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Outcomes with allogeneic stem cell transplant using cryopreserved versus fresh hematopoietic progenitor cell products.
Wan, Bo Angela; Lindo, Lorenzo; Mourad, Yasser Abou; Chung, Shanee; Forrest, Donna; Kuchenbauer, Florian; Nantel, Stephen; Narayanan, Sujaatha; Nevill, Tomas; Power, Maryse; Rodrigo, Judith; Sanford, David; Song, Kevin; Stubbins, Ryan J; Sutherland, Heather; Toze, Cynthia L; White, Jennifer; Roy, Claudie; Hay, Kevin A.
Afiliación
  • Wan BA; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
  • Lindo L; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Terry Fox Laboratory, BC Cancer Research Institute, Vancouver, British Columbia, Canada.
  • Mourad YA; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Chung S; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Forrest D; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Kuchenbauer F; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Nantel S; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Narayanan S; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Nevill T; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Power M; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Rodrigo J; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Sanford D; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Song K; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Stubbins RJ; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Sutherland H; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Toze CL; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • White J; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Roy C; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada.
  • Hay KA; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Terry Fox Laboratory, BC Cancer Research Institute, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplant Program of BC, Vancouver, British Columbia, Canada; Cumming School of Medicine, Universit
Cytotherapy ; 2024 May 08.
Article en En | MEDLINE | ID: mdl-38819367
ABSTRACT

BACKGROUND:

Allogeneic hematopoietic stem cell transplant (alloHSCT) is a mainstay of treatment for hematologic malignancies such as acute leukemias and aggressive lymphomas. Historically, fresh hematopoietic progenitor cell (HPC) products have been preferred to cryopreserved products (cryo-HPC) due to concerns of loss of stem cell viability and number with the cryopreservation procedure.

OBJECTIVE:

We aimed to analyze the outcomes of patients who received cryo-HPCs during the COVID-19 pandemic and compare this against historical cohorts that received fresh HPC. STUDY

DESIGN:

A retrospective chart review was conducted on all adult patients who received a peripheral blood alloHSCT in British Columbia, Canada between June 2017 and November 2021. Baseline characteristics, Kaplan-Meier (KM) overall survival (OS), engraftment, and incidences of acute and chronic graft versus host disease were compared between patients who received cryo-HPCs and fresh HPCs. Univariable analysis followed by multivariable analysis was performed using a backward stepwise selection procedure to generate predictors of OS, cumulative incidence of relapse (CIR), nonrelapse mortality (NRM), and primary and secondary graft failure.

RESULTS:

Three hundred eighty-three patients were included in the analysis, with cryo-HPC representing 40%. Median viability was higher in the fresh-HPC group at 99.2% (IQR 98.3-99.5) versus cryo-HPCs at 97.0% (96.0, 98.6) (P < 0.01). The 12-month actuarial survivals were 77% in the fresh HPC and 75% in the cryo-HPC groups (P = 0.21). There were no differences between cryo-HPCs and fresh HPCs on univariable analysis of OS, CIR, or NRM. There was a shorter median time to platelet engraftment in patients receiving fresh HPC at 17 days (IQR 16, 20) versus cryo-HPC at 21 days (IQR 18, 29), P < 0.001. There was a shorter median time to neutrophil engraftment in the fresh HPC group at 17 days (IQR 14, 20) versus 20 days (17, 23), P < 0.001. Cryo-HPC accounted for 5 out of 6 cases of primary graft failure (P = 0.04), and 3 out of five cases of secondary graft failure (P = 0.39). There were no significant differences in acute GVHD between the fresh HPC and cryo-HPC groups (P = 0.34). The incidence of moderate or severe chronic GVHD was 32% in the fresh-HPC group and 17% in the cryo-HPC group (P < 0.001). In multivariable analysis, cryopreservation did not emerge as an independent predictor of OS, CIR, NRM, primary GF or secondary GF. However, viability <90% on arrival at our center was a significant predictor of OS (HR 5.3, 2.3-12.3, P < 0.01), primary graft failure (OR 36.3, 5.4-210.2, P < 0.01), and secondary graft failure (OR 18.4, 1.7-121.1, P < 0.01).

CONCLUSIONS:

Patients who received cryo-HPCs had similar OS and relapse rates to those who received fresh-HPCs but typically took 2-3 days longer to achieve engraftment of platelets or neutrophils and were associated increased primary graft failure. However, after accounting for multiple variables, cryopreservation was no longer a significant predictor of survival or engraftment while viability <90% emerged as an important predictor of OS, primary graft failure, and secondary graft failure. If confirmed, this suggests that viability on arrival at the infusion center may be a good quality control indicator used to identify HPC products that may warrant recollection if the risk of graft failure is sufficiently increased.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: Cytotherapy Asunto de la revista: TERAPEUTICA Año: 2024 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: Cytotherapy Asunto de la revista: TERAPEUTICA Año: 2024 Tipo del documento: Article País de afiliación: Canadá