Durable Remission after Prophylactic Donor Lymphocyte Transfusion Following Allogeneic Stem Cell Transplantation with Reduced Conditioning for High-Risk AML and MDS.

Abstract Prophylactic transfusion of donor lymphocytes (pDLT) is an attractive form of maintenance therapy after allogeneic stem cell transplantation in patients with high risk of relapse. However, clinical experience is limited, and disease response is often achieved at the expense of severe graft-versus-host disease (GvHD). We here report our data on pDLT in high-risk AML and MDS. Cells were given within a prospective protocol that contained a sequence of chemotherapy, reduced intensity conditioning for allogeneic transplantation, and pDLT (FLAMSA-regimen). For pDLT, patients had to be in CR at least 120 days from transplantation, off immunosuppression for 30 days, and free of GvHD. 22/86 patients alive at day +120 fulfilled the criteria for pDLT. They had been transplanted for refractory or relapsed leukemia (n=9 each) or in CR1 because of unfavorable cytogenetics (n=4). 14 patients had an unfavorable karyotype, 8 with complex aberrations. Reasons for withholding pDLT in 64 patients included cGvHD or prolonged immunosuppression (n=38), refractory or relapsed leukemia (n=15), refusal of patient or donor (n=4 each), a history of grade IV acute GvHD (n=2), and chronic infections (n=3). The median time from transplant to first pDLT was 167 days (range 120–297). Median follow up of transfused patients is 696 days (range 209–1341). Ten patients received 1, 6 patients received 2, and 6 patients received 3 transfusions in escalating doses, containing a median of 1x106, 5x106 and 1x107 CD3+ cells/kg at pDLT 1, 2 and 3, respectively. Reasons for giving less than 3 transfusions were GvHD, relapse or refusal of the patient. Induction of GvHD was the main complication; grade III acute GvHD developed in 1, and chronic GvHD in 7 patients. So far, 5 patients have relapsed despite pDLT. One died of refractory leukemia, whereas 2 achieved secondary CR following adoptive immunotherapy. Two patients are currently under treatment. At present, 18/22 patients are alive and in CR at a median of 423 days post DLT. The current leukemia free survival at two years from first pDLT is 79%. Nineteen patients were complete chimeras at time of pDLT. pDLT converted mixed into complete bone marrow chimerism in 1, but failed in 2 cases. In our experience, pDLT is safe after allogeneic transplantation for high risk AML, when given at low doses and to a selected group of patients. Results are encouraging, and long term survival can be achieved. However, further studies need to define more precisely the contribution of pDLT to the therapeutic effect of the entire procedure.

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Effect of Rituximab on the Incidence of GVHD in Lymphoma Patients who Received the BEAM-Conditioning and an Allogeneic Stem Cell Transplantation.

Blood ◽

10.1182/blood.v104.11.4980.4980 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4980-4980

Author(s):

Issa F. Khouri ◽

Rima M. Saliba ◽

Daniel R. Couriel ◽

Grace-Julia Okoroji ◽

Sandra Acholonu ◽

...

Keyword(s):

Stem Cell ◽

B Cells ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Acute Gvhd ◽

Chronic Gvhd ◽

Conditioning Regimen ◽

Control Group ◽

Study Group

Abstract It has been postulated that B cells functioning as antigen-presenting cells may have an important role in the pathogenesis of GVHD. Depletion of donor cells from B-cells resulted in a low incidence of GVHD in mouse model (Schultz et al. BMT1995:16:289–289). More recently, we observed a lower incidence of chronic (and to a lesser extent acute GVHD) in patients with CLL who received an allogeneic stem cell transplantation after a non-myeloablative conditioning regimen containing rituximab (Exp Hematol32:28–35, 2004). The purpose of this study is to investigate the effect of rituximab on GVHD in the setting of a more intense chemotherapy with BEAM, in patients who received an allogeneic peripheral blood stem cell from HLA-identical siblings. To test this hypothesis, we retrospectively studied 11 consecutive patients with non-Hodgkin’s lymphoma who received BEAM/Rituximab at the M. D. Anderson Cancer Center. We attempted to match these patients by age, donor-recipient gender, and donor-recipient CMV reactivity to a historical control of 44 patients with lymphoma, who received BEAM alone as a conditioning regimen, without the Rituximab. Tacrolimus and methotrexate were used for GVHD prophylaxis in both groups. A total of 10 patients in the study group, could be matched with 19 patients in the control group and were included in the final analysis. The outcome of the 2 groups is shown below: Rituximab-Study Group Control Group -value P No. of patients 10 19 Median age 41 44 0.4 (range) (19–55) (19–60) Patient-Donor sex-matched 9(82%) 18(95%) 0.6 Median # CD34 + cells infused (106/kg) 5.1 4.73 0.1 Patient or Donor CMV+ 9(82%) 18(95%) 0.6 Patient and Donor CMV − 1(10%) 1(5%) Median # prior chemoregimens 3 3 0.9 range (1–8) (1–9) Median follow-up 17 38 range (8–48) (27–77) Acute GVHD 2–4 (n,%) 5(50%) 7(37%) 0.5 Acute GVHD 3–4 (n,%) 3(30%) 5(26%) 0.6 Chronic GVHD (n, % cumulative incidence) 8 (90% + 15) 10 (53% + 12 0.01 Our data suggest that the described protective effect of Rituximab against GVHD in mouse models or in the setting of non-myeloablative allogeneic transplantation, may be overcome by the BEAM. This more intense conditioning regimen may induce more GVHD by enhancing T-cell cytokines release and by causing more gastrointestinal toxicity, thus allowing for a greater antigen presentation.

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High-Dose Rituximab in the Conditioning Regimen Before Allogeneic Stem Cell Transplantation Reduces the Incidence of Acute Gvhd in B-Cell Lymphomas

Blood ◽

10.1182/blood.v118.21.4546.4546 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4546-4546

Author(s):

Paolo Corradini ◽

Barbara Sarina ◽

Cristiana Carniti ◽

Francesca Patriarca ◽

Angelo Michele Carella ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

B Cell ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Immune Reconstitution ◽

Acute Gvhd ◽

Chronic Gvhd ◽

High Dose ◽

Unrelated Donors

Abstract Abstract 4546 Background: Reduced-intensity conditioning (RIC) followed by allogeneic stem cell transplantation (alloSCT) is an effective salvage therapy for relapsed lymphomas. The present GITMO study is a prospective multicenter phase II trial for patients affected by relapsed CD20 positive lymphomas. Compared with the previous thiotepa/fludarabine/cyclophosphamide GITMO protocol (Leukemia 2007), the thiotepa dose is increased, and high-dose Rituximab is included in the regimen to improve the outcome and possibly modulate the incidence of acute GVHD. Aims: Primary end-point was 1-year progression-free survival; secondary endpoints were non-relapse mortality and incidence of acute and chronic GVHD. Methods: Fifty-seven patients (pts) were enrolled so far in the study and 49 are evaluable for analysis. Treatment plan consisted of high-dose R (500 mg/ms on day -6) followed by thiotepa (12 mg/kg), fludarabine (60 mg/kg) and cyclophosphamide (60 mg/kg). Graft-versus-host disease (GVHD) prophylaxis included cyclosporine and mini-methotrexate; ATG (7.5 mk/kg) was only added for pts allografted from one antigen mismatched sibling or unrelated donors. Histopathological subtypes included 24 aggressive (HG) (n= 17 diffuse large B-cell lymphomas, n= 7 mantle cell lymphomas) and 25 indolent lymphomas (LG) (n= 13 follicular lymphomas, n= 12 small lymphocytic/chronic lymphocytic leukemia). Patients were allografted from related siblings (SIB) (n= 32 matched, n=1 one single mismatched) or unrelated donors (UD) (n=11 matched, n=5 mismatched). All the pts had chemosensitive disease (n=20, 41% in complete remission) and 26 (53%) came from a failed autoSCT. Results: At a median follow-up of 13 months (range, 5–44 months), 36 pts are alive [n=27 (75%) in CR] and 13 died from any cause [n=6 for non-relapse mortality (NRM), n=7 for disease progression]. All the patients engrafted (94% had full donor chimerism at 3 months). The cumulative incidence (CI) of NRM was 13% at 1 year: 9% vs 19% for SIB and MUD (p=0.3), and 9% versus 16% for for LG and HG (p=0.3), respectively. In total only 11 of 49 pts had acute GVHD (n=8 grade II, n=3 grade III) with an estimated CI of 21% at 100 days. In the previous GITMO study the incidence was 35% with SIB only. Forty pts are evaluable for chronic GVHD with an estimated CI of 41% and 47% at 1 and 2 year, respectively (n=11 limited, n=3 extensive). Infections after engraftment requiring hospitalization or intravenous treatment were evaluable in 46 pts (n=3 excluded for early death). The overall incidence of infections was 58% (n=27) including 5 pts experienced sepsis and 10 pts pneumonia. Preliminary data on immune-reconstitution at 1 year showed: 1) low number of circulating B cells (median CD19+/ul: 129/ul) with an expansion of naive cells (IgD+, CD27-); 2) the median value of IgM was 89 mg/dl whereas IgG and IgA remained at low levels. The CI of relapse was 26% and 37% at 1 year and 2 years, respectively. In the indolent and aggressive groups, OS estimates at 2 years were 79% (95%CI, 52%-91%) and 61% (95 CI, 38%-77%) and PFS estimates were 53% (95%CI, 23%-76%) and 48% (95% CI, 27%-66%), respectively. Conclusions: The present data suggest that the administration of high-dose R is feasible and causes an unexpected reduction of the incidence of acute GVHD without increasing the NRM and the incidence of severe infections complications. Complete data evaluating the effects of R on immune reconstitution are ongoing. Disclosures: No relevant conflicts of interest to declare.

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Ursodeoxycholic acid for the prevention of hepatic complications in allogeneic stem cell transplantation

Blood ◽

10.1182/blood-2001-12-0159 ◽

2002 ◽

Vol 100 (6) ◽

pp. 1977-1983 ◽

Cited By ~ 159

Author(s):

Tapani Ruutu ◽

Britta Eriksson ◽

Kari Remes ◽

Eeva Juvonen ◽

Liisa Volin ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Ursodeoxycholic Acid ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Acute Gvhd ◽

Chronic Gvhd ◽

Treated Group ◽

Control Group ◽

To Receive

Abstract The role of ursodeoxycholic acid (UDCA) in the prevention of hepatic complications after allogeneic stem cell transplantation was studied in a prospective randomized open-label multicenter trial. A total of 242 patients were allocated to receive (n = 123) or not to receive (n = 119) UDCA in the dose of 12 mg/kg/d orally from the day preceding the conditioning until day 90 after transplantation. In the UDCA-treated group a significantly smaller proportion of patients developed a serum bilirubin level exceeding 50 μM (18 of 123 versus 31 of 119, P = .04), and similarly a smaller proportion of patients exceeded the alanine aminotransferase level of 100 U/L. There was no difference in the incidence of veno-occlusive disease of the liver. Compared to the control group, in the UDCA-treated group there was a nonsignificant trend toward a lower overall incidence of acute graft-versus-host disease (GVHD) and a significantly lower incidence of grade III to IV acute GVHD (5 of 123 versus 17 of 119,P = .01), stage II to IV liver and intestinal GVHD, and stage III to IV skin GVHD. There was no difference in the incidence of chronic GVHD or in the relapse rate. Among the patients given UDCA, the survival at 1 year was significantly better, 71% versus 55% (P = .02), and the nonrelapse mortality rate was lower, 19% versus 34% (P = .01), than in the control group. There were significantly more deaths in GVHD in the control group. In conclusion, UDCA administration reduced hepatic problems and severe acute GVHD and improved survival. These results suggest a role for UDCA in the prevention of transplant-related complications in allogeneic transplantation.

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Comparable Results with Treosulfan Based Conditioning Regimen in Matched Related and Matched Unrelated Donor Transplants for Beta Thalassemia Major and the Challenges from India: A Single Center Experience

Blood ◽

10.1182/blood.v126.23.4315.4315 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4315-4315

Author(s):

M Joseph John ◽

Amrith Mathew ◽

Chepsy C Philip

Keyword(s):

Stem Cell ◽

High Risk ◽

Stem Cell Transplantation ◽

Risk Stratification ◽

Cell Transplantation ◽

Acute Gvhd ◽

Chronic Gvhd ◽

Thalassemia Major ◽

Unrelated Donor ◽

Matched Unrelated Donor

Abstract Background: Hematopoietic stem cell transplantation (HSCT) is the only curative treatment for patients with thalassemia major. Majority of the patients undergoing transplants in India belongs to advanced Pesaro risk stratification and 2013 data from India using treosulfan based conditioning for matched related donor transplants (MRD) has showed an event free survival of 78.8 ± 6.0 at 3 years (Mathews et al. Plos One 2013). Advanced age and risk stratification is a deterrent in proceeding with matched unrelated donor (MUD) transplant in India. Since only 25-30 % of patients are likely to get a MRD, MUD transplant is a feasible option in the background of limited life expectancy in patients with thalassemia major. However, there is no data comparing MRD and matched unrelated donor (MUD) transplants from India. Method: This is a retrospective analysis to compare the outcomes between MRD and MUD transplants from a single institution. Events were defined as primary graft failure, graft rejection leading to recurrence of transfusion dependence or death. Results: A total of 123 patients with thalassemia major underwent MUD search in DKMS and DATRI registries. Fifteen (12%) and 13 (10%) patients found 10/10 HLA identical donors respectively and 4 (3%) of them had matches in both the registries. Very few patients underwent NMDP search due to cost constraints. Among the 36 patients who underwent stem cell transplantation, MRD group had 27 patients and MUD group has 9 patients. Base line characteristics of age, sex and Pesaro risk stratification were matched. (Table: 1) Majority of patients belonged to high risk category in both the groups. The conditioning regimens used in both the groups were thiotepa, fludarabine, and treosulfan (TreoFluT). All the MRD non-sibling transplants and MUD transplants also received antithymocyte globulin (ATG) as part of the conditioning regimen. All patients received HLA identical (10/10) grafts. In the MRD group, the stem cell source was 24 (89%), 2 (7%) and 1 (4%) from sibling, parent and 1st cousin respectively. The MUD grafts were procured from 3 different registries DKMS (German) 5 (56%), NMDP (US) 2 (22%) and DATRI (Indian) 2 (22%). Cyclosporine and short course methotrexate were used as Graft versus host disease (GVHD) prophylaxis in all the patients Multiple challenges are involved in the availability and procurement of donor grafts from different registries. A special DCGI (Drug controller General of India) approval needs to be taken for every graft source procured from overseas. The estimated average cost of MRD transplant is 24000 US$ and MUD transplant is 48000 US$ for DKMS and DATRI grafts and 78000 US$ for NMDP grafts. Inspite of lower costs than the western countries, affordability is a major concern even if matched donors are available. Overall survival at 1 year in MRD and MUD groups was 84.3 ± 7.2% and 88.9 ± 10.5% at a median follow up of 20 (0-57) months and 13 (1-31) months respectively (p= 0.799) (Fig:1). The thalassemia free survival at 1 year was 84.3 ± 7.2% and 77.8 ± 13.9% with a median follow up of 20 (0-57) and 12 (1-31) months respectively (p= 0.732). (Fig: 2). Conclusion: Although the incidence of acute GVHD and chronic GVHD incidence are higher in the MUD transplant group, TreoFluT based conditioning for allogeneic stem cell transplantation with both matched related and unrelated donor graft source is a feasible option in beta thalassemia major patients even in high risk category from developing countries. Table 1. Patient demographics and transplant characteristics MRD (n= 27) n(%) Median(range)Mean ± SD MUD n=9 n(%) Median(range)Mean ± SD P-value Age (yrs) 10 (2-18) 9 (2-18) 0.502 Sex: Male 19 (70) 6 (66) 0.835 Class I 1 (4) 2 (22) 0.135 Class II 6 (22) 3 (33) Class III 20 (74) 4 (44) Class III Vellore high risk 11 (55) 3 (75) 0.693 Stem cell source PBSC BM BM + CB BM + PBSC + CB 23 (85) 2 (7) 1 (4) 1 (4) 7 (78) 2 (22) 0 0 0.599 Cell dose MNC/TNC x 108/Kg CD34 x 106/Kg 8.04 (3.49 -14.6) 5.91 (0.23 -27.75) 7.2 (2.83 -10.47) 8.47 (0.49 -21.6) 0.782 0.381 Acute GVHD 6 (22) 6 (66) 0.014 Grades I and II 5 (19) 4 (44) 0.505 Grades III and IV 1 (4) 2 (22) Classic acute GVHD 5 (18) 3 (33) 0.287 Persistent 0 0 Recurrent 0 3 (33) Late onset 1 (4) 0 Chronic GVHD 6 (22) 6 (67) 0.014 Classic Chronic GVH 5 (18) 3 (33) 0.545 Overlap syndrome 1 (4) 3 (33) Disclosures No relevant conflicts of interest to declare.

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Repetitively Administered Low-Dose Donor Lymphocyte Infusion for Prevention of Relapse after Allogeneic Stem Cell Transplantation in Patients with High-Risk Acute Leukemia

Cancers ◽

10.3390/cancers13112699 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2699

Author(s):

Panagiotis Tsirigotis ◽

Konstantinos Gkirkas ◽

Vassiliki Kitsiou ◽

Spiros Chondropoulos ◽

Theofilos Athanassiades ◽

...

Keyword(s):

Stem Cell ◽

High Risk ◽

Stem Cell Transplantation ◽

Acute Leukemia ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Cumulative Incidence ◽

Low Dose ◽

Acute Gvhd ◽

Donor Lymphocyte Infusion

Background: Patients with high-risk acute leukemia have a high risk of relapse after allogeneic stem cell transplantation (allo-SCT). In an effort to reduce the relapse rate, various therapeutic methods have been implemented into clinical practice. Among them, prophylactic donor lymphocyte infusion (pro-DLI) has shown significant efficacy. However, the widespread application of pro-DLI has been restricted mostly due to concerns regarding the development of graft versus host disease (GVHD). In the present study, we tested the safety and efficacy of a novel method of prophylactic-DLI based by repetitive administration of low lymphocyte doses. Methods: DLI was administered to patients with high-risk acute leukemia at a dose of 2 × 106/kg CD3-positive cells. DLI at the same dose was repeated every two months for at least 36 months post-allo-SCT, or until relapse or any clinical or laboratory feature suggested GVHD, whichever occurred first. Forty-four patients with a median age of 53 years (range 20–67) who underwent allo-SCT between 2011 and 2020 were included in our study. Thirty-three patients with high-risk acute myeloid leukemia (AML) and 11 with high-risk acute lymphoblastic leukemia (ALL) after allo-SCT from a matched sibling (MSD, no = 38 pts) or a matched-unrelated donor (MUD, no = 6 pts) received pro-DLI. Twenty-three patients were in CR1, all with unfavorable genetic features; 12 patients were in CR2 or beyond; and 9 patients had refractory disease at the time of transplant. Ten out of 23 patients in CR1 had detectable minimal residual disease (MRD) at the time of allo-SCT. Disease risk index (DRI) was high and intermediate in 21 and 23 patients, respectively. Conditioning was myeloablative (MAC) in 36 and reduced intensity (RIC) in 8 patients, while GVHD prophylaxis consisted of cyclosporine-A in combination with low-dose alemtuzumab in 39 patients or with low-dose MTX in 5 patients, respectively. Results: Thirty-five patients completed the scheduled treatment and received a median of 8 DLI doses (range 1–35). Fifteen out of 35 patients received all planned doses, while DLI was discontinued in 20 patients. Reasons for discontinuation included GVHD development in nine, donor unavailability in seven, disease relapse in three, and secondary malignancy in one patient, respectively. Nine patients were still on treatment with DLI, and they received a median of four (range 2–12) doses. Fourteen percent of patients developed transient grade-II acute GVHD while 12% developed chronic GVHD post-DLI administration. Acute GVHD was managed successfully with short course steroids, and four out of five patients with cGVHD were disease-free and off immunosuppression. With a median follow-up of 44 months (range 8–120), relapse-free (RFS) and overall survival (OS) were 74%, (95% CI, 54–87%) and 78%, (95% CI, 58–89%) respectively, while the cumulative incidence of non-relapse mortality (NRM) was 13% (95% CI, 4–28%). The cumulative incidence of relapse in patients with intermediate and high DRI is 7% and 15%, respectively. Conclusion: Prolonged—up to three years—low-dose pro-DLI administered every two months is safe and effective in reducing relapse rate in patients with high-risk acute leukemia. The low-dose repetitive administration DLI strategy reduced the risk of DLI-mediated GVHD, while the prolonged repeated administration helped in preventing relapse, possibly by inducing a sustained and prolonged immunological pressure on residual leukemic cells. This novel strategy deserves testing in larger cohort of patients with high-risk acute leukemia.

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Repetitive Infusions of Cytokine-Induced Killer (CIK) Cells for Treatment of Impending Relapse in High-Risk Leukemia Patients after Allogeneic Stem Cell Transplantation

Blood ◽

10.1182/blood.v124.21.2438.2438 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2438-2438

Author(s):

Eva Rettinger ◽

Sabine Huenecke ◽

Verena Pfirrmann ◽

Michael Merker ◽

Andre Manfred Willasch ◽

...

Keyword(s):

T Cells ◽

Stem Cell ◽

High Risk ◽

Complete Remission ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Acute Gvhd ◽

Cik Cells ◽

Cik Cell

Abstract Introduction: Allogeneic stem cell transplantation (SCT) is an established treatment option for patients with high-risk leukemias. But the success of this approach is still limited by patients’ relapse. Evidence was presented, that minimal residual disease (MRD) status in principle could be treated by donor lymphocyte infusion (DLI). However, T cells within DLI raise the risk for severe graft versus host disease (GvHD). Cytokine-induced killer (CIK) cells, mainly T cells sharing in part characteristics of natural killer (NK) cells, demonstrated potent non major histocompatibility complex (MHC)-restricted cytotoxicity against hematological malignancies, but displayed negligible alloreactivity in vitro and caused minimal GvHD in vivo. Here, we report our single center experience of repetitive, dose-escalating CIK cell infusions in 12 leukemia patients with impending (n=10) or overt relapse (n=2) after allogeneic SCT. Patients and Methods: Between August 11, 2011 and July 31, 2014 CIK cell infusions approved by the regulatory authorities (Regierungspräsidium Darmstadt, Germany) were given repetitively on compassionate used basis to 12 patients (<18 years of age, n=11, median age 9, range 1-16 years; >18 years of age, n=1, age 69 years) with haematological malignancies (AML, n=6; ALL, n=5; CML, n=1) and evidence of relapse in the absence of acute GvHD >grade I after allogeneic SCT. CIK cells obtained from peripheral blood mononuclear cells of original stem cell donors were generated within 10 days under good manufacturing practice (GMP)-conditions in the presence of interferong, anti-CD3 antibody, interleukin-2 and -15. Results: Altogether 53 CIK cell infusions (median number 3.5, range 1-10 per patient) from matched unrelated (n=6) or haploidentical (n=6) stem cell donors were offered at a minimum of three weeks after allogeneic SCT and an interval of 4-6 weeks between infusions (median follow up after 1st CIK cell infusion 8, range 3-22 months). Patients with overt relapse underwent cytoreductive chemotherapy before infusions. Based on our cumulative experience starting doses of CIK cell infusions were 5x106 CD3+CD56- CIK cells/kg in pediatric and 1x106 CD3+CD56- CIK cells/kg in adult patients. Regardless of donor type, dose escalation continued until a maximal dose of 100x106 CD3+CD56- CIK cells/kg was reached(median dose 10x106, range 0.1-100x106 CD3+CD56- CIK cells/kg). Acute GvHD grade I occurred in two patients after infusions of 1x106 or 5x106 CD3+CD56- CIK cells/kg. Another two patients developed acute GvHD grade III after infusion of 10x106 CD3+CD56-CIK cells/kg, respectively. In 3 patients with relapsed AML CIK cell infusions provided transient remission, but ultimately all three patients relapsed and succumbed to their diseases 8-9 months after first CIK cell infusion. Two patients with ALL and one patient with AML relapsed 2, 5, and 12 months after first CIK cell infusion, respectively. All patients were offered further anti-leukemic treatment including allogeneic SCT. Two AML patients died due to infections 9 and 12 months after the last CIK cell infusion. Both patients were in complete remission at the time of death. Three high-risk patients with ALL and one CML-patient with impending relapse indicated by MRD or BCR/ABL are still in complete remission. Conclusion: In conclusion, allogeneic CIK cell infusions seemed to be very promising and may improve cell-based immune therapies especially in leukemia patients with impending relapse after allogeneic SCT. Disclosures No relevant conflicts of interest to declare.

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Pilot Study of Reduced-Intensity Conditioning Followed by Allogeneic Stem Cell Transplantation in Patients with Myelofibrosis.

Blood ◽

10.1182/blood.v104.11.1512.1512 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1512-1512

Author(s):

Nicolaus Kroeger ◽

Tatjana Zabelina ◽

Heike Schieder ◽

Jens Panse ◽

Francis Ayuk ◽

...

Keyword(s):

Stem Cell ◽

Pilot Study ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Chronic Gvhd ◽

Disease Free Survival ◽

Allogeneic Transplantation ◽

Reduced Intensity Conditioning ◽

Reduced Intensity

Abstract We evaluated in a prospective pilot- study the effect of reduced intensity conditioning with busulfan (10 mg/kg), fludarabine (150 mg/m²) and anti-thymocyte globulin followed by allogeneic stem cell transplantation from related and unrelated donors in 14 patients with myelofibrosis. Study objectives were engraftment, chimerism, treatment- related mortality (TRM) and response. The median age of the patients was 51 (range, 32 – 63) years. According the Lille score there were low risk (n=4), intermediare risk (n= 7) and high risk (n=3) The median time until leukocyte (> 1.0 x 109/l) and platelet (> 20 x 109/l) engraftment was 16 (range, 11 – 26) days and 26 (range, 9 – 139) days, respectively. No graft failure occurred. Complete donor chimerism on day 100 was seen in 13 patients (93%). Acute graft-versus host disease (GvHD) grade II-IV occurred in 50% and grade III/IV 29 % of the patients. The incidence of chronic GvHD was 54 %. Two patients died due to treatment complications, resulting in a TRM at one year of 15% (95% CI: 0–35%). Hematological response after allogeneic transplantation was seen in all patients and complete histopathological remission was observed in 90%of patients. After a median follow-up of 13 (range, 3 – 48) months, the 3-years estimated overall and disease-free survival is 85 % (95 % CI: 65–100 %).

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Allogeneic Stem Cell Transplantation in Relapsed/Refractory Multiple Myeloma Treatment: Is It Still Relevant?

Journal of Clinical Medicine ◽

10.3390/jcm9082354 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2354

Author(s):

Hyunkyung Park ◽

Ja Min Byun ◽

Sung-Soo Yoon ◽

Youngil Koh ◽

Dong-Yeop Shin ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

High Risk ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Conditioning Regimen ◽

Optimal Timing ◽

Term Survival ◽

One Year

Background: Despite offering an attractive option, the role of allogeneic stem cell transplantation (alloSCT) for treatment of multiple myeloma (MM) remains unclear. Methods: Recognizing the paucity of data in the Asian population, we retrospectively evaluated the outcomes of 24 patients (median age 52) undergoing alloSCT between April 2003 and November 2017. Results: The median time from diagnosis to alloSCT was 39.4 months. The majority of the patients (70.8%) underwent alloSCT followed by reduced intensity conditioning regimens after a median of five lines of therapy. Among 24 patients, 15 patients (62.5%) had a high-risk MM feature. The two-year relapse-free survival (RFS) and overall survival (OS) of the total patients were 29.2 ± 9.3% and 44.3 ± 10.3%, respectively. Patients who were treated with less chemotherapy lines (<5) before alloSCT had a prolonged RFS and OS. All patients (seven patients) who received a myeloablative conditioning regimen had high-risk features, but two out of seven patients showed long-term survival without lasting sequelae. Nine patients (37.5%) experienced non-relapse mortality (NRM) within one year after alloSCT (the one-year cumulative incidence of NRM was 38.3 ± 10.1%). Conclusion: AlloSCT can still be implemented as effective salvage option in the treatment of relapsed/refractory high-risk MM. The optimal timing of alloSCT remains to be determined.

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Impact of Age on Hospitalization and Readmission on Post Allogeneic Stem Cell Transplantation Outcome, Single Center Experience

Blood ◽

10.1182/blood-2021-146275 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4122-4122

Author(s):

Eshrak Al-Shaibani ◽

Shiyi Chen ◽

Wilson Lam ◽

Arjun Law ◽

Ivan Pasic ◽

...

Keyword(s):

Risk Factors ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Research Funding ◽

Acute Gvhd ◽

Chronic Gvhd ◽

Conditioning Regimen ◽

Hospitalization Period

Abstract Background: Recent advances and improvement of supportive care allowed allogeneic stem cell transplantation (HCT) to be offered to selected older patients. However, data regarding outcome and factors affecting the outcomes are limited. Method: We retrospective analyzed the outcome in 332 patients, median age 65 years (60-76), who underwent HLA-matched related (n=85), matched unrelated (n=205) and haploidentical donor (n=42) HCT, between January 2014 to December 2019. Of these 60% were male. Diagnosis was leukemia: 193, MDS: 76, MF: 46 and others: 17. Graft source was PBSC in 98%. Reduce-intensity conditioning regimen was used in 95%, and in vivo T-cell depleted in 89% of patients. We categorized them to 3 age-groups (G): G1 60-65y, (n=175), G2 >65-70y (n=127), and G3 >70y (n=30).Cox models were used to compare the rates of overall survival (OS), non-relapse mortality( NRM), event free-survival (EFS), length of hospitalization for HCT, GVHD and reasons of re-hospitalization during the first year post HCT. Results: The median follow up was 14 months (range: 1-123 months). Median days of hospitalization during HCT period were 30-days (range: 20-132 days), with trend towards significance when stratified by age group (p=0.049). HCT-CI scores were 0-1 (n=143), 2-3 (n=107) and >3 (n=70). The cumulative incidences of grade II-IV acute-GVHD was 38.3% and 16.3% for grades III-IV. Moderate-severe chronic-GVHD was 23.7%. Increasing age was not associated with increases in acute GVHD (p=0.86) or chronic-GVHD (p= 0.6). Overall, 188 (56%) patients were re-hospitalized within the first 6-month of HCT, and 61 (18%) in the second 6-month period. The 2-year OS rate (Fig 1) were 56% in G1, 53% in G2 and 34% in G3 (p=0.05). The 2-year EFS rate (Fig 2) were 54% for G1, 49% for G2, and 31% for G3 (P=0.04). Cumulative incidence of NRM at 2-year (Fig 3) were 25% in G1, 36% in G2 and 52% in G3 (p=0.008). Further results are illustrated in Table 1. Risk factors such as age, KPS, HCT-CI, donor-type, readmission and GVHD were analyzed for their associations with outcomes using univariate analyses, those with significant results entered in multivariate-analysis Table 2. Patients aged 60-≤65 had significantly better EFS (p=0.04) and associated with a border line significant trend for lower NRM (p=0.05) than those aged >70. Re-admission in the first 6-month post HCT had a significant impact on the OS, EFS and NRM. HCT-CI >3 had significant impact on NRM. Conclusion: Age had a significant impact on hospitalization period during HCT. Age >70 had significant impact on EFS and trend toward higher NRM. HCT-CI, acute and chronic-GVHD and readmission in first 6-month post-HCT were significant risk factors. Readmission in the first 6 months correlated with lower OS, EFS and higher NRM. Acute GVHD III-IV or moderate-severe chronic GVHD associated with poor outcomes. Selecting patients based on HCT-CI, and good management of GVHD and post-HCT complication may improve the clinical outcome. Figure 1 Figure 1. Disclosures Law: Novartis: Consultancy; Actinium Pharmaceuticals: Research Funding. Kim: Bristol-Meier Squibb: Research Funding; Pfizer: Honoraria; Paladin: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Lipton: Bristol Myers Squibb, Ariad, Pfizer, Novartis: Consultancy, Research Funding.

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Chronic graft-versus-host disease after allogeneic blood stem cell transplantation

Blood ◽

10.1182/blood.v98.6.1695 ◽

2001 ◽

Vol 98 (6) ◽

pp. 1695-1700 ◽

Cited By ~ 165

Author(s):

Donna Przepiorka ◽

Paolo Anderlini ◽

Rima Saliba ◽

Karen Cleary ◽

Rakesh Mehra ◽

...

Keyword(s):

Risk Factors ◽

Stem Cell ◽

High Risk ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Acute Gvhd ◽

Chronic Gvhd ◽

Blood Stem Cell ◽

Gvhd Prophylaxis ◽

Blood Stem Cell Transplantation

Abstract The incidence, characteristics, risk factors for, and impact of chronic graft-vs-host disease (GVHD) were evaluated in a consecutive series of 116 evaluable HLA-identical blood stem cell transplant recipients. Minimum follow-up was 18 months. Limited chronic GVHD occurred in 6% (95% confidence interval [CI], 0%-13%), and clinical extensive chronic GVHD in 71% (95% CI, 61%-80%). The cumulative incidence was 57% (95% CI, 48%-66%). In univariate analyses, GVHD prophylaxis other than tacrolimus and methotrexate, prior grades 2 to 4 acute GVHD, use of corticosteroids on day 100, and total nucleated cell dose were significant risk factors for clinical extensive chronic GVHD. On multivariate analysis, GVHD prophylaxis with tacrolimus and methotrexate was associated with a reduced risk of chronic GVHD (hazard ratio [HR], 0.35; P = .001), whereas the risk was increased with prior acute GVHD (HR, 1.67;P = .046). When adjusted for disease status at the time of transplantation, high-risk chronic GVHD had an adverse impact on overall mortality (HR, 6.6; P < .001) and treatment failure (HR, 5.2; P < .001) at 18 months. It was concluded that there is a substantial rate of chronic GVHD after HLA-identical allogeneic blood stem cell transplantation, that clinical factors may alter the risk of chronic GVHD, and that high-risk chronic GVHD adversely affects outcome.

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