Second haploidentical peripheral blood stem cell transplantation for treatment of acute leukemia with relapse after first allogeneic peripheral blood stem cell transplantation

Yeh, Shih-Peng; Lin, Chih-Hung; Chen, T. T.; Lo, W. J.; Lin, Ching-Yuang; Chiu, Chang‐Fang

doi:10.1038/bmt.2015.67

Cited by 9 publications

(2 citation statements)

References 6 publications

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“…This has been particularly relevant with PTCy, given the significant rate of disease relapse observed. Although in our study overall efficacy is difficult to assess given the small [60][61][62][63] . Indeed, in our cohort 42% of patients receiving haploidentical HSCT2 for leukemia relapse after allogeneic transplantation could be rescued, with low rates of NRM.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 94%

Post-transplantation Cyclophosphamide and Sirolimus after Haploidentical Hematopoietic Stem Cell Transplantation Using a Treosulfan-based Myeloablative Conditioning and Peripheral Blood Stem Cells

Cieri

Greco²,

Crucitti

et al. 2015

Biology of Blood and Marrow Transplantation

133

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Haploidentical hematopoietic stem cell transplantation (HSCT) performed using bone marrow (BM) grafts and post-transplantation cyclophosphamide (PTCy) has gained much interest for the excellent toxicity profile after both reduced-intensity and myeloablative conditioning. We investigated, in a cohort of 40 high-risk hematological patients, the feasibility of peripheral blood stem cells grafts after a treosulfan-melphalan myeloablative conditioning, followed by a PTCy and sirolimus-based graft-versus-host disease (GVHD) prophylaxis (Sir-PTCy). Donor engraftment occurred in all patients, with full donor chimerism achieved by day 30. Post-HSCT recovery of lymphocyte subsets was broad and fast, with a median time to CD4 > 200/μL of 41 days. Cumulative incidences of grade II to IV and III-IV acute GVHD were 15% and 7.5%, respectively, and were associated with a significant early increase in circulating regulatory T cells at day 15 after HSCT, with values < 5% being predictive of subsequent GVHD occurrence. The 1-year cumulative incidence of chronic GVHD was 20%. Nonrelapse mortality (NRM) at 100 days and 1 year were 12% and 17%, respectively. With a median follow-up for living patients of 15 months, the estimated 1-year overall and disease-free survival (DFS) was 56% and 48%, respectively. Outcomes were more favorable in patients who underwent transplantation in complete remission (1-year DFS 71%) versus patients who underwent transplantation with active disease (DFS, 34%; P = .01). Overall, myeloablative haploidentical HSCT with peripheral blood stem cells (PBSC) and Sir-PTCy is a feasible treatment option: the low rates of GVHD and NRM as well as the favorable immune reconstitution profile pave the way for a prospective comparative trial comparing BM and PBSC in this specific transplantation setting.

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Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 94%

Post-transplantation Cyclophosphamide and Sirolimus after Haploidentical Hematopoietic Stem Cell Transplantation Using a Treosulfan-based Myeloablative Conditioning and Peripheral Blood Stem Cells

Cieri

Greco²,

Crucitti

et al. 2015

Biology of Blood and Marrow Transplantation

133

View full text Add to dashboard Cite

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“…However, relapse remains the major cause of haplo‐HSCT treatment failure (Kobayashi et al , ; Huang, ; Mo et al , ). Although no standardized therapeutic regimens exist, donor lymphoblastic infusion (DLI) and a second course of haplo‐HSCT are the two main established options for relapsed B‐ALL after haplo‐HSCT (Zeidan et al , ; Yeh et al , ).…”

mentioning

confidence: 99%

Donor‐derivedCD19‐targeted T cell infusion induces minimal residual disease‐negative remission in relapsed B‐cell acute lymphoblastic leukaemia with no response to donor lymphocyte infusions after haploidentical haematopoietic stem cell transplantation

et al. 2017

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Relapse is a common cause of failure in patients with B-cell acute lymphoblastic leukaemia (B-ALL) after haploidentical haematopoietic stem cell transplantation (haplo-HSCT), and non-responders to donor lymphoblastic infusion after HSCT have a very poor prognosis. Although donor-derived CD19-directed chimeric antigen receptor-modified (CAR) T cells can potentially cure leukaemia, their effectiveness and safety have not been confirmed in relapsed B-ALL cases after haplo-HSCT. Between January 2015 and January 2017, two and four patients each received one and two infusions of CAR T cells from haplo-HSCT donors. Five (83·33%) achieved minimal residual disease (MRD)-negative remission; one patient was discharged automatically without evaluation after developing severe thrombotic microangiopathies. Four of five responsive patients relapsed after 2-7 months, and one died of sepsis following MRD-negative remission after a second infusion. None of the other second infusion recipients achieved a second complete remission. Five patients (83·33%) experienced eight courses of grade 1-3 cytokine release syndrome; two were treated with tocilizumab. Two (33·3%) and one patient developed grade 2 and 3 acute graft-versus-host disease (aGVHD), respectively; the former was controlled with glucocorticoids. Donor-derived CAR T-cell infusion seems be effective and safe for relapsed B-ALL after haplo-HSCT, although larger clinical studies are needed.

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Geriatric nutritional risk index as a useful prognostic factor in second allogeneic hematopoietic stem cell transplantation

et al. 2020

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Second haploidentical peripheral blood stem cell transplantation for treatment of acute leukemia with relapse after first allogeneic peripheral blood stem cell transplantation

Cited by 9 publications

References 6 publications

Post-transplantation Cyclophosphamide and Sirolimus after Haploidentical Hematopoietic Stem Cell Transplantation Using a Treosulfan-based Myeloablative Conditioning and Peripheral Blood Stem Cells

Post-transplantation Cyclophosphamide and Sirolimus after Haploidentical Hematopoietic Stem Cell Transplantation Using a Treosulfan-based Myeloablative Conditioning and Peripheral Blood Stem Cells

Donor‐derivedCD19‐targeted T cell infusion induces minimal residual disease‐negative remission in relapsed B‐cell acute lymphoblastic leukaemia with no response to donor lymphocyte infusions after haploidentical haematopoietic stem cell transplantation

Geriatric nutritional risk index as a useful prognostic factor in second allogeneic hematopoietic stem cell transplantation

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