Unique Reduced-Intensity Conditioning Haploidentical Peripheral Blood Stem Cell Transplantation Protocol for Patients with Hematologic Malignancy

•A unique reduced-intensity conditioning (RIC)-haploidentical (haplo)-high-dose peripheral blood stem cell transplantation (HDPSCT) protocol did not lead to a high incidence of acute graft-versus-host disease (GVHD).•The unique RIC-haplo-HDPSCT protocol was associated with improved engraftment and s...

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Veröffentlicht in:Transplantation and cellular therapy 2023-05, Vol.29 (5), p.331.e1-331.e8
Hauptverfasser: Xu, Jianli, Miao, Wenyan, Yuan, Hailong, Liu, Ying, Chen, Gang, Wang, Hongbo, Aizezi, Gulibadanmu, Qu, Jianhua, Duan, Xianlin, Yang, Ruixue, Muhashi, Maliya, Han, Chunxia, Ding, Linglu, Abulaiti, Nadiya, Pang, Nannan, Zhang, Le, Jiang, Ming
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container_end_page 331.e8
container_issue 5
container_start_page 331.e1
container_title Transplantation and cellular therapy
container_volume 29
creator Xu, Jianli
Miao, Wenyan
Yuan, Hailong
Liu, Ying
Chen, Gang
Wang, Hongbo
Aizezi, Gulibadanmu
Qu, Jianhua
Duan, Xianlin
Yang, Ruixue
Muhashi, Maliya
Han, Chunxia
Ding, Linglu
Abulaiti, Nadiya
Pang, Nannan
Zhang, Le
Jiang, Ming
description •A unique reduced-intensity conditioning (RIC)-haploidentical (haplo)-high-dose peripheral blood stem cell transplantation (HDPSCT) protocol did not lead to a high incidence of acute graft-versus-host disease (GVHD).•The unique RIC-haplo-HDPSCT protocol was associated with improved engraftment and survival.•GVHD was reduced with the addition of basiliximab and dexamethasone. Reduced-intensity conditioning (RIC) haploidentical (haplo-) hematopoietic stem cell transplantation (HSCT) requires more hematopoietic progenitor and stem cells (HPSCs) to promote engraftment and immune reconstitution and needs a stronger graft-versus-leukemia effect. Peripheral blood stem cells (PBSCs) offer advantages over bone marrow; however, the use of higher-dose non-T cell-depleted (non-TCD) in vitro PBSCs may increase the occurrence of severe graft-versus-host disease (GVHD). This prospective, single-arm clinical study was performed to investigate using high-dose non-TCD in vitro PBSCs as the graft source, using fludarabine/Ara-C/busulfan (FAB) as the conditioning regimen, using rabbit antithymocyte globulin to remove T cells in vivo, and enhancing GVHD prophylaxis with an IL-2 receptor antagonist in RIC-haplo-HSCT in patients with hematologic malignancies age 50 to 70 years or
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Reduced-intensity conditioning (RIC) haploidentical (haplo-) hematopoietic stem cell transplantation (HSCT) requires more hematopoietic progenitor and stem cells (HPSCs) to promote engraftment and immune reconstitution and needs a stronger graft-versus-leukemia effect. Peripheral blood stem cells (PBSCs) offer advantages over bone marrow; however, the use of higher-dose non-T cell-depleted (non-TCD) in vitro PBSCs may increase the occurrence of severe graft-versus-host disease (GVHD). This prospective, single-arm clinical study was performed to investigate using high-dose non-TCD in vitro PBSCs as the graft source, using fludarabine/Ara-C/busulfan (FAB) as the conditioning regimen, using rabbit antithymocyte globulin to remove T cells in vivo, and enhancing GVHD prophylaxis with an IL-2 receptor antagonist in RIC-haplo-HSCT in patients with hematologic malignancies age 50 to 70 years or &lt;50 years with comorbidities (Hematopoietic Cell Transplantation Comorbidity Index score ≥2) classified as intermediate to high risk. The primary endpoint was day 100 acute GVHD (aGVHD). A total of 47 patients were enrolled; the median age was 52 years (range, 30 to 68 years), the median duration of follow-up was 34 months (range, 2 to 99 months), and the medium-infused doses of mononuclear cells, CD34+ cells, and CD3+ cells were 15.93 × 108/kg, 8.68 × 106/kg, and 5.57 × 108/kg, respectively. The cumulative incidence of grade II-IV aGVHD at day 100 was 30.3% (95% confidence interval [CI], 15.9% to 44.8%), and that of grade III-IV aGVHD was 10.2% (95% CI, .6% to 19.8%). The 2-year cumulative incidence of chronic GVHD (cGVHD) was 34.9% (95% CI, 19.0% to 50.8%). The 2-year cumulative incidences of localized and extensive cGVHD were 26.1% (95% CI, 11.80% to 40.40%) and 8.7% (95% CI, 3.26% to 20.65%), respectively. The 2-year cumulative incidence of relapse was 17.3% (95% CI, 5.1% to 29.5%), the 2-year overall survival rate was 71.2% (95% CI, 57.9% to 84.5%), and the 2-year disease-free survival rate was 66.2% (95% CI, 52.1% to 80.3%). The incidence of aGVHD was not high, and the overall efficacy was good. This study demonstrates that this unique RIC-haplo-PBSC transplantation protocol was effective in treating hematologic malignancies. Nonetheless, larger prospective multicenter clinical trials and experimental studies should be performed to further confirm our findings.</description><identifier>ISSN: 2666-6367</identifier><identifier>EISSN: 2666-6367</identifier><identifier>DOI: 10.1016/j.jtct.2023.02.005</identifier><identifier>PMID: 36775200</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Antithymocyte globulin ; Graft vs Host Disease - prevention &amp; control ; Haploidentical peripheral blood stem cell transplantation ; Hematologic malignancy ; Hematologic Neoplasms - therapy ; Hematopoietic Stem Cell Transplantation - methods ; Humans ; IL-2 receptor antagonist ; Multicenter Studies as Topic ; Peripheral Blood Stem Cell Transplantation ; Prospective Studies ; Reduced-intensity conditioning</subject><ispartof>Transplantation and cellular therapy, 2023-05, Vol.29 (5), p.331.e1-331.e8</ispartof><rights>2023 The American Society for Transplantation and Cellular Therapy</rights><rights>Copyright © 2023 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c351t-cdd7853900fe7af9a2ec361895d8debd04c927fd10a8c667bcb1e06384620d0d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36775200$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Xu, Jianli</creatorcontrib><creatorcontrib>Miao, Wenyan</creatorcontrib><creatorcontrib>Yuan, Hailong</creatorcontrib><creatorcontrib>Liu, Ying</creatorcontrib><creatorcontrib>Chen, Gang</creatorcontrib><creatorcontrib>Wang, Hongbo</creatorcontrib><creatorcontrib>Aizezi, Gulibadanmu</creatorcontrib><creatorcontrib>Qu, Jianhua</creatorcontrib><creatorcontrib>Duan, Xianlin</creatorcontrib><creatorcontrib>Yang, Ruixue</creatorcontrib><creatorcontrib>Muhashi, Maliya</creatorcontrib><creatorcontrib>Han, Chunxia</creatorcontrib><creatorcontrib>Ding, Linglu</creatorcontrib><creatorcontrib>Abulaiti, Nadiya</creatorcontrib><creatorcontrib>Pang, Nannan</creatorcontrib><creatorcontrib>Zhang, Le</creatorcontrib><creatorcontrib>Jiang, Ming</creatorcontrib><title>Unique Reduced-Intensity Conditioning Haploidentical Peripheral Blood Stem Cell Transplantation Protocol for Patients with Hematologic Malignancy</title><title>Transplantation and cellular therapy</title><addtitle>Transplant Cell Ther</addtitle><description>•A unique reduced-intensity conditioning (RIC)-haploidentical (haplo)-high-dose peripheral blood stem cell transplantation (HDPSCT) protocol did not lead to a high incidence of acute graft-versus-host disease (GVHD).•The unique RIC-haplo-HDPSCT protocol was associated with improved engraftment and survival.•GVHD was reduced with the addition of basiliximab and dexamethasone. Reduced-intensity conditioning (RIC) haploidentical (haplo-) hematopoietic stem cell transplantation (HSCT) requires more hematopoietic progenitor and stem cells (HPSCs) to promote engraftment and immune reconstitution and needs a stronger graft-versus-leukemia effect. Peripheral blood stem cells (PBSCs) offer advantages over bone marrow; however, the use of higher-dose non-T cell-depleted (non-TCD) in vitro PBSCs may increase the occurrence of severe graft-versus-host disease (GVHD). This prospective, single-arm clinical study was performed to investigate using high-dose non-TCD in vitro PBSCs as the graft source, using fludarabine/Ara-C/busulfan (FAB) as the conditioning regimen, using rabbit antithymocyte globulin to remove T cells in vivo, and enhancing GVHD prophylaxis with an IL-2 receptor antagonist in RIC-haplo-HSCT in patients with hematologic malignancies age 50 to 70 years or &lt;50 years with comorbidities (Hematopoietic Cell Transplantation Comorbidity Index score ≥2) classified as intermediate to high risk. The primary endpoint was day 100 acute GVHD (aGVHD). A total of 47 patients were enrolled; the median age was 52 years (range, 30 to 68 years), the median duration of follow-up was 34 months (range, 2 to 99 months), and the medium-infused doses of mononuclear cells, CD34+ cells, and CD3+ cells were 15.93 × 108/kg, 8.68 × 106/kg, and 5.57 × 108/kg, respectively. The cumulative incidence of grade II-IV aGVHD at day 100 was 30.3% (95% confidence interval [CI], 15.9% to 44.8%), and that of grade III-IV aGVHD was 10.2% (95% CI, .6% to 19.8%). The 2-year cumulative incidence of chronic GVHD (cGVHD) was 34.9% (95% CI, 19.0% to 50.8%). The 2-year cumulative incidences of localized and extensive cGVHD were 26.1% (95% CI, 11.80% to 40.40%) and 8.7% (95% CI, 3.26% to 20.65%), respectively. The 2-year cumulative incidence of relapse was 17.3% (95% CI, 5.1% to 29.5%), the 2-year overall survival rate was 71.2% (95% CI, 57.9% to 84.5%), and the 2-year disease-free survival rate was 66.2% (95% CI, 52.1% to 80.3%). The incidence of aGVHD was not high, and the overall efficacy was good. This study demonstrates that this unique RIC-haplo-PBSC transplantation protocol was effective in treating hematologic malignancies. Nonetheless, larger prospective multicenter clinical trials and experimental studies should be performed to further confirm our findings.</description><subject>Antithymocyte globulin</subject><subject>Graft vs Host Disease - prevention &amp; control</subject><subject>Haploidentical peripheral blood stem cell transplantation</subject><subject>Hematologic malignancy</subject><subject>Hematologic Neoplasms - therapy</subject><subject>Hematopoietic Stem Cell Transplantation - methods</subject><subject>Humans</subject><subject>IL-2 receptor antagonist</subject><subject>Multicenter Studies as Topic</subject><subject>Peripheral Blood Stem Cell Transplantation</subject><subject>Prospective Studies</subject><subject>Reduced-intensity conditioning</subject><issn>2666-6367</issn><issn>2666-6367</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFvEzEQhS1ERau2f4AD8pHLLrN21rsrcYGIkkpFRNCeLceeTR157cV2qPIz-Mc4SkGcOM1o9N4nzXuEvG6gbqAR73b1LutcM2C8BlYDtC_IBRNCVIKL7uU_-zm5TmkHAGzBoeHwipyXa9cygAvy68HbH3uk39DsNZrq1mf0yeYDXQZvbLbBW7-lKzW7YA36bLVydI3Rzo8Yy_rRhWDo94wTXaJz9D4qn2anfFZHM13HkIMOjo4h0nW5FUaiTzY_0hVOKgcXtlbTL8rZrVdeH67I2ahcwuvneUkebj7dL1fV3dfPt8sPd5XmbZMrbUzXt3wAGLFT46AYai6afmhNb3BjYKEH1o2mAdVrIbqN3jQIgvcLwcCA4Zfk7Yk7x1ASSFlONunygvIY9kmyEtHQMj4MRcpOUh1DShFHOUc7qXiQDchjG3Inj23IYxsSmCxtFNObZ_5-M6H5a_mTfRG8PwmwfPnTYpRJl3RKCzZigZlg_8f_DQTcnt8</recordid><startdate>202305</startdate><enddate>202305</enddate><creator>Xu, Jianli</creator><creator>Miao, Wenyan</creator><creator>Yuan, Hailong</creator><creator>Liu, Ying</creator><creator>Chen, Gang</creator><creator>Wang, Hongbo</creator><creator>Aizezi, Gulibadanmu</creator><creator>Qu, Jianhua</creator><creator>Duan, Xianlin</creator><creator>Yang, Ruixue</creator><creator>Muhashi, Maliya</creator><creator>Han, Chunxia</creator><creator>Ding, Linglu</creator><creator>Abulaiti, Nadiya</creator><creator>Pang, Nannan</creator><creator>Zhang, Le</creator><creator>Jiang, Ming</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202305</creationdate><title>Unique Reduced-Intensity Conditioning Haploidentical Peripheral Blood Stem Cell Transplantation Protocol for Patients with Hematologic Malignancy</title><author>Xu, Jianli ; 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This prospective, single-arm clinical study was performed to investigate using high-dose non-TCD in vitro PBSCs as the graft source, using fludarabine/Ara-C/busulfan (FAB) as the conditioning regimen, using rabbit antithymocyte globulin to remove T cells in vivo, and enhancing GVHD prophylaxis with an IL-2 receptor antagonist in RIC-haplo-HSCT in patients with hematologic malignancies age 50 to 70 years or &lt;50 years with comorbidities (Hematopoietic Cell Transplantation Comorbidity Index score ≥2) classified as intermediate to high risk. The primary endpoint was day 100 acute GVHD (aGVHD). A total of 47 patients were enrolled; the median age was 52 years (range, 30 to 68 years), the median duration of follow-up was 34 months (range, 2 to 99 months), and the medium-infused doses of mononuclear cells, CD34+ cells, and CD3+ cells were 15.93 × 108/kg, 8.68 × 106/kg, and 5.57 × 108/kg, respectively. The cumulative incidence of grade II-IV aGVHD at day 100 was 30.3% (95% confidence interval [CI], 15.9% to 44.8%), and that of grade III-IV aGVHD was 10.2% (95% CI, .6% to 19.8%). The 2-year cumulative incidence of chronic GVHD (cGVHD) was 34.9% (95% CI, 19.0% to 50.8%). The 2-year cumulative incidences of localized and extensive cGVHD were 26.1% (95% CI, 11.80% to 40.40%) and 8.7% (95% CI, 3.26% to 20.65%), respectively. The 2-year cumulative incidence of relapse was 17.3% (95% CI, 5.1% to 29.5%), the 2-year overall survival rate was 71.2% (95% CI, 57.9% to 84.5%), and the 2-year disease-free survival rate was 66.2% (95% CI, 52.1% to 80.3%). The incidence of aGVHD was not high, and the overall efficacy was good. This study demonstrates that this unique RIC-haplo-PBSC transplantation protocol was effective in treating hematologic malignancies. Nonetheless, larger prospective multicenter clinical trials and experimental studies should be performed to further confirm our findings.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36775200</pmid><doi>10.1016/j.jtct.2023.02.005</doi><oa>free_for_read</oa></addata></record>
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subjects Antithymocyte globulin
Graft vs Host Disease - prevention & control
Haploidentical peripheral blood stem cell transplantation
Hematologic malignancy
Hematologic Neoplasms - therapy
Hematopoietic Stem Cell Transplantation - methods
Humans
IL-2 receptor antagonist
Multicenter Studies as Topic
Peripheral Blood Stem Cell Transplantation
Prospective Studies
Reduced-intensity conditioning
title Unique Reduced-Intensity Conditioning Haploidentical Peripheral Blood Stem Cell Transplantation Protocol for Patients with Hematologic Malignancy
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