Impact of macrophage infiltration of skin lesions on survival after allogeneic stem cell transplantation: a clue to refractory graft-versus-host disease

We retrospectively reviewed 104 biopsy specimens of previously untreated skin acute graft-versus-host disease (GVHD) within 100 days after allogeneic stem cell transplantation, and analyzed the relationship between types of infiltrating cells and clinical outcomes. Counting the total number of CD8+ T cells, CD163+ macrophages, and CD1a+ dendritic cells in 4 fields under original magnification ×200, the infiltration of more than 200 cells of CD163+ macrophages (many macrophages [MM]) was the only significant predictor for refractory GHVD (odds ratio, 3.79; 95% confidence interval, 1.22-11.8; P = .02). In 46 patients given steroid treatments, MM was the only significant predictor for refractory acute GVHD (odds ratio, 5.05; 95% confidence interval, 1.19-21.3; P = .03). Overall survival of patients with MM was significantly lower than that of those with an infiltration of less than 200 cells of CD163+ macrophages. Macrophage infiltration of skin lesions could be a significant predictive factor for refractory GVHD and a poor prognosis.

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Allogeneic stem cell transplantation after reduced-intensity conditioning in patients with myelofibrosis: a prospective, multicenter study of the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation

Blood ◽

10.1182/blood-2009-07-234880 ◽

2009 ◽

Vol 114 (26) ◽

pp. 5264-5270 ◽

Cited By ~ 227

Author(s):

Nicolaus Kröger ◽

Ernst Holler ◽

Guido Kobbe ◽

Martin Bornhäuser ◽

Rainer Schwerdtfeger ◽

...

Keyword(s):

Stem Cell ◽

Confidence Interval ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Graft Versus Host Disease ◽

Allogeneic Stem Cell Transplantation ◽

Cumulative Incidence ◽

Reduced Intensity Conditioning ◽

Graft Versus Host ◽

Reduced Intensity

Abstract From 2002 to 2007, 103 patients with primary myelofibrosis or postessential thrombocythemia and polycythemia vera myelofibrosis and a median age of 55 years (range, 32-68 years) were included in a prospective multicenter phase 2 trial to determine efficacy of a busulfan (10 mg/kg)/fludarabine (180 mg/m2)–based reduced-intensity conditioning regimen followed by allogeneic stem cell transplantation from related (n = 33) or unrelated donors (n = 70). All but 2 patients (2%) showed leukocyte and platelet engraftment after a median of 18 and 22 days, respectively. Acute graft-versus-host disease grade 2 to 4 occurred in 27% and chronic graft-versus-host disease in 43% of the patients. Cumulative incidence of nonrelapse mortality at 1 year was 16% (95% confidence interval, 9%-23%) and significantly lower for patients with a completely matched donor (12% vs 38%; P = .003). The cumulative incidence of relapse at 3 years was 22% (95% confidence interval, 13%-31%) and was influenced by Lille risk profile (low, 14%; intermediate, 22%; and high, 34%; P = .02). The estimated 5-year event-free and overall survival was 51% and 67%, respectively. In a multivariate analysis, age older than 55 years (hazard ratio = 2.70; P = .02) and human leukocyte antigen–mismatched donor (hazard ratio = 3.04; P = .006) remained significant factors for survival. The study was registered at www.clinicaltrials.gov as #NCT 00599547.

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Donor-derived CMV-specific T cells reduce the requirement for CMV-directed pharmacotherapy after allogeneic stem cell transplantation

Blood ◽

10.1182/blood-2012-08-448977 ◽

2013 ◽

Vol 121 (18) ◽

pp. 3745-3758 ◽

Cited By ~ 136

Author(s):

Emily Blyth ◽

Leighton Clancy ◽

Renee Simms ◽

Chun K. K. Ma ◽

Jane Burgess ◽

...

Keyword(s):

T Cells ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Graft Versus Host Disease ◽

Allogeneic Stem Cell Transplantation ◽

Organ Damage ◽

Host Disease ◽

Graft Versus Host ◽

Key Points

Key Points Infusion of CMV-specific T cells early posttransplant does not increase acute or chronic graft-versus-host disease. CMV-specific T cells early posttransplant reduce the need for pharmacotherapy without increased rates of CMV-related organ damage.

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