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Giaccone L, Mancini G, Mordini N, Gargiulo G, De Cecco V, Angelini S, Arpinati M, Baronciani D, Bozzoli V, Bramanti S, Calore E, Cavattoni IM, Cimminiello M, Colombo AA, Facchini L, Falcioni S, Faraci M, Fedele R, Guidi S, Iori AP, Marotta S, Micò MC, Milone G, Onida F, Pastore D, Patriarca F, Pini M, Raimondi R, Rovelli A, Santarone S, Severino A, Skert C, Stanghellini MTL, Tecchio C, Vassallo E, Chiarucci M, Bruno B, Bonifazi F, Olivieri A. 'Real-life' report on the management of chronic GvHD in the Gruppo Italiano Trapianto Midollo Osseo (GITMO). Bone Marrow Transplant 2017; 53:58-63. [PMID: 29084200 DOI: 10.1038/bmt.2017.223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/18/2017] [Accepted: 08/31/2017] [Indexed: 01/24/2023]
Abstract
Several guidelines have been published about management of chronic GvHD (cGvHD), but the clinical practice still remains demanding. The Gruppo Italiano Trapianto di Midollo Osseo (GITMO) has planned a prospective observational study on cGvHD, supported by a dedicated software, including the updated recommendations. In view of this study, two surveys have been conducted, focusing the management of cGvHD and ancillary therapy in cGvHD, to address the current 'real life' situation. The two surveys were sent to all 57 GITMO centers, performing allografting in Italy; the response rate was 57% and 66% of the interviewed centers, respectively. The first survey showed a great disparity especially regarding steroid-refractory cGvHD, although extracorporeal photo-apheresis resulted as the most indicated treatment in this setting. Another challenging issue was the strategy for tapering steroid: our survey showed a great variance, and this disagreement could be a real bias in evaluating outcomes in prospective studies. As for the second survey, the results suggest that the ancillary treatments are not standardized in many centers. All responding centers reported a strong need to standardize management of cGvHD and to participate in prospective trials. Before starting observational and/or interventional studies, a detailed knowledge of current practice should be encouraged.
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Affiliation(s)
- L Giaccone
- Department of Molecular Biotechnology and Health Sciences, University of Torino, and Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - G Mancini
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - N Mordini
- Division of Hematology, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - G Gargiulo
- UOC Ematology and TCSE, AOU Federico II, Napoli, Italy
| | - V De Cecco
- UOC Oncoematology Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Angelini
- Division of Hematology and Stem Cell Transplantation, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - M Arpinati
- Division of Hematology, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
| | - D Baronciani
- Ospedale di Riferimento Regionale Businco, AO Brotzu, Cagliari, Italy
| | - V Bozzoli
- Divisione di Ematologia, Ospedale di Lecce, Lecce, Italy
| | - S Bramanti
- Division of Hematology, Ospedale Humanitas, Rozzano, Italy
| | - E Calore
- Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University Hospital of Padova, Padova, Italy
| | - I M Cavattoni
- Hematology and Bone Marrow Transplant Unit, Ospedale Centrale di Bolzano, Bolzano, Italy
| | - M Cimminiello
- UOC di Ematologia con TMO, Ospedale San Carlo, Potenza, Italy
| | - A A Colombo
- Divisione di Ematologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Facchini
- Hematology Unit, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - S Falcioni
- U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - M Faraci
- Department of Pediatric Hematology-Oncology, IRCCS G. Gaslini, Genova, Italy
| | - R Fedele
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - S Guidi
- Department of Hematology, Bone Marrow Transplant Unit, University of Firenze, Firenze, Italy
| | - A P Iori
- Department of 'Cellular Biotechnologies and Hematology', Azienda Policlinico Umberto I, Università La Sapienza, Roma, Italy
| | - S Marotta
- UOC Ematology and TCSE, AOU Federico II, Napoli, Italy
| | - M C Micò
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - G Milone
- Hematology and Bone Marrow Transplant Unit, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - F Onida
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-University of Milan, Milano, Italy
| | - D Pastore
- Dipartimento di Ematologia, Università di Bari, Bari, Italy
| | - F Patriarca
- Azienda Ospedaliera-Universitaria di Udine, DISM Università di Udine, Udine, Italy
| | - M Pini
- Hematology, AO SS Antonio e Biagio e C Arrigo, Alessandria, Italy
| | - R Raimondi
- Hematology and Bone Marrow Transplant Unit, Ospedale San Bortolo, Vicenza, Italy
| | - A Rovelli
- BMT Unit, MBBM Foundation, Paediatric Department, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - S Santarone
- Unità Terapia Intensiva Ematologica per il Trapianto Emopoietico, Ospedale Civile, Pescara, Italy
| | - A Severino
- Divisione di Ematologia, Ospedale San Camillo, Roma, Italy
| | - C Skert
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - M T L Stanghellini
- Molecular Hematology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - C Tecchio
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - E Vassallo
- Pediatric Onco-Hematology and Stem Cell Transplant Division, AO Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Chiarucci
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - B Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, and Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - F Bonifazi
- Division of Hematology, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
| | - A Olivieri
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
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Bonifazi F, Bandini G, Rondelli D, Falcioni S, Stanzani M, Bontadini A, Tazzari PL, Arpinati M, Giannini B, Conte R, Baccarani M. Reduced incidence of GVHD without increase in relapse with low-dose rabbit ATG in the preparative regimen for unrelated bone marrow transplants in CML. Bone Marrow Transplant 2003; 32:237-42. [PMID: 12858193 DOI: 10.1038/sj.bmt.1704138] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
SUMMARY Antithymocyte globulin (ATG) treatment prevents graft failure and results in a low incidence of GVHD, but an increased risk of relapse could be expected as a consequence of reduced GVHD. From September 1995 to June 2001, 28 consecutive chronic myeloid leukemia (CML) patients underwent unrelated bone marrow transplants: 21 were in chronic phase (CP) and seven in advanced phase (AP). Median age was 35.5 years (range 20-50). HLA typing was based on high-resolution molecular techniques; in eight cases there were one or more allele mismatches. The preparative regimen consisted of TBI, EDX 120 mg/kg and rabbit ATG 15 mg/kg. All patients engrafted and no rejection occurred. Acute GVHD grade III-IV occurred in six patients (21%). Chronic GVHD occurred in 10 (40%) and it was extensive in one. Four out of seven patients transplanted in AP had a hematological relapse. Of 21 in CP, there was one cytogenetic and one molecular relapse: these two patients are now in complete remission with imatinib mesylate. With a median follow-up of 45.7 months, the 5-year survival is 76.2% for those transplanted in CP. These data demonstrate that transplants performed in CP, with low-dose ATG, are associated with a good outcome, low incidence of GVHD and no increase of relapse.
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Affiliation(s)
- F Bonifazi
- Institute of Hematology and Clinical Oncology L e A. Seràgnoli, University of Bologna, St Orsola Hospital, Bologna, Italy
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Arpinati M, Chirumbolo G, Urbini B, Martelli V, Stanzani M, Falcioni S, Bonifazi F, Bandini G, Tura S, Baccarani M, Rondelli D. Use of anti-BDCA-2 antibody for detection of dendritic cells type-2 (DC2) in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 29:887-91. [PMID: 12080352 DOI: 10.1038/sj.bmt.1703569] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2002] [Accepted: 03/21/2002] [Indexed: 11/09/2022]
Abstract
TH2-inducing dendritic cells (DC2) are commonly identified as negative for lineage markers and positive for HLA-DR and CD123 expression. More recently, normal blood DC2 were shown also to be positive for BDCA-2 and BDCA-4 antigens. The aim of this study was to evaluate whether BDCA-2 expression on DC2 is impaired in patients undergoing an allogeneic hematopoietic stem cell transplantation (HSCT) and in healthy donors treated with G-CSF for HSC mobilization. Flow cytometry assays for DC2 detection using either a triple staining with anti-HLA-DR PerCP, anti-Lin(+) anti-CD34 FITC and anti-CD123 PE monoclonal antibodies (mAbs), or a double staining with anti-HLA-DR PE and anti-BDCA-2 FITC mAbs were compared in blood samples from patients who underwent an allogeneic HSCT (n = 30) or from healthy donors before (n = 11) and after (n = 8) G-CSF mobilization, as well as in healthy donors' leukapheresis products (n = 12) or bone marrow (n = 4). Staining of BDCA-2(+) cells with other markers such as anti-CD38, anti-CD54 and anti-CD58 were also performed. Median values of CD123(+) DC2 and BDCA-2(+) DC2 were not statistically different in the blood of patients previously treated with chemotherapy, nor in the blood or bone marrow of heathy donors. Also, a 5 day G-CSF treatment did not affect BDCA-2 or adhesion molecule expression on healthy donors' blood DC2 significantly. A correlation between all the results (n = 65) obtained with the two assays was demonstrated in a linear regression curve (r = 0.914) (P = 0.00001). BDCA-2 is a marker highly specific for DC2 that is not downregulated by chemotherapy or G-CSF treatment. Therefore, the anti-BDCA-2 mAb can be efficiently combined with other mAbs and used in studies addressing the role of DC2 in the allogeneic HSCT setting.
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Affiliation(s)
- M Arpinati
- Research Center for Transplant Immunology, Institute of Hematology and Medical Oncology Seràgnoli, University of Bologna, Bologna, Italy
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Trisolini R, Stanzani M, Lazzari Agli L, Colangelo A, Bonifazi F, Falcioni S, Patelli M, Falcone F, Bandini G, Tura S, Poletti V. Delayed non-infectious lung disease in allogeneic bone marrow transplant recipients. Sarcoidosis Vasc Diffuse Lung Dis 2001; 18:75-84. [PMID: 11354551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND AIM OF THE WORK The studies on late-onset non-infectious respiratory complications after allogeneic bone marrow transplantation (allo-BMT) have been mainly focused on bronchiolitis obliterans to date. The aim of this work was to analyze the incidence, clinico-pathologic characteristics and outcome of the entire spectrum of entities falling into the group of delayed non-infectious lung disease (DLD). METHODS Retrospective chart review was carried out of 112 patients who underwent allo-BMT for hematologic malignancies between April 1995 and November 1998 at a single Institution. The categorization of the pulmonary disease was made by analyzing clinical data, bronchoalveolar lavage (BAL), high-resolution computed tomography (HRCT) and histology when possible. RESULTS DLD occurred in 10 (10%) out of 97 recipients who survived at least 100 days following allo-BMT and was defined as bronchiolitis obliterans (BO; 4 cases), acute lung injury (ALI; 1 case) and subacute cellular interstitial pneumonia (SCIP; 5 cases). The BAL-profile was characterized by a marked increase of the neutrophil percentage in BO cases and of the lymphocyte (predominantly CD8+) percentage in parenchymal DLDs (SCIP, ALI). HRCT proved to be helpful to correctly identify BO cases, whereas histology was always needed to better define DLD presenting with an interstitial and/or alveolar pattern. The predominant airway involvement as well as the acute-onset of a respiratory illness with histological evidence of diffuse alveolar damage were associated with a worse prognosis because of a poor response to the immunosuppressive treatment. CONCLUSIONS DLDs represent a group of entities heterogeneous in regard to variables such as onset and clinical behaviour (acute, subacute or chronic), predominant pattern of lung involvement (airway or parenchymal), response to treatment. Although immunopathologic mechanisms related to c-GVHD probably have a relevant pathogenic importance in this setting, the possible role of associated events (eg, drug toxicity and infections) at least in priming the lung damage need to be better clarified for its therapeutical implications.
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Affiliation(s)
- R Trisolini
- Dipartimento di Malattie del Torace, Ospedali Bellaria e Maggiore, Bologna, Italy
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Rondelli D, Re F, Bandini G, Raspadori D, Arpinati M, Senese B, Stanzani M, Bonifazi F, Falcioni S, Chirumbolo G, Tura S. Different immune reconstitution in multiple myeloma, chronic myeloid leukemia and acute myeloid leukemia patients after allogeneic transplantation of peripheral blood stem cells. Bone Marrow Transplant 2000; 26:1325-31. [PMID: 11223973 DOI: 10.1038/sj.bmt.1702709] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this study we compared the lymphocyte reconstitution in 13 multiple myeloma (MM), nine acute myeloid leukemia (AML) and 10 chronic myeloid leukemia (CML) patients after allogeneic G-CSF-mobilized PBSC transplantation from HLA-identical siblings. Conditioning regimens included standard total body irradiation + cyclophosphamide (CY), or busulphan + CY, whereas VP-16 was added in patients with advanced disease. Overall comparable numbers of mononuclear cells, CD34+ cells and CD3+ T cells were infused in each group. A significantly higher CD3+ T cell number was observed in MM and AML than in CML patients 1 month after transplant. However, MM patients showed a faster and better recovery of CD4+ T cells than both AML and CML patients at 3 months (P = 0.01 and P = 0.01, respectively) and 12 months (P = 0.01 vs AML, while P = NS vs CML) after transplant, and had a CD4:CD8 ratio > 1 with a median CD4+ T cell value > 400/microl 1 year after transplant. Development of acute graft-versus-host disease (GVHD) did not affect CD4:CD8 ratios but patients who experienced acute GVHD > grade I had lower CD4+ and CD8+ T cell numbers at all time points. However, after excluding patients with GVHD > grade I, MM patients still showed a significantly higher CD4+ T cell value than patients with myeloproliferative diseases 1 year after transplant. These findings suggest that although allogeneic PBSC transplantation induces rapid immune reconstitution, different kinetics may occur among patients with hematological malignancies. In particular, the rapid reconstitution of CD4+ T cells in MM patients may contribute to the low transplant-related mortality achieved in this disease.
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Affiliation(s)
- D Rondelli
- Institute of Hematology and Medical Oncology 'Seràgnoli', University of Bologna, Italy
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