1.
Autograft immune content and survival in non-Hodgkin's lymphoma: A post hoc analysis
Porrata, L. F., Inwards, D. J., Ansell, S. M., Micallef, I. N., Johnston, P. B., Villasboas, J. C., Markovic, S. N.
Leukemia research. 2019;81:1-9
Abstract
The infusion of autograft absolute lymphocyte and monocyte counts affect survival in patients undergoing autologous peripheral hematopoietic stem cell transplantation (APHSCT). However, the specific autograft immune effector cells affecting survival post-APHSCT are unknown. Thus, we performed an ad hoc analysis from our published double-blind, randomized phase III clinical trial in non-Hodgkin's lymphoma (NHL) patients, looking at the infused autograft immune effector cells and their relationship with clinical outcomes post-APHSCT. Between December 2007 and October 2010, we performed a double-blind phase III randomized study registered with ClinicalTrials.gov, number NCT00566228. A total of 111 patients finished the trial and apheresis collection samples were analyzed for immune effector cells. Overall survival (OS) and progression-free survival (PFS) were calculated from the date of APHSCT. With a median follow-up of 82.8 months (range: 2.1-122.3 months), we identified by univariate analysis that the autograft numbers of macrophage type 1 (M 1), macrophage type 2 (M 2), dendritic cell type 1 (DC 1), dendritic cell type 2 (DC 2), myeloid-derived suppressor cells (MDSC), CD4+PD-1-, CD4+PD-1+, CD8+PD-1-, CD8+PD-1+, lymphocyte to monocyte ratio (A-LMR), NKp30, and KIR2DL2, were predictors for OS and PFS. Multivariate analysis revealed that A-LMR, MDSC, NKp30, KIR2DL2 and lactate dehydrogenase were independent predictors for OS. Independent predictors for PFS identified by multivariate analysis included DC1, MDSC, NKp30, CD4+PD-1- and M 2. Our findings indicate that the number of specific infused autograft immune effector cells affect survival ; thus providing a platform to develop an immunocompetent autograft with direct impact on clinical outcomes in NHL post-APHSCT.
2.
Immunologic Autograft Engineering and Survival in Non-Hodgkin Lymphoma
Porrata, L. F., Burgstaler, E. A., Winters, J. L., Jacob, E. K., Gastineau, D. A., Suman, V. J., Inwards, D. J., Ansell, S. M., Micallef, I. N., Johnston, P. B., et al
Biology of Blood & Marrow Transplantation. 2016;22(6):1017-23
Abstract
Retrospective studies have reported that the collected and infused autograft absolute lymphocyte count (A-ALC) affects clinical outcomes after autologous peripheral hematopoietic stem cell transplantation (APHSCT). We hypothesized that manipulation of the apheresis machine to target a higher A-ALC dose would translate into prolonged progression-free survival (PFS) in patients with non-Hodgkin lymphoma (NHL) undergoing APHSCT. Between December 2007 and October 2010, we performed a double-blind, phase III, randomized study randomly assigning 122 patients with NHL to undergo collection with the Fenwal Amicus Apheresis system with our standard settings (mononuclear cells offset of 1.5 and RBC offset of 5.0) or at modified settings (mononuclear cells offset of 1.5 and RBC of 6.0). The primary endpoint was PFS. Neither PFS (hazard ratio [HR] of modified to standard, 1.13; 95% confidence interval [CI], .62 to 2.08; P = .70) nor overall survival (OS) (HR modified to standard, .85; 95% CI, .39 to 1.86; P = .68) were found to differ by collection method. Collection of A-ALC between both methods was similar. Both PFS (P = .0025; HR, 2.77; 95% CI, 1.39 to 5.52) and OS (P = .004; HR, 3.38; 95% CI, 1.27 to 9.01) were inferior in patients infused with an A-ALC < .5 x 10(9) lymphocytes/kg compared with patients infused with an A-ALC > .5 x 10(9) lymphocytes/kg, regardless of the method of collection. We did not detect significant differences in clinical outcomes or in the A-ALC collection between the modified and the standard Fenwal Amicus settings; however, despite physician discretion on primary number of collections and range of cells infused, higher A-ALC infused dose were associated with better survival after APHSCT. Copyright © 2016 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.