Unmanipulated haploidentical hematopoietic stem cell transplantation using very low-dose antithymocyte globulin and methylprednisolone in adults with relapsed/refractory acute leukemia

Konishi, Tatsuya; Doki, Noriko; Nagata, Akihito; Yamada, Yuta; Takezaki, Toshiaki; Kaito, Satoshi; Kurosawa, Shuhei; Sakaguchi, Masahiro; Harada, Kaito; Yasuda, Shunichiro; Yoshioka, Kosuke; Inamoto, Kyoko; Toya, Takashi; Igarashi, Aiko; Najima, Yuho; Kobayashi, Takeshi; Kakihana, Kazuhiko; Sakamaki, Hisashi

doi:10.1007/s00277-019-03865-x

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…The transplantation procedures have been described in detail in another paper 8 . Generally, patients with lymphoid malignancy were conditioned using a total body irradiation (TBI) regimen (12 Gy), including CY (120 mg/kg) with or without cytarabine (8 g/m 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…The transplantation procedures have been described in detail in another paper. 8 Generally, patients with lymphoid malignancy were conditioned using a total body irradiation (TBI) regimen (12 Gy), including CY (120 mg/kg) with or without cytarabine (8 g/m 2 ). Patients with myeloid malignancy were conditioned using a non-TBI regimen or 1-day TBI (4 Gy) that included intravenous busulfan (BU) (12.8 mg/kg) and CY (120 mg/kg).…”

Section: Transplantation Proceduresmentioning

confidence: 99%

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Cyclophosphamide‐induced cardiotoxicity at conditioning for allogeneic hematopoietic stem cell transplantation would occur among the patients treated with 120 mg/kg or less

Marumo

Omori

Tara

et al. 2022

Asia-Pac J Clncl Oncology

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Cyclophosphamide (CY)-induced cardiotoxicity involves rare lethal complications. We previously reported the cardiac events of 811 allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients; 12 out of 811 recipients (1.5%) developed fatal heart failure. The mortality rate was also very high (91.6%, 11/12). CY dose (200 mg/kg or more) was reported as the independent risk factor. The main disease in patients treated with 200 mg/kg or more of CY was severe aplastic anemia (AA). Therefore, we reduced the dose of CY during conditioning for AA (from 200 to 100 mg/kg), and then we analyzed the clinical features of 294 patients who received a total dose of at least 100 mg/kg of CY. We also compared the clinical features between the current study and our previous study. The proportion of patients treated with at least 200 mg/kg of CY was reduced from 4.2% to 0%. However, CY-induced heart failure occurred in four of the 294 patients (1.4%), which was similar to the finding reported in our previous study (1.5%). Two of these four patients received a post-transplant CY (PTCy) regimen (CY 100 mg/kg). All four patients were treated in the cardiac intensive care unit (C-ICU), and two patients survived. In summary, even the CY dose of 120 mg/kg or less would cause cardiotoxicity. We should also carefully monitor patients treated with PTCy, considering the possibility of CY-induced cardiotoxicity. Early diagnosis and ICU management have contributed to improved outcomes. K E Y W O R D Sallogeneic hematopoietic stem cell transplantation (allo-HSCT), cyclophosphamide (CY), haploidentical-HSCT, heart failure, intensive care unit (ICU)

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Section: Methodsmentioning

confidence: 99%

Section: Transplantation Proceduresmentioning

confidence: 99%

Cyclophosphamide‐induced cardiotoxicity at conditioning for allogeneic hematopoietic stem cell transplantation would occur among the patients treated with 120 mg/kg or less

Marumo

Omori

Tara

et al. 2022

Asia-Pac J Clncl Oncology

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“…Serum samples were serially collected before vaccination, 2 weeks ± 7 days after the first vaccination dose, 5 or 6 weeks after the first vaccination dose (i.e., 2 weeks after the second vaccination dose), 3 months ± 1 month after the first vaccination dose, and 6 months ± 1 month after the first vaccination dose. The detailed transplantation procedures have been previously described 14 . Clinically significant CMV infection was defined as the initiation of preemptive anti‐CMV therapy or onset of CMV end‐organ disease.…”

Section: Methodsmentioning

confidence: 99%

“…The detailed transplantation procedures have been previously described. 14 Clinically significant CMV infection was defined as the initiation of preemptive anti-CMV therapy or onset of CMV end-organ disease. The severity of COVID-19 was classified according to WHO recommendations.…”

Section: Patientsmentioning

confidence: 99%

Attenuated humoral response against SARS‐CoV‐2 mRNA vaccination in allogeneic stem cell transplantation recipients

et al. 2022

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Antibody persistence several months after SARS‐CoV‐2 mRNA vaccination in allogeneic stem cell transplantation recipients remains largely unknown. We sequentially evaluated the humoral response to two doses of mRNA vaccines in 128 adult recipients and identified the risk factors involved in a poor response. The median interval between stem cell transplantation and vaccination was 2.7 years. The SARS‐CoV‐2 S1 antibody became positive after the second vaccination dose in 87.6% of the recipients, and the median titer was 1,235.4 arbitrary units (AU)/mL. In patients on corticosteroid treatment, the corticosteroid dose inversely correlated with antibody titer. Multivariate analysis identified risk factors for poor peak response such as an interval from stem cell transplantation ≤ 1 year, history of clinically significant cytomegalovirus infection, and use of > 5 mg/day prednisolone at vaccination. Six months after vaccination, the median titer decreased to 185.15 AU/mL, and use of > 5 mg/day prednisolone at vaccination was significantly associated with a poor response. These results indicate that early vaccination after stem cell transplantation (<12 months) and cytomegalovirus infection are risk factors for poor peak response, while steroid use is important for a peak as well as a persistent response. In conclusion, although humoral response is observed in many stem cell transplantation recipients after two doses of vaccination, antibody titers diminish with time, and factors associated with persistence and a peak immunity should be considered separately.

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“…The causes of death were classified based on a previous study [17]. The transplantation procedures and conditioning regimens have been described in a previous study [18]. Neutrophil engraftment was defined as the first day of three consecutive days when the absolute neutrophil count was ≥ 0.5 × 10 9 /L.…”

Section: Diagnostic Criteria Considered For This Studymentioning

confidence: 99%

Changes in vaccination strategies contribute to the development of invasive pneumococcal disease in allogeneic hematopoietic stem cell transplantation recipients: a retrospective study for promoting vaccination

et al. 2021

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients are at high risk of developing invasive pneumococcal disease (IPD) with substantial morbidity and mortality. Pneumococcal polysaccharide vaccine (PPSV23) and pneumococcal conjugate vaccine (PCV13) are the primary prevention strategy. The difference between the Japanese and international guidelines is limited except when to start PCV13. However, Japanese data regarding the incidence of IPD after allo-HSCT that include vaccination status are limited. Therefore, we aimed to study the clinical characteristics of patients with IPD following allo-HSCT, focusing on unvaccinated patients. We retrospectively reviewed allo-HSCT recipients between April 2005 and December 2018 at Komagome Hospital. Among 1,091 recipients, 11 (1008/100,000 recipients) developed 13 episodes of IPD. The median period from the first allo-HSCT to the first IPD episode was 686 days (10-3040 days). Ten patients developed IPD before vaccination, and seven of these unvaccinated patients with late-onset IPD were ineligible for vaccination based on domestic guidelines. Although appropriate treatments resulted in a good short-term prognosis, most episodes of IPD developed in unvaccinated allo-HSCT recipients. Our data support the promotion of better adherence to the current guidelines and the importance of pneumococcal vaccination even years after allo-HSCT to protect against late-onset IPD.

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Unmanipulated haploidentical hematopoietic stem cell transplantation using very low-dose antithymocyte globulin and methylprednisolone in adults with relapsed/refractory acute leukemia

Cited by 6 publications

References 25 publications

Cyclophosphamide‐induced cardiotoxicity at conditioning for allogeneic hematopoietic stem cell transplantation would occur among the patients treated with 120 mg/kg or less

Cyclophosphamide‐induced cardiotoxicity at conditioning for allogeneic hematopoietic stem cell transplantation would occur among the patients treated with 120 mg/kg or less

Attenuated humoral response against SARS‐CoV‐2 mRNA vaccination in allogeneic stem cell transplantation recipients

Changes in vaccination strategies contribute to the development of invasive pneumococcal disease in allogeneic hematopoietic stem cell transplantation recipients: a retrospective study for promoting vaccination

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