scholarly journals Glucagon-Like Peptide-1 Is Associated With Systemic Inflammation in Pediatric Patients Treated With Hematopoietic Stem Cell Transplantation

2021 ◽  
Vol 12 ◽  
Author(s):  
Maria Ebbesen ◽  
Hannelouise Kissow ◽  
Bolette Hartmann ◽  
Katrine Kielsen ◽  
Kaspar Sørensen ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Systemic Inflammation ◽  
Pediatric Patients ◽  
Conditioning Regimen ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) are challenged with severe side effects, which are propagated by mucosal barrier disruption, and the related microbial translocation and systemic inflammation. Glucagon-like peptide-1 (GLP-1), a well-known incretin hormone, possesses anti-inflammatory properties and promotes regeneration of damaged intestinal epithelium in animal studies. We hypothesized that the immense inter-individual variation in the degree of mucosal damage and systemic inflammation, seen after HSCT is influenced by endogenous GLP-1 and could be related to acute post-transplant complications. In this prospective study we measured serial weekly fasting plasma GLP-1, along with C-reactive protein (CRP), and citrulline in 82 pediatric patients during allogeneic HSCT together with a fasting plasma GLP-1 in sex- and age-matched healthy controls. Overall, GLP-1 levels were increased in the patients during the course of HSCT compared with the controls, but tended to decrease post-transplant, most pronounced in patients receiving high-intensity conditioning regimen. The increase in CRP seen in the early post-transplant phase was significantly lower from day +8 to +13 in patients with GLP-1 above the upper quartile (>10 pmol/L) at day 0 (all P ≤ 0.03). Similar findings were seen for peak CRP levels after adjusting for type of conditioning (-47.0%; 95% CI, -8.1 – -69.4%, P = 0.02). Citrulline declined significantly following the transplantation illustrating a decrease in viable enterocytes, most evident in patients receiving high-intensity conditioning regimen. GLP-1 levels at day 0 associated with the recovery rate of citrulline from day 0 to +21 (34 percentage points (pp)/GLP-1 doubling; 95% CI, 10 – 58pp; P = 0. 008) and day 0 to day +90 (48 pp/GLP-1 doubling; 95% CI, 17 – 79pp; P = 0. 004), also after adjustment for type of conditioning. This translated into a reduced risk of acute graft-versus-host disease (aGvHD) in patients with highest day 0 GLP-1 levels (>10 pmol/L) (cause-specific HR: 0.3; 95% CI, 0.2 – 0.9, P = 0.02). In conclusion, this study strongly suggests that GLP-1 influences regeneration of injured epithelial barriers and ameliorates inflammatory responses in the early post-transplant phase.

Genetic Determinants of Busulfan Clearance and Outcomes in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplantation- Result of a Multicentric Prospective Study on Behalf of the Pediatric Disease Working Party of the European Blood and Marrow Transplantation Group

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 424-424
Author(s):  
Marc Ansari ◽  
M A Rezgui ◽  
Chakradhara Rao S Uppugunduri ◽  
Yves Théoret ◽  
Yves Chalandon ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Clinical Outcomes ◽  
Dose Adjustment ◽  
Null Allele ◽  
Pediatric Patients ◽  
Conditioning Regimen ◽  
The Other ◽  
Hematopoietic Stem

Abstract Busulfan (BU) dose adjustment following therapeutic drug concentration monitoring improves outcomes of hematopoietic stem cell transplantation (HSCT). Further improvement could be achieved through genotype-based BU dose adjustments. Studies with large and homogeneous samples are essential to establish the utility of genetic factors as a predictor of BU dose and outcomes of HSCT. In this multicentric study, we included 139 children aged between 0.1 to 19.9 years (65 females) receiving BU based myeloablative conditioning regimen prior to allogeneic HSCT. Genetic predictors of BU plasma levels, dose adjustment, and clinical outcomes post HSCT were prospectively evaluated. Patients received BU in a conventional 6 h dosing schedule as a two hours infusion for four days in combination with cyclophosphamide (CY; n=106), or CY and etoposide (15) or melphalan and CY (15).The remaining patients received BU with melphalan (2) or fludarabine (1). BU first dose pharmacokinetic parameters (PKs) in patients were estimated and were adjusted to steady state concentrations (Css) of 600-900 ng/mL. All the patients were genotyped for defining GSTA1*A1,*A2, *B1 and *B2 haplotypes, GSTM1, GSTT1 null alleles, CYP2C9*2,*3, CYP2C19*2,*17, CYP2B6*5, *9 and GSTP1 1578A>G, GSTP1 2293 C>T polymorphisms. Standard criteria were followed for defining clinical outcomes of HSCT such as neutrophil recovery, platelet recovery, acute graft versus host disease (aGvHD), sinusoidal obstruction syndrome (SOS), event-free survival (EFS), non-relapse mortality (NRM), hemorrhagic cystitis (HC), and graft failure (Ther Drug Monit. 2014;36:93-9; Bone Marrow Transplant. 2013; 48:939-46; Pharmacogenomics J. 2014; 14:263-71). PKs such as BU clearance (CL), area under the curve concentration (AUC), and Css were compared among genotype groups using non-parametric tests. The PKs and genetic variants or haplotypes were also associated with the clinical outcomes individually or in combinations in both univariate and multivariate analysis. Statistical significance was set at p<0.05. Higher BU CL, and lower AUC and Css levels were seen in GSTA1*A2 carriers compared to the other patients (p<0.05). The effect was more apparent in patients with malignancies (n=86; p<0.02) and in females (n=65; p<0.01). Patients with two GSTA1*A2 copies needed a higher BU dose adjustment than the other patients (p=0.01). Higher incidences of NRM (26.1 vs 5.7 %, p<0.0001) and lower EFS in patients with BU Css above median 631.0 ng/mL (21.4 vs 55.1%, p<0.0001, 70 patients had first dose Css above 631 ng/mL) has also been documented. Higher frequency of SOS was seen in individuals with two copies of GSTA1*B haplotype (28.6 Vs 8.6%; p=0.02). Higher incidences of aGVHD grade I-IV was seen in homozygous carriers of GSTA1*B haplotype (61.5 vs 30.4 %; p=0.008) and seems to be further increased in patients having also GSTP1 1578 GG genotype (75% Vs 32.2 %; p=0.006). Patients with malignancies carrying both GSTM1 and T1 null genotype had lower EFS compared to the remaining patients (n=86; 11.1 vs 59.7 %, p<0.0001). Higher incidences of HC before day 30 was seen in individuals with GSTM1 functional alleles compared to null allele carriers (n=138; 23.4 Vs 8.2 %; p=0.01) and was further potentiated through interaction with CYP2C9 (n=104; 25.7 Vs 5.8 %; p=0.004). In pediatric patients receiving conditioning regimen based on two alkylating agents with BU as one of the components, dosing algorithms for BU based on demographics and GSTA1 haplotype may improve the outcomes of HSCT. These observations also indicate that therapeutic window of BU in children might not be similar to that of adult patients especially in GSTM1 and T1 null allele carriers. This data also highlight that presence of both GSTM1 and T1 null genotypes are the independent risk factors for the occurrence of events in malignant patients receiving HSCT. Disclosures No relevant conflicts of interest to declare.

Influence Of GST Gene Polymorphisms On Busulfan Pharmacokinetics and Outcome Of Hematopoietic Stem Cell Transplantation In Thalassemia Pediatric Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2052-2052
Author(s):  
Marc Ansari ◽  
Aziz Resgui ◽  
Patricia Huezo-Diaz ◽  
Sarah Marktel ◽  
Michel Duval ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Graft Failure ◽  
Pediatric Patients ◽  
Acute Gvhd ◽  
Gene Dosage ◽  
Conditioning Regimen ◽  
Gene Dosage Effect ◽  
Hematopoietic Stem

Abstract Introduction The only curative therapy for thalassemia remains the replacement of the defective erythropoiesis by allogeneic hematopoietic stem cell transplantation (HSCT). Although largely successful, HSCT can have serious adverse effects such as; veno-occlusive disease (VOD), graft failure and graft versus host disease (GVHD) associated mainly with the conditioning regimen. Most commonly used conditioning regimens in children comprise the alkylating agent busulfan (BU). Interindividual differences in Bu pharmacokinetics (PK) have been observed and may be an important cause of resistance to treatment and toxicity. It has been hypothesized that some of this variability in treatment might be predicted by genetic variants of enzymes involved in the metabolism of BU. Identifying pharmacogenetic determinants of BU may allow for prospective identification of patients with suboptimal drug responses allowing for complementation of traditional treatment protocols by genotype-based BU dose adjustment. Since BU is mainly metabolized by glutathione S-transferase (GST), we studied the relationship between functional variants within GSTA1, GSTM1 and first dose pharmacokinetics (PK) and outcomes of intravenous (IV) busulfan (Bu). Methods The study was performed on 44 thalassemia (thalassemia major = 35 and thalassemia intermediate = 9) pediatric patients (median age = 8, Female = 47.7%) of Middle Eastern origin, who underwent allogeneic HSCT with IV BU as part of a myeloablative-conditioning regimen. According to the standard, 5 different IV Bu doses were given based on weight: 1.0mg/kg for <9 kg, 1.2 mg/kg for 9-16 kg, 1.1 mg/kg for 16-23 kg, 0.95 mg/kg for 23-34 kg, and 0.8 mg/kg for >34 kg. Bu was administered as a 2-hour IV infusion every 6 hours for a total of 16 doses from day -9 to day -6. Bu levels following the first Bu dose were measured using an established analytical method and the PK parameters were estimated using non-compartmental analysis. Bu dose levels were adjusted at dose 4 to achieve Bu Css of 600-900 ng/mL. Genomic DNA collected prior to myeloablation was used for genotyping GSTM1 del by gel electrophoresis and GSTA1promoter variants (-69C>T, -513T>C, -631T>G and -1142) by allele-specific oligonucleotide hybridization. Statistical analysis was performed by using Linear regression to test gene-dosage effect and to assess the effect on genotype on (maximum concentration (Cmax), area under the curve (AUC), Css and Clearance (CL) in a univariate model. The cumulative incidence of aGVHD in relation to GST genotypes was estimated by one-survival curves using Kaplan-Meier analysis and log-rank test. Univariate Cox regression analysis was used to estimate hazard ratio (HR) with 95% confidence interval (CI). Results Neutrophil, platelet recoveries, grade 1-4 acute GVHD, grade 2-4 acute GVHD and VOD incidences were 93.2%, 88.6%, 34.1%, 11.4% and 2% respectively. Overall survival rate was 90.9%, events free survival was 84%, while 13.6% of patients had primary and secondary graft failure. Gene-dosage effect between GSTA1 T-69 and G-1142 alleles (defining haplotypes *B and *B1, respectively) and higher Bu exposure (higher Bu levels, p≤ 0.001 and lower clearance, p=0.001) was seen. An association was also seen with GSTM1, where patients with GSTM1 null genotype had a higher occurrence of GVHD grade 1-4 (p=0.01), see Figure 1. Discussion/Conclusion A strong association between GSTA1*B and BU PK was observed in accordance with the functionality of this variant and our previous analysis in a different patient cohort. We were unable to test whether this variant increases BU related-VOD due to the low VOD cases. GSTA1 and GSTM1 variants could potentially open the possibility to tailor first Bu dose according to patient genetics. Disclosures: No relevant conflicts of interest to declare.

scholarly journals IMMUNITY TO INFECTIONS AFTER HAPLOIDENTICAL HEMATOPOIETIC STEM CELL TRANSPLANTATION

2016 ◽  
Vol 8 ◽  
pp. 2016057 ◽  
Author(s):  
Franco Aversa ◽  
Lucia Prezioso ◽  
Ilenia Manfra ◽  
Federica Galaverna ◽  
Angelica Spolzino ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
T Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Conditioning Regimen ◽  
Hematopoietic Stem ◽  
Post Transplant

The advantage of using a Human Leukocyte Antigen (HLA)-mismatched related donor is that almost every patient who does not have a HLA-identical donor or who urgently needs hematopoietic stem cell transplantation (HSCT) has at least one family member with whom shares one haplotype (haploidentical) and who is promptly available as a donor. The major challenge of haplo-HSCT is intense bi-directional alloreactivity leading to high incidences of graft rejection and graft-versus-host disease (GVHD). Advances in graft processing and in pharmacologic prophylaxis of GVHD have reduced these risks and have made haplo-HSCT a viable alternative for patients lacking a matched donor. Indeed, the haplo-HSCT  has spread to centers worldwide even though some centers have preferred an approach based on T cell depletion of G-CSF-mobilized peripheral blood progenitor cells (PBPCs), others have focused on new strategies for GvHD prevention, such as G-CSF priming of bone marrow and robust post-transplant immune suppression or post-transplant cyclophosphamide (PTCY). Today, the graft can be a megadose of T-cell depleted PBPCs or standard dose of unmanipulated bone marrow and/or PBPCs.  Although haplo-HSCT modalities are based mainly on high intensity conditioning regimens, recently introduced reduced intensity regimens (RIC)   showed promise in decreasing early transplant-related mortality (TRM), and extending the opportunity of HSCT to an elderly population with more comorbidities. Infections are still mostly responsible for toxicity and non-relapse mortality due to prolonged immunosuppression related, or not, to GVHD. Future challenges lie in determining the safest preparative conditioning regimen, minimizing GvHD and promoting rapid and more robust immune reconstitution.

The Outcome of Hematopoietic Stem Cell Transplantation in Pediatric Patients with Hemophagocytic Lymphohistiocytosis in Korea.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5073-5073
Author(s):  
Jae Hee Lee ◽  
Hoi Soo Yoon ◽  
Joon Sup Song ◽  
Ho Jun Im ◽  
Hyung Nam Moon ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Graft Failure ◽  
Pediatric Patients ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Cell Sources ◽  
Conditioning Regimens

Abstract Objective: Chemoimmunotherapy based treatments improved the survival of patients with hemophagocytic lymphohistiocytosis (HLH), but the outcome is still unsatisfactory. We analyzed the outcome of pediatric patients with HLH after hematopoietic stem cell transplantation (HSCT) in a nation-wide HLH registry. Methods: Retrospective nation-wide data recruitment for HLH pediatric patients diagnosed between 1996 and 2005 was carried out by Histiocytosis Working Party of the KSH and KSPHO. Sixteen patients who received HSCT among enrolled 129 pediatric patients with HLH were analyzed for transplant related variables and events. Results: The probability of 3-year survival after HSCT was 81.2% with median follow-up of 27.5 months compared to the 35.2% for patients who were treated with chemoimmunotherapy only (P=0.03). The reasons for HSCT were active disease at 2 months after treatment (n=8), relapsed disease (n=5), and familial HLH (n=3). Eight patients received transplants from matched unrelated donors, 5 from matched siblings and 3 using unrelated cord blood units. Stem cell sources were bone marrow for all the 13 allogeneic transplants other than 3 cord blood transplants. Conditioning regimens were busulphan, cytoxan, and VP-16 with (5) or without (7) antithymocyte globulin (ATG) in 12 patients, fludarabin and melphalan in 3, and other regimen in 1. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine (CSA) + MTX in 11 patients, CSA +MMF in 2, and others in 2. Twelve patients are alive in complete remission state, 3 patients died of infection and graft failure at early post-transplant period, and 1 patient relapsed at post-transplant 30 days. The relapsed patient developed tuberculous encephalitis after retreatment with chemoimmunotherapy, and alive with supportive care. After HSCT, acute GVHD developed in 5 patients, infection in 5, veno-occlusive disease (VOD) in 2, graft failure in 2, and post-transplant lymphoproliferative disease (PTLD) in 1. Acute lymphoblastic leukemia developed in 1 patient about 2 years after HSCT. Variables such as age at diagnosis, etiology of HLH (familial or secondary), central nervous system (CNS) involvement, disease state after 8 weeks of initial treatment, conditioning regimens, and stem cell sources were not associated with significant difference with regard to 3-year overall survival after HSCT. Conclusion: HSCT revealed excellent outcome for patients with familial, relapsed, or severe and persistent secondary HLH in Korean nation-wide HLH registry.

Allogeneic hematopoietic stem cell transplantation for cutaneous T-cell lymphoma (CTCL)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7540-7540
Author(s):  
C. Hosing ◽  
M. Donato ◽  
I. F. Khouri ◽  
D. T. Chu ◽  
D. L. Bethancourt ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Conditioning Regimen ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
Post Transplant ◽  
Treatment Regimens

7540 Background: Patients (pts.) with advanced CTCL have a poor prognosis. There has been limited experience with the use of allogeneic hematopoietic stem cell transplantation (HSCT) in these pts. We report the results of 11 pts. with advanced CTCL/Sezary syndrome who underwent allogeneic HSCT at our institution. Patients and Methods: All pts. signed informed consent. Median age at the time of HSCT was 50.5 years (range, 22–63). There were 8 F/3M. All were diagnosed with stage IV disease. The median number of prior treatment regimens was 5.5 (range, 3–11). Treatment regimens included PUVA, TSEB, ECP, topical therapy, retinoids, bexarotene, denileukin diftitox, and multiagent chemotherapy. Seven pts. had a PR to treatment administered prior to transplantation, 2 pts. were in CRu and 2 pts. had SD. The conditioning regimen was fludarabine (125 mg/m2), melphalan 140 mg/m2 in 8 pts., fludarabine (125 mg/m2), cyclophosphamide (3 g/m2) ± rituximab in 2 pts., and fludarabine (120 mg/m2), busulfan (11.2 mg/m2) in 1 pt. Patients who received unrelated or mismatched related stem cells also received ATG. GVHD prophylaxis was with tacrolimus/methotrexate in all patients. Results: Ten of 11 pts. engrafted with a median time to ANC >500 mm3 of 12 days (range, 8–14). One pt. died at 17 days post transplant without engraftment due to sepsis. One pt. developed autologous reconstitution and underwent a 2nd allogeneic HSCT procedure and remains in CR at 3 years post transplant. Of the remaining 9 pts., 7 achieved full donor chimerism and 2 pts. were mixed chimera. At the time of this report 4 of 11 pts. have died. Cause of death was sepsis in 2, fungal pneumonia in 1, and PD in 1 pt. Three pts. relapsed post transplant, all 3 were induced back in to a CR by tapering of immunosuppression (2) or DLI (1). Overall 7 pts. continue to be alive and remission with a median follow up of 2.9 years (range, 3 months to 4.4 years). Four of 7 pts. have cGVHD requiring treatment (Table). Conclusions: Allogeneic HSCT is an effective therapy for refractory CTCL/SS and merits further evaluation. [Table: see text] No significant financial relationships to disclose.

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