensity conditioning (RIC) was given to 65% of patients. Overall incidence of cGVHD was 46% for patients surviving more than 100 days after HSCT (n = 747). Older patient age [HR 1.15, p < 0.001], prior acute GVHD [1.30, p = 0.024], and RIC [1.36, p = 0.028] increased overall cGVHD. In addition, RIC [4.85, p < 0.001], prior aGVHD [2.14, p = 0.001] and female donor to male recipient [1.80, p = 0.008] increased the risk of severe cGVHD. ATG had a protective effect for both overall [0.41, p < 0.001] and severe cGVHD [0.20, p < 0.001]. Relapse-free survival (RFS) was impaired in patients with severe cGVHD. RIC, prior aGVHD, and female-to-male donation increase the risk of severe cGVHD. ATG reduces the risk of all grades of cGVHD without hampering RFS. GVHD prophylaxis may be tailored according to the risk profile of patients.
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Affiliation(s)
- Gabriel Afram
- Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
| | - Jose Antonio Pérez Simón
- Department of Hematology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Mats Remberger
- Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Teresa Caballero-Velázquez
- Department of Hematology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Rodrigo Martino
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Luis Piñana
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Hematology, Hospital Clinico Universitario, Valencia, Spain
| | - Olle Ringden
- Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Albert Esquirol
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lucia Lopez-Corral
- Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Irene Garcia
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Oriana López-Godino
- Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Jordi Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Dolores Caballero
- Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Per Ljungman
- Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Lourdes Vazquez
- Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Hans Hägglund
- Division of Hematology, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
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33
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Nomdedéu JF, Esquirol A, Carricondo M, Pratcorona M, Hoyos M, Garrido A, Rubio M, Bussaglia E, García-Cadenas I, Estivill C, Brunet S, Martino R, Sierra J. Bone Marrow WT1 Levels in Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myelogenous Leukemia and Myelodysplasia: Clinically Relevant Time Points and 100 Copies Threshold Value. Biol Blood Marrow Transplant 2018; 24:55-63. [DOI: 10.1016/j.bbmt.2017.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023]
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34
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Bierings M, Bonfim C, Peffault De Latour R, Aljurf M, Mehta PA, Knol C, Boulad F, Tbakhi A, Esquirol A, McQuaker G, Sucak GA, Othman TB, Halkes CJM, Carpenter B, Niederwieser D, Zecca M, Kröger N, Michallet M, Risitano AM, Ehninger G, Porcher R, Dufour C. Transplant results in adults with Fanconi anaemia. Br J Haematol 2017; 180:100-109. [PMID: 29094350 DOI: 10.1111/bjh.15006] [Citation(s) in RCA: 21] [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: 06/04/2017] [Accepted: 09/09/2017] [Indexed: 12/25/2022]
Abstract
The outcomes of adult patients transplanted for Fanconi anaemia (FA) have not been well described. We retrospectively analysed 199 adult patients with FA transplanted between 1991 and 2014. Patients were a median of 16 years of age when diagnosed with FA, and underwent transplantation at a median age of 23 years. Time between diagnosis and transplant was shortest (median 2 years) in those patients who had a human leucocyte antigen identical sibling donor. Fifty four percent of patients had bone marrow (BM) failure at transplantation and 46% had clonal disease (34% myelodysplasia, 12% acute leukaemia). BM was the main stem cell source, the conditioning regimen included cyclophosphamide in 96% of cases and fludarabine in 64%. Engraftment occurred in 82% (95% confidence interval [CI] 76-87%), acute graft-versus-host disease (GvHD) grade II-IV in 22% (95% CI 16-28%) and the incidence of chronic GvHD at 96 months was 26% (95% CI 20-33). Non-relapse mortality at 96 months was 56% with an overall survival of 34%, which improved with more recent transplants. Median follow-up was 58 months. Patients transplanted after 2000 had improved survival (84% at 36 months), using BM from an identical sibling and fludarabine in the conditioning regimen. Factors associated with improved outcome in multivariate analysis were use of fludarabine and an identical sibling or matched non-sibling donor. Main causes of death were infection (37%), GvHD (24%) and organ failure (12%). The presence of clonal disease at transplant did not significant impact on survival. Secondary malignancies were reported in 15 of 131 evaluable patients.
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Affiliation(s)
- Marc Bierings
- Department of Haematology and Stem Cell Transplantation, Utrecht University Children's Hospital, Utrecht, The Netherlands
| | | | | | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Parinda A Mehta
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | - Cora Knol
- EBMT Data Office, Leiden, The Netherlands
| | - Farid Boulad
- Paediatric Bone Marrow Transplant Service, Memorial Sloan Kettering, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Marco Zecca
- Paediatric Haematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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35
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Paviglianiti A, Ruggeri A, Volt F, Sanz G, Milpied N, Furst S, Esquirol A, Arcese W, Picardi A, Ferra C, Ifrah N, Bourhis JH, Raj K, von dem Borne PA, Sica S, Menard AL, Bloor A, Kenzey C, Gluckman E, Rocha V. Evaluation of a disease risk index for adult patients undergoing umbilical cord blood transplantation for haematological malignancies. Br J Haematol 2017; 179:790-801. [DOI: 10.1111/bjh.14962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Annalisa Paviglianiti
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
| | - Annalisa Ruggeri
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
- Service d'Hématologie et thérapie cellulaire; Hopital Saint Antoine; Paris France
| | - Fernanda Volt
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
| | - Guillermo Sanz
- Department of Haematology; Hospital Universitario La Fe; Valencia Spain
| | - Noel Milpied
- Service d'Hématologie et thérapie cellulaire; Bordeaux France
| | - Sabine Furst
- Service d'Hématologie et thérapie cellulaire; Institute Paoli Calmettes Marseille; Marseille France
| | - Albert Esquirol
- Clinical Haematology Service; Hospital de la Santa Creu i Sant Pau; Jose Carreras Leukaemia Research Institute; Barcelona Spain
| | - William Arcese
- Stem Cell Transplant Unit; Rome Transplant Network; Tor Vergata University; Rome Italy
| | - Alessandra Picardi
- Stem Cell Transplant Unit; Rome Transplant Network; Tor Vergata University; Rome Italy
| | | | - Norbert Ifrah
- Departement of Haematology; CHU Angers; Angers France
| | - Jean H. Bourhis
- Departement of Haematology; Institute Gustave Roussy; Paris France
| | - Kavita Raj
- Departement of Haematology; Kings Hospital & Guy Hospital; London UK
| | | | - Simona Sica
- Department of Haematology; Università Cattolica Sacro Cuore; Roma Italy
| | | | - Adrian Bloor
- Departement of Haematology; Christie NHS Trust Hospital; Manchester UK
| | - Chantal Kenzey
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
| | - Eliane Gluckman
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
| | - Vanderson Rocha
- Eurocord; Hôpital Saint Louis; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
- Serviço de Hematologia; Hemoterapia e TerapiaCelular; Hospital das Clinicas; Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
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36
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Piñana JL, Perez-Pitarch A, Garcia-cadenas I, Barba P, Hernandez-Boluda JC, Esquirol A, Fox ML, Terol MJ, Queraltó JM, Vima J, Valcarcel D, Ferriols-Lisart R, Sierra J, Solano C, Martino R. A Time-to-Event Model for Acute Kidney Injury after Reduced-Intensity Conditioning Stem Cell Transplantation Using a Tacrolimus- and Sirolimus-based Graft-versus-Host Disease Prophylaxis. Biol Blood Marrow Transplant 2017; 23:1177-1185. [DOI: 10.1016/j.bbmt.2017.03.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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Bazarbachi A, Boumendil A, Finel H, Mohty M, Castagna L, Blaise D, Peggs K, Afanasyev B, Diez-Martin J, Corradini P, Socié G, Robinson S, Gutiérrez-García G, Bonifazi F, Yakoub-Agha I, Gülbas Z, Bloor A, Delage J, Esquirol A, Malladi R, Scheid C, Ghesquières H, Montoto S, Dreger P, Sureda A. BRENTUXIMAB VEDOTIN FOR RELAPSED HODGKIN LYMPHOMA AFTER ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION: a RETROSPECTIVE STUDY OF THE EBMT LYMPHOMA WORKING PARTY. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- A. Bazarbachi
- Department of internal medicine; American University of Beirut; Beirut Lebanon
| | - A. Boumendil
- EBMT LWP Paris Office; Hôpital Saint-Antoine; Paris France
| | - H. Finel
- EBMT LWP Paris Office; Hôpital Saint-Antoine; Paris France
| | - M. Mohty
- Service d'Hématologie et Thérapie Cellulaire; Hôpital Saint Antoine; Paris France
| | - L. Castagna
- Department of Hematology; Istituto Clinico Humanitas; Milan Italy
| | - D. Blaise
- Department of internal medicine; Institut Paoli Calmettes; Marseille France
| | - K. Peggs
- Department of internal medicine; University College London Hospital; London UK
| | - B. Afanasyev
- Department of internal medicine; First State Pavlov Medical University of St. Petersburg; St. Petersburg Russian Federation
| | - J. Diez-Martin
- Department of internal medicine; Hospital Gregorio Marañón; Madrid Spain
| | - P. Corradini
- IRCCS Istituto Nazionale dei Tumori; University of Milano; Milan Italy
| | - G. Socié
- Department of internal medicine; Hopital St. Louis; Paris France
| | - S. Robinson
- Department of internal medicine; University Hospital Bristol; Bristol UK
| | | | - F. Bonifazi
- S.Orsola-Malpighi Hospital; Bologna University; Bologna Italy
| | | | - Z. Gülbas
- Department of internal medicine; Anadolu Medical Center Hospital; Kocaeli Turkey
| | - A. Bloor
- Department of internal medicine; Christie NHS Trust Hospital; Manchester UK
| | - J. Delage
- Department of internal medicine; CHU Lapeyronie; Montpellier France
| | - A. Esquirol
- Department of internal medicine; Hospital Santa Creu i Sant Pau; Barcelona Spain
| | - R. Malladi
- Department of internal medicine; Queen Elizabeth Hospital; Birmingham UK
| | - C. Scheid
- Department of internal medicine; University of Cologne; Cologne Germany
| | - H. Ghesquières
- Department of internal medicine; Centre Hospitalier Lyon Sud; Lyon France
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. Dreger
- Dept Medicine V; University of Heidelberg; Heidelberg Germany
| | - A. Sureda
- Department of Haematology; Institut Catala d'Oncologia, Hospital Duran I Reynals; Barcelona Spain
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38
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Barata A, Martino R, Gich I, García-Cadenas I, Abella E, Barba P, Briones J, Brunet S, Esquirol A, García-Pallarols F, Garrido A, Granell M, Martinez J, Mensa I, Novelli S, Sánchez-González B, Valcárcel D, Sierra J. Do Patients and Physicians Agree When They Assess Quality of Life? Biol Blood Marrow Transplant 2017; 23:1005-1010. [DOI: 10.1016/j.bbmt.2017.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/09/2017] [Indexed: 02/02/2023]
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Bosch R, Mora A, Vicente EP, Ferrer G, Jansà S, Damle R, Gorlatov S, Rai K, Montserrat E, Nomdedeu J, Pratcorona M, Blanco L, Saavedra S, Garrido A, Esquirol A, Garcia I, Granell M, Martino R, Delgado J, Sierra J, Chiorazzi N, Moreno C. FcγRIIb expression in early stage chronic lymphocytic leukemia. Leuk Lymphoma 2017; 58:2642-2648. [PMID: 28372509 DOI: 10.1080/10428194.2017.1307981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In normal B-cells, B-cell antigen receptor (BCR) signaling can be negatively regulated by the low-affinity receptor FcγRIIb (CD32b). To better understand the role of FcγRIIb in chronic lymphocytic leukemia (CLL), we correlated its expression on 155 samples from newly-diagnosed Binet A patients with clinical characteristics and outcome. FcγRIIb expression was similar in normal B-cells and leukemic cells, this being heterogenous among patients and within CLL clones. FcγRIIb expression did not correlate with well known prognostic markers [disease stage, serum beta-2 microglobulin (B2M), IGHV mutational status, expression of ZAP-70 and CD38, and cytogenetics] except for a weak concordance with CD49d. Moreover, patients with low FcγRIIb expression (69/155, 44.5%) required therapy earlier than those with high FcγRIIb expression (86/155, 55.5%) (median 151.4 months vs. not reached; p=.071). These results encourage further investigation on the role of FcγRIIb in CLL biology and prognostic significance in larger series of patients.
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Affiliation(s)
- Rosa Bosch
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Alba Mora
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Eva Puy Vicente
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Gerardo Ferrer
- c Karches Centre for Chronic Lymphocytic Leukemia Research, The Feinstein Institute for Medical Research , Manhasset , NY , USA
| | - Sonia Jansà
- d Department of Human Anatomy and Embryology , University of Barcelona , Barcelona , Spain
| | - Rajendra Damle
- c Karches Centre for Chronic Lymphocytic Leukemia Research, The Feinstein Institute for Medical Research , Manhasset , NY , USA
| | | | - Kanti Rai
- f Haematology/Oncology, Oncology LIJ Medical Centre , Lake Success , NY , USA
| | - Emili Montserrat
- g Department of Hematology , Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS , Barcelona , Spain
| | - Josep Nomdedeu
- h Laboratory of Hematology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Marta Pratcorona
- h Laboratory of Hematology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Laura Blanco
- h Laboratory of Hematology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Silvana Saavedra
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Ana Garrido
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Albert Esquirol
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Irene Garcia
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Miquel Granell
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Rodrigo Martino
- b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Julio Delgado
- g Department of Hematology , Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS , Barcelona , Spain
| | - Jorge Sierra
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
| | - Nicholas Chiorazzi
- c Karches Centre for Chronic Lymphocytic Leukemia Research, The Feinstein Institute for Medical Research , Manhasset , NY , USA
| | - Carol Moreno
- a Laboratory of Oncology/Hematology and Transplantation , Institute of Biomedical Research, IIB Sant Pau , Barcelona , Spain.,b Department of Hematology , Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona , Barcelona , Spain
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40
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Picleanu AM, Novelli S, Monter A, Garcia-Cadenas I, Caballero AC, Martino R, Esquirol A, Briones J, Sierra J. Allogeneic hematopoietic stem cell transplantation for non-Hodgkin's lymphomas: a retrospective analysis of 77 cases. Ann Hematol 2017; 96:787-796. [PMID: 28168350 DOI: 10.1007/s00277-017-2934-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a therapeutic option for relapsed, advanced, and otherwise incurable non-Hodgkin's lymphomas (NHL) suggested by the existence of a graft-versus-lymphoma effect. The main complications are graft-versus-host disease and infections. We performed a retrospective analysis of patients with NHL, who received an allo-SCT between January 1995 and December 2014. The parameters that had an impact on overall survival were age ≤60 years old, chemosensitive disease pre-allo-SCT, and indolent NHL histology. The parameters that had an impact on progression-free survival were age ≤60 years old and chemosensitive disease pre-allo-SCT. Only aggressive NHL histology and refractory disease pre-allo-SCT showed an increased risk of death in the multivariate model. The use of allo-SCT for young patients with multiple relapsed chemosensitive indolent NHL is a suitable option. Despite poor prognosis, young aggressive NHL patients can be considered for allo-SCT provided they have chemosensitive disease.
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Affiliation(s)
- Ana M Picleanu
- Hematology Department, Hospital Filantropia, Craiova, Romania
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Anna Monter
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Garcia-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana C Caballero
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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41
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Kharfan-Dabaja MA, Parody R, Perkins J, Lopez-Godino O, Lopez-Corral L, Vazquez L, Caballero D, Falantes J, Shapiro J, Ortí G, Barba P, Valcárcel D, Esquirol A, Martino R, Piñana JL, Solano C, Tsalatsanis A, Pidala J, Anasetti C, Perez-Simón JA. Tacrolimus plus sirolimus with or without ATG as GVHD prophylaxis in HLA-mismatched unrelated donor allogeneic stem cell transplantation. Bone Marrow Transplant 2016; 52:438-444. [PMID: 27819684 DOI: 10.1038/bmt.2016.269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 12/28/2022]
Abstract
HLA-matched related or unrelated donors are not universally available. Consequently, patients can be offered hematopoietic stem cell transplantation (HSCT) from alternative donors, including mismatched unrelated donors (MMURD), known to cause a higher incidence of acute GVHD (aGVHD) and chronic GVHD. In vivo T-cell-depletion strategies, such as antithymocyte globulin (ATG) therapy, significantly decrease the risk of GVHD. We performed a multicenter, retrospective study comparing tacrolimus (TAC) and sirolimus (SIR) with or without ATG in 104 patients (TAC-SIR=45, TAC-SIR-ATG=59) who underwent MMURD HSCT. Use of ATG was associated with a lower incidence, albeit not statistically significant, of grades 2-4 aGVHD (46% vs 64%, P=0.09), no difference in grades 3-4 aGVHD (10% vs 15%, P=0.43), a trend for a lower incidence of moderate/severe chronic GVHD (16% vs 37%, P=0.09) and more frequent Epstein-Barr virus reactivation (54% vs 18%, P=0.0002). There were no statistically significant differences in 3-year overall survival (OS) (TAC-SIR-ATG=40% (95% confidence interval (CI)=24-56%) vs TAC-SIR=54% (95% CI=37-70%), P=0.43) or 3-year cumulative incidence of relapse/progression (TAC-SIR-ATG=40% (95% CI=28-58%) vs TAC-SIR=22% (95% CI=13-39%), P=0.92). An intermediate Center for International Blood & Marrow Transplant Research disease risk resulted in a significantly lower non-relapse mortality and better OS at 3 years. Our study suggests that addition of ATG to TAC-SIR in MMURD HSCT does not affect OS when compared with TAC-SIR alone.
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Affiliation(s)
- M A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - R Parody
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Sevilla, Spain
| | - J Perkins
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,College of Pharmacy, University of South Florida, Tampa, FL, USA
| | | | | | - L Vazquez
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - D Caballero
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - J Falantes
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Sevilla, Spain
| | - J Shapiro
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - G Ortí
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - P Barba
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - D Valcárcel
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - A Esquirol
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - R Martino
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - J L Piñana
- Hospital Clínico de Valenci, Valencia, Spain
| | - C Solano
- Hospital Clínico de Valenci, Valencia, Spain
| | - A Tsalatsanis
- Center for Evidence-Based Medicine, University of South Florida College of Medicine, Tampa, FL, USA
| | - J Pidala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - C Anasetti
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J A Perez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Sevilla, Spain
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García-Cadenas I, Rivera I, Martino R, Esquirol A, Barba P, Novelli S, Orti G, Briones J, Brunet S, Valcarcel D, Sierra J. Patterns of infection and infection-related mortality in patients with steroid-refractory acute graft versus host disease. Bone Marrow Transplant 2016; 52:107-113. [PMID: 27595281 DOI: 10.1038/bmt.2016.225] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 01/20/2023]
Abstract
This study aimed to characterize the incidence, etiology and outcome of infectious episodes in patients with steroid refractory acute GvHD (SR-GvHD). The cohort included 127 adults treated with inolimomab (77%) or etanercept (23%) owing to acute 2-4 SR-GvHD, with a response rate of 43% on day +30 and a 4-year survival of 15%. The 1-year cumulative incidences of bacterial, CMV and invasive fungal infection were 74%, 65% and 14%, respectively. A high rate (37%) of enterococcal infections was observed. Twenty patients (15.7%) developed BK virus-hemorrhagic cystitis and five percent had an EBV reactivation with only one case of PTLD. One-third of long-term survivors developed pneumonia by a community respiratory virus and/or encapsulated bacteria, mostly associated with chronic GvHD. Infections were an important cause of non-relapse mortality, with a 4-year incidence of 46%. In multivariate analysis, use of rituximab in the 6 months before SCT (hazard ratio; HR 4.2; 95% confidence interval; CI 1.1-16.3), severe infection before SR-GvHD onset (HR 5.8; 95% CI 1.3-26.3) and a baseline C-reactive protein >15 UI/mL (HR 2.9; 95% CI 1.1-8.5) were associated with infection-related mortality. High rates of opportunistic infections with remarkable mortality warrant further efforts to optimize long-term outcomes after SR-GvHD.
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Affiliation(s)
- I García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Rivera
- Hematology Department, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Barba
- Hematology Department, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Orti
- Hematology Department, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Brunet
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Valcarcel
- Hematology Department, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Kekre N, Marquez-Malaver FJ, Cabrero M, Piñana J, Esquirol A, Soiffer RJ, Caballero D, Terol MJ, Martino R, Antin JH, Lopez-Corral L, Solano C, Armand P, Pérez-Simon JA. Fludarabine/Busulfan versus Fludarabine/Melphalan Conditioning in Patients Undergoing Reduced-Intensity Conditioning Hematopoietic Stem Cell Transplantation for Lymphoma. Biol Blood Marrow Transplant 2016; 22:1808-1815. [PMID: 27470290 DOI: 10.1016/j.bbmt.2016.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/15/2016] [Indexed: 02/06/2023]
Abstract
There is at present little data to guide the choice of conditioning for patients with lymphoma undergoing reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (SCT). In this study, we compared the outcomes of patients undergoing RIC SCT who received fludarabine and melphalan (FluMel), the standard RIC regimen used by the Spanish Group of Transplantation, and fludarabine and busulfan (FluBu), the standard RIC regimen used by the Dana-Farber Cancer Institute/Brigham and Women's Hospital. We analyzed 136 patients undergoing RIC SCT for lymphoma with either FluBu (n = 61) or FluMel (n = 75) conditioning between 2007 and 2014. Median follow-up was 36 months. The cumulative incidence of grades II to IV acute graft-versus-host disease (GVHD) was 13% with FluBu and 36% with FluMel (P = .002). The cumulative incidence of nonrelapse mortality (NRM) at 1 year was 3.3% with FluBu and 31% with FluMel (P < .0001). The cumulative incidence of relapse at 1 year was 29% with FluBu and 10% with FluMel (P = .08). The 3-year disease-free survival rate was 47% with FluBu and 36% with FluMel (P = .24), and the 3-year overall survival rate was 62% with FluBu and 48% with FluMel (P = .01). In multivariable analysis, FluMel was associated with a higher risk of acute grades II to IV GVHD (HR, 7.45; 95% CI, 2.30 to 24.17; P = .001) and higher risk of NRM (HR, 4.87; 95% CI, 1.36 to 17.44; P = .015). The type of conditioning was not significantly associated with relapse or disease-free survival in multivariable models. However, conditioning regimen was the only factor significantly associated with overall survival: FluMel conditioning was associated with a hazard ratio for death of 2.78 (95% CI, 1.23 to 6.27; P = .014) compared with FluBu. In conclusion, the use of FluBu as conditioning for patients undergoing SCT for lymphoma was associated with a lower risk of acute GVHD and NRM and improved overall survival when compared with FluMel in our retrospective study. These results confirm the differences between these RIC regimens in terms of toxicity and efficacy and support the need for comparative prospective studies.
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Affiliation(s)
- Natasha Kekre
- Division of Hematology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Francisco J Marquez-Malaver
- Department of Hematology, Instituto de Biomedicina de Sevilla (IBIS)/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Monica Cabrero
- Hematology Department, University Hospital, Instituto Biosanitario de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Jl Piñana
- Department of Hematology/Oncology, Hospital Clinico Universitario, Valencia, Valencia, Spain
| | - Albert Esquirol
- Department of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Jose Carreras Leukemia Research Institute, Barcelona, Spain
| | - Robert J Soiffer
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Dolores Caballero
- Hematology Department, University Hospital, Instituto Biosanitario de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - M J Terol
- Department of Hematology/Oncology, Hospital Clinico Universitario, Valencia, Valencia, Spain
| | - Rodrigo Martino
- Department of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Jose Carreras Leukemia Research Institute, Barcelona, Spain
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - L Lopez-Corral
- Hematology Department, University Hospital, Instituto Biosanitario de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Carlos Solano
- Department of Hematology/Oncology, Hospital Clinico Universitario, Valencia, Valencia, Spain
| | - Philippe Armand
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jose A Pérez-Simon
- Department of Hematology, Instituto de Biomedicina de Sevilla (IBIS)/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.
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Parody R, López-Corral L, Lopez-Godino O, Martinez C, Martino R, Solano C, Barba P, Caballero D, García-Cadenas I, Piñana JL, Marquez-Malaver FJ, Vazquez L, Esquirol A, Boluda JCH, Sanchez-Guijo F, Pérez-Simon JA. GvHD prophylaxis with tacrolimus plus sirolimus after reduced intensity conditioning allogeneic transplantation: results of a multicenter study. Bone Marrow Transplant 2016; 51:1524-1526. [DOI: 10.1038/bmt.2016.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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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Koenecke C, Heim D, van Biezen A, Heuser M, Aljurf M, Kyrcz-Krzemien S, Volin L, de Souza CA, Gedde-Dahl T, Sengeloev H, Schanz U, Komarnicki M, Arroyo CH, Tholouli E, Gluckman E, Esquirol A, Yakoub-Agha I, Gürman G, Olavarria E, Kröger N. Outcome of patients with chronic myeloid leukemia and a low-risk score: allogeneic hematopoietic stem cell transplantation in the era of targeted therapy. A report from the EBMT Chronic Malignancies Working Party. Bone Marrow Transplant 2016; 51:1259-61. [PMID: 27111041 DOI: 10.1038/bmt.2016.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C Koenecke
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - D Heim
- Department of Medicine and Hematology, University Hospital, Basel, Switzerland
| | - A van Biezen
- Department of Medical Statistics & BioInformatics, LUMC, Leiden, The Netherlands
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - M Aljurf
- Department of Hematology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - S Kyrcz-Krzemien
- Department of Hematology, Silesian Medical Academy University, Katowice, Poland
| | - L Volin
- Stem Cell Transplantation Unit, Helsinki University Central Hospital, Helsinki, Finland
| | - C A de Souza
- Cidade Universitaria 'Zeferino Vaz', Campinas SP, Brazil
| | - T Gedde-Dahl
- Department of Medicine, Rikshospitalet, The National Hospital, Oslo, Norway
| | - H Sengeloev
- BMT Unit, Rigshospitalet, Copenhagen, Denmark
| | - U Schanz
- Division of Medicine, University Hospital, Zürich, Switzerland
| | - M Komarnicki
- Department of Hematology, K Marcinkowski University of Medical Science, Poznań, Poland
| | - C H Arroyo
- Department of Hematology, Hospital Reina Sofia Córdoba, Córdoba, Spain
| | - E Tholouli
- Department of Hematology, Manchester Royal Infirmary, Manchester, UK
| | - E Gluckman
- Department of Hematology, Hopital St Louis, Paris, France
| | - A Esquirol
- Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - I Yakoub-Agha
- LIRIC INSERM U995, Université Lille 2, CHRU de Lille, Lille, France
| | - G Gürman
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - E Olavarria
- Department of Haematology, Imperial College, Hammersmith Hospital, London, UK
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
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46
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Barata A, Jim H, Martino R, Barba P, Garcia-Pallarols F, Esquirol A, Garcia-Cadenas I, Gich I, Ballarín G, Cortés S, Brunet S, Valcarcel D, Sierra J. Transplant-Related Concerns at Hospital Discharge Predict Increases in Depression. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Martino R, Bautista G, Parody R, García I, Esquirol A, Rovira M, Cabrera JR, Regidor C, Fores R, García-Marco JA, Serrano D, Barba P, Heras I, Marquez-Malaver FJ, Sánchez-Ortega I, Duarte R, Saavedra S, Sierra J, Vazquez L. Severe infections after single umbilical cord blood transplantation in adults with or without the co-infusion of CD34+ cells from a third-party donor: results of a multicenter study from the Grupo Español de Trasplante Hematopoyético (GETH). Transpl Infect Dis 2015; 17:221-33. [PMID: 25652036 DOI: 10.1111/tid.12361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/27/2014] [Accepted: 01/18/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Umbilical cord blood transplantation (CBT) is an established alternative source of stem cells in the setting of unrelated transplantation. When compared with other sources, single-unit CBT (sCBT) is associated with a delayed hematologic recovery, which may lead to a higher infection-related mortality (IRM). Co-infusion with the sCBT of CD34+ peripheral blood stem cells from a third-party donor (TPD) (sCBT + TPDCD34+) has been shown to markedly accelerate leukocyte recovery, potentially reducing the IRM. However, to our knowledge, no comparative studies have focused on severe infections and IRM with these 2 sCBT strategies. METHODS A total of 148 consecutive sCBT (2000-2010, median follow-up 4.5 years) were included in a multicenter retrospective study to analyze the incidence and risk factors of IRM and severe viral and invasive fungal infections (IFIs). Neutrophil engraftment occurred in 90% of sCBT (n = 77) and 94% sCBT + TPDCD34+ (n = 71) recipients at a median of 23 and 12 days post transplantation, respectively (P < 0.01). RESULTS The 4-year IRM was 24% and 20%, respectively (P = 0.7), with no differences at day +30 (5% and 4%, respectively) and day +100 (10% and 8%, respectively). In multivariate analysis early status of the underlying malignancy, cytomegalovirus (CMV)-seronegative recipient and high CD34+ cell content in the cord blood unit before cryostorage (≥1.4 × 10(5) /kg) were protective of IRM. Among the causes of IRM, bacterial infections and IFIs were more common in sCBT (15% vs. 4%), while CMV disease and parasitic infections were more common in the sCBT + TPDCD34+ cohort (5% vs. 16%). CONCLUSION These data show that sCBT supported with TPDCD34(+) cells results in much shorter periods of post-transplant leukopenia, but the short- and long-term rates of IRM were comparable to those of sCBT, presumably because immune recovery is equally delayed in both graft types.
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Affiliation(s)
- R Martino
- Clinical Hematology Service, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute, Barcelona, Spain
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Barba P, Martino R, Orti G, Esquirol A, Perez-Hoyos S, Sierra J, Valcárcel D. Validation of a new integrated prognostic score to predict non-relapse mortality in patients undergoing reduced-intensity conditioning allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2015; 50:1371-4. [DOI: 10.1038/bmt.2015.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Piñana JL, Sanz J, Esquirol A, Martino R, Picardi A, Barba P, Parody R, Gayoso J, Montesinos P, Guidi S, Terol MJ, Moscardó F, Solano C, Arcese W, Sanz MA, Sierra J, Sanz G. Umbilical cord blood transplantation in adults with advanced hodgkin's disease: high incidence of post-transplant lymphoproliferative disease. Eur J Haematol 2015; 96:128-35. [PMID: 25845981 DOI: 10.1111/ejh.12557] [Citation(s) in RCA: 18] [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] [Accepted: 03/26/2015] [Indexed: 11/28/2022]
Abstract
We report the outcome of 30 consecutive patients with Hodgkin disease (HD) who underwent single-unit UCBT. Most (90%) patients had failed previous autologous hematopoietic stem cell transplantation. The conditioning regimens were based on combinations of thiotepa, busulfan, cyclophosphamide or fludarabine, and antithymocyte globulin. The cumulative incidence (CI) of myeloid engraftment was 90% [95% confidence interval (C.I.), 74-98%] with a median of 18 d (range, 10-48). CI of acute graft-versus-host disease (GvHD) grades II-IV was 30% (95% C.I., 17-44%), while the incidence of chronic GVHD was 42% (95% C.I., 23-77%). The non-relapse mortality (NRM) at 100 d and 4 yr was 30% (95% C.I., 13-46%) and 47% (95% C.I., 29-65%), respectively. EBV-related post-transplant lymphoproliferative disease (EBV-PTLD) accounted for more than one-third of transplant-related death, with an estimate incidence of 26% (95% C.I., 9-44). The incidence of relapse at 4 yr was 25% (95% C.I., 9-42%). Four-year event-free survival (EFS) and overall survival (OS) were 28% and 30%, respectively. Despite a high NRM and an unexpected high incidence of EBV-PTLD, UCBT in heavily pretreated HD patients is an option for patients lacking a suitable adult donor, provided the disease is not in refractory relapse.
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Affiliation(s)
- José Luis Piñana
- Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - Jaime Sanz
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | - Albert Esquirol
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rodrigo Martino
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alessandra Picardi
- Rome Transplant Network, UOC Trapianto di Cellule Staminali, Università di Roma Tor Vergata, Rome, Italy
| | - Pere Barba
- Department of Hematology, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Rocio Parody
- Department of Clinical Hematology, Hospital Virgen del Rocio, Sevilla, Spain
| | - Jorge Gayoso
- Department of Hematology, Hospital Gregorio Marañon, Madrid, Spain
| | - Pau Montesinos
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | - Stefano Guidi
- Bone Marrow Transplant Unit, Department of Hematology, AOU Careggi, Florence, Italy
| | - Maria José Terol
- Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - Federico Moscardó
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | - Carlos Solano
- Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - William Arcese
- Rome Transplant Network, UOC Trapianto di Cellule Staminali, Università di Roma Tor Vergata, Rome, Italy
| | - Miguel A Sanz
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain.,Medicine Department, Universitat de Valencia, Valencia, Spain
| | - Jorge Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and Jose Carreras Leukemia Research Institute, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Guillermo Sanz
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
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Barba P, Martino R, Martinez-Cuadron D, Olga G, Esquirol A, Gil-Cortés C, Gonzalez J, Fernandez-Avilés F, Valcárcel D, Guardia R, Duarte RF, Hernandez-Rivas JM, Abella E, Montesinos P, Ribera JM. Impact of transplant eligibility and availability of a human leukocyte antigen-identical matched related donor on outcome of older patients with acute lymphoblastic leukemia. Leuk Lymphoma 2015; 56:2812-8. [DOI: 10.3109/10428194.2015.1014365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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