Single cord blood transplantation for acute myeloid leukemia patients aged 60 years or older: a retrospective study in Japan

Isobe, Masamichi; Konuma, Takaaki; Masuko, Masayoshi; Uchida, Naoyuki; Miyakoshi, Shigesaburo; Sugio, Yasuhiro; Yoshida, Shuro; Tanaka, Masatsugu; Matsuhashi, Yoshiko; Hattori, Norimichi; Onizuka, Makoto; Aotsuka, Nobuyuki; Kouzai, Yasuji; Wake, Atsushi; Kimura, Takafumi; Ichinohe, Tatsuo; Atsuta, Yoshiko; Yanada, Masamitsu

doi:10.1007/s00277-021-04464-5

Cited by 8 publications

(4 citation statements)

References 67 publications

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Section: Discussionmentioning

confidence: 99%

“…In these reports, cGVHD may have been associated with multiple organs, but there were also several single-organ cases. The development of severe, new-onset oral mucosal cGVHD > 100 days after cord blood transplantation is rare 6 . Therefore, our patient's symptoms were consid- The oral mucosal epithelium is desquamated (A: hematoxyline and eosin (HE) stain, original magnification 4×) and there is extensive inflammatory cell infiltration (B: HE stain, original magnification 20×).…”

Section: Discussionmentioning

confidence: 99%

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A case of severe oral mucosal GVHD induced by heterologous SARS-CoV-2 vaccination after cord blood transplantation

2023

BCT

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Patients who have undergone hematopoietic cell transplantation (HCT) are at a higher risk of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection than the general population. Therefore, early vaccination is recommended for post-transplant patients. Although exacerbation of chronic graft-versus-host disease (cGVHD) after the initial vaccination has been reported, it is unknown whether severe cGVHD occurs when different RNA vaccines are combined. We treated a patient who developed severe oral mucosal cGVHD after receiving two different RNA vaccines. Visual inspection showed that the patient presented with typical mucocutaneous cGVHD, and cGVHD in this case responded well to low-dose steroids compared to common oral GVHD exacerbations. Histopathological findings revealed T cell, B cell, and conspicuous neutrophil infiltration. Multiple doses of SARS-Cov2 vaccination are required in post-transplant recipients. In conclusion, it is essential to obtain the vaccination history of allo-HSCT recipients with cGVHD exacerbation. Furthermore, reviewing the pathological findings may help treat patients with lower doses of steroids.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A case of severe oral mucosal GVHD induced by heterologous SARS-CoV-2 vaccination after cord blood transplantation

2023

BCT

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“…In combination with a calcineurin inhibitor, mycophenolate mofetil (MMF) is used for the prophylaxis of graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT). Compared to intravenous methotrexate (MTX), MMF is associated with a lower incidence of mucositis and shorter time to hematopoietic engraftment but comparable incidence of acute GVHD 1 - 3 , resulting in the preferred use of MMF for GVHD prophylaxis in elderly patients 4 - 6 or those undergoing cord blood transplantation (CBT) 5 - 8 . In contrast to other countries, MMF has only been approved as an oral formulation in Japan.…”

Section: Introductionmentioning

confidence: 99%

Influence of interruption of oral mycophenolate mofetil for graft-versus-host disease prophylaxis on outcomes after single cord blood transplantation

2024

BCT

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Mycophenolate mofetil (MMF), in combination with a calcineurin inhibitor, is used as the prophylaxis for graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT). Compared to intravenous methotrexate (MTX), MMF is associated with a lower incidence of mucositis and shorter time for hematopoietic engraftment but comparable incidence of acute GVHD, resulting in the preferred use of MMF for GVHD prophylaxis in elderly patients or those undergoing cord blood transplantation (CBT). Although several studies have evaluated the clinical impact of MTX omission due to toxicity after allogeneic HCT, the impact of oral MMF interruption for GVHD prophylaxis on transplant outcomes remains unclear. Therefore, in this study, we retrospectively analyzed the consecutive data of adult patients who underwent single-unit unrelated CBT and received oral MMF in combination with cyclosporine for GVHD prophylaxis at our hospital. Among the 53 patients, the planned dose of MMF was interrupted in 14 with a median of 19.5 d (range, 3-27 d) of CBT. In multivariate analysis, MMF interruption, which was treated as a time-dependent covariate, was significantly associated with poorer overall survival (hazard ratio [HR], 5.41; 95% confidence interval [CI], 2.03-14.43; P < 0.001) and higher non-relapse mortality (HR, 7.56; 95% CI, 1.99-28.79; P = 0.002). Further studies with larger cohorts are necessary to confirm the clinical significance of oral MMF interruption in GVHD prophylaxis.

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“…However, only 30% of patients requiring HSCT can find HLA-matched related donors (3,4). Umbilical cord blood is a potential source of hematopoietic stem cells (HSCs) for allogeneic transplantation and is associated with relevant biological and immunological characteristics such as low immunogenicity and highly proliferative nature of the constituent HSCs and hematopoietic progenitor cells (5)(6)(7)(8). Furthermore, umbilical cord blood collection is easy and harmless to the donor.…”

Section: Introductionmentioning

confidence: 99%

Dynamic comparison of early immune reactions and immune cell reconstitution after umbilical cord blood transplantation and peripheral blood stem cell transplantation

et al. 2023

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Umbilical cord blood transplantation (UCBT) and peripheral blood stem cell transplantation (PBSCT) are effective allogeneic treatments for patients with malignant and non-malignant refractory hematological diseases. However, the differences in the immune cell reconstitution and the immune reactions during initial stages post-transplantation are not well established between UCBT and PBSCT. Therefore, in this study, we analyzed the differences in the immune reactions during the early stages (days 7-100 post-transplantation) such as pre-engraftment syndrome (PES), engraftment syndrome (ES), and acute graft-versus-host disease (aGVHD) and the immune cell reconstitution between the UCBT and the PBSCT group of patients. We enrolled a cohort of patients that underwent UCBT or PBSCT and healthy controls (n=25 each) and evaluated their peripheral blood mononuclear cell (PBMC) samples and plasma cytokine (IL-10 and GM-CSF) levels using flow cytometry and ELISA, respectively. Our results showed that the incidences of early immune reactions such as PES, ES, and aGVHD were significantly higher in the UCBT group compared to the PBSCT group. Furthermore, in comparison with the PBSCT group, the UCBT group showed higher proportion and numbers of naïve CD4+ T cells, lower proportion and numbers of Tregs, higher proportion of CD8+ T cells with increased activity, and higher proportion of mature CD56dim CD16+ NK cells during the early stages post-transplantation. Moreover, the plasma levels of GM-CSF were significantly higher in the UCBT group compared to the PBSCT group in the third week after transplantation. Overall, our findings demonstrated significant differences in the post-transplantation immune cell reconstitution between the UCBT and the PBSCT group of patients. These characteristics were associated with significant differences between the UCBT and the PBSCT groups regarding the incidences of immune reactions during the early stages post transplantation.

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Single cord blood transplantation for acute myeloid leukemia patients aged 60 years or older: a retrospective study in Japan

Cited by 8 publications

References 67 publications

A case of severe oral mucosal GVHD induced by heterologous SARS-CoV-2 vaccination after cord blood transplantation

A case of severe oral mucosal GVHD induced by heterologous SARS-CoV-2 vaccination after cord blood transplantation

Influence of interruption of oral mycophenolate mofetil for graft-versus-host disease prophylaxis on outcomes after single cord blood transplantation

Dynamic comparison of early immune reactions and immune cell reconstitution after umbilical cord blood transplantation and peripheral blood stem cell transplantation

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