Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide
Abstract Cytokine release syndrome (CRS) represents a life‐threatening side effect after haploidentical stem cell transplantation (Haplo‐SCT) with posttransplant cyclophosphamide (PT‐Cy). Factors predictive of CRS development is still a matter of debate. We retrospectively analyzed 102 consecutive p...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.2607 |
| _version_ | 1818962874525024256 |
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| author | Jacopo Mariotti Daniela Taurino Fabrizio Marino Stefania Bramanti Barbara Sarina Lucio Morabito Chiara De Philippis Clara Di Vito Domenico Mavilio Carmelo Carlo‐Stella Matteo Della Porta Armando Santoro Luca Castagna |
| author_facet | Jacopo Mariotti Daniela Taurino Fabrizio Marino Stefania Bramanti Barbara Sarina Lucio Morabito Chiara De Philippis Clara Di Vito Domenico Mavilio Carmelo Carlo‐Stella Matteo Della Porta Armando Santoro Luca Castagna |
| author_sort | Jacopo Mariotti |
| collection | DOAJ |
| description | Abstract Cytokine release syndrome (CRS) represents a life‐threatening side effect after haploidentical stem cell transplantation (Haplo‐SCT) with posttransplant cyclophosphamide (PT‐Cy). Factors predictive of CRS development is still a matter of debate. We retrospectively analyzed 102 consecutive patients receiving a bone marrow (BM) (n = 42) or peripheral blood stem cells (PBSC) (n = 60) Haplo‐SCT with PT‐Cy. The two cohorts were similar in main patients’ characteristics besides disease type (P = .02). Cumulative incidence of grades 1, 2, and ≥3 CRS was 80%, 52%, and 15% at a median of 2, 4, and 7 days, respectively. Moderate/High‐grade fever (39°‐41°), grade 1 and grade ≥3 CRS occurred more frequently after PBSC relative to BM grafts (68% vs 33%, P = .0005; 87% vs 71%, P = .009; 20% vs 7%, P = .07). Only patients experiencing grade ≥3 CRS had a worse outcome in terms of 1‐year overall survival (OS) and nonrelapse mortality (NRM): 39% vs 80% (P = .002) and 40% vs 8% (P = .005), respectively. By univariate analysis the only factors associated with the increased risk of ≥3 CRS were pretransplant disease status (8% for complete remission, 11% for partial remission, and 38% for active disease, P = .002), HLA‐DRB1 mismatching (57% vs 14%, P = .007), and PBSC graft (P = .07). By multivariable analysis, only pretransplant disease status (hazard ratio, HR: 6.84, P = .005) and HLA‐DRB1 mismatching (HR: 17.19, P = .003) remained independent predictors of grade ≥3 CRS. Only grade ≥3 CRS is clinically relevant for the final outcome of patients receiving Haplo‐SCT with PT‐Cy, is more frequent after a PBSC graft and is associated with pretransplant active disease and HLA‐DRB1 mismatching. |
| first_indexed | 2024-12-20T12:36:15Z |
| format | Article |
| id | doaj.art-99e62eeddf6c46e0b49324a1098a5134 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-12-20T12:36:15Z |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-99e62eeddf6c46e0b49324a1098a51342022-12-21T19:40:36ZengWileyCancer Medicine2045-76342020-01-0191526110.1002/cam4.2607Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamideJacopo Mariotti0Daniela Taurino1Fabrizio Marino2Stefania Bramanti3Barbara Sarina4Lucio Morabito5Chiara De Philippis6Clara Di Vito7Domenico Mavilio8Carmelo Carlo‐Stella9Matteo Della Porta10Armando Santoro11Luca Castagna12Bone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyUnit of Clinical and Experimental Immunology Humanitas Clinical and Research Center Rozzano ItalyUnit of Clinical and Experimental Immunology Humanitas Clinical and Research Center Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyBone Marrow Transplant Unit Humanitas Clinical and Research Center-IRCCS-via Manzoni 56 Rozzano ItalyAbstract Cytokine release syndrome (CRS) represents a life‐threatening side effect after haploidentical stem cell transplantation (Haplo‐SCT) with posttransplant cyclophosphamide (PT‐Cy). Factors predictive of CRS development is still a matter of debate. We retrospectively analyzed 102 consecutive patients receiving a bone marrow (BM) (n = 42) or peripheral blood stem cells (PBSC) (n = 60) Haplo‐SCT with PT‐Cy. The two cohorts were similar in main patients’ characteristics besides disease type (P = .02). Cumulative incidence of grades 1, 2, and ≥3 CRS was 80%, 52%, and 15% at a median of 2, 4, and 7 days, respectively. Moderate/High‐grade fever (39°‐41°), grade 1 and grade ≥3 CRS occurred more frequently after PBSC relative to BM grafts (68% vs 33%, P = .0005; 87% vs 71%, P = .009; 20% vs 7%, P = .07). Only patients experiencing grade ≥3 CRS had a worse outcome in terms of 1‐year overall survival (OS) and nonrelapse mortality (NRM): 39% vs 80% (P = .002) and 40% vs 8% (P = .005), respectively. By univariate analysis the only factors associated with the increased risk of ≥3 CRS were pretransplant disease status (8% for complete remission, 11% for partial remission, and 38% for active disease, P = .002), HLA‐DRB1 mismatching (57% vs 14%, P = .007), and PBSC graft (P = .07). By multivariable analysis, only pretransplant disease status (hazard ratio, HR: 6.84, P = .005) and HLA‐DRB1 mismatching (HR: 17.19, P = .003) remained independent predictors of grade ≥3 CRS. Only grade ≥3 CRS is clinically relevant for the final outcome of patients receiving Haplo‐SCT with PT‐Cy, is more frequent after a PBSC graft and is associated with pretransplant active disease and HLA‐DRB1 mismatching.https://doi.org/10.1002/cam4.2607cytokine release syndromedisease burdenhaploidentical stem cell transplant with posttransplant cyclophosphamideHLA mismatch |
| spellingShingle | Jacopo Mariotti Daniela Taurino Fabrizio Marino Stefania Bramanti Barbara Sarina Lucio Morabito Chiara De Philippis Clara Di Vito Domenico Mavilio Carmelo Carlo‐Stella Matteo Della Porta Armando Santoro Luca Castagna Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide Cancer Medicine cytokine release syndrome disease burden haploidentical stem cell transplant with posttransplant cyclophosphamide HLA mismatch |
| title | Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide |
| title_full | Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide |
| title_fullStr | Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide |
| title_full_unstemmed | Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide |
| title_short | Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide |
| title_sort | pretransplant active disease status and hla class ii mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide |
| topic | cytokine release syndrome disease burden haploidentical stem cell transplant with posttransplant cyclophosphamide HLA mismatch |
| url | https://doi.org/10.1002/cam4.2607 |
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