Search

The public French Cord Blood Banks Network was established in 1999 with the objective of standardizing the practices governing umbilical cord blood (UCB) banking in France. The Network adopted a strategy to optimize its inventory and improve the quality of its banked units based on a quality improvement process using outcome data regularly provided by Eurocord. This study aimed to describe the results, over 10 years, of UCBT facilitated by a national network that used the same criteria of UCB collection and banking and to assess how modifications of banking criteria and unit selection might influence transplant outcomes. Nine hundred and ninety-nine units (593 single-unit and 203 double-unit grafts) were released by the Network to transplant 796 patients with malignant (83%) and non-malignant (17%) diseases. Median cell dose exceeded 3.5 × 107 TNC/kg in 86%. There was a trend to select units more recently collected and with higher cell dose. Neutrophil engraftment was 88.2% (85.7–90.7) and 79.3% (72.6–86.5) respectively for malignant and non-malignant diseases with a trend to faster recovery with higher cell doses. The respective 3-year transplant-related mortality were 31.1% (27.5–35.1) and 34.3% (27.0–43.5). OS was 49% ± 4 in malignant and 62% ± 4 in non-malignant disorders. In multivariate analysis, cell dose was the only unit-related factor associated with outcomes. Our results reflect the benefit on clinical outcomes of the strategy adopted by the Network to bank units with higher cell counts.

PURPOSE This study aimed to assess how the contamination rate of organ-cultured corneas has evolved and to analyze the evolution of microorganisms involved. METHODS Data from the Besancon eye bank were reviewed over 14 years (2005-2018). The changes in the contamination rate and the contaminant species found during the organ culture storage were analyzed. Microbiological tests were performed twice on the storage media-at day 5 and before the deswelling phase. RESULTS Among the 17,979 donor corneas collected, 1240 corneas were microbiological-test positive. The average annual contamination rate was 6.8% (range: 5.2%-8.9%). Seventy-five percent of contaminations were bacterial. The most frequently found bacterium was Staphylococcus spp. (31.3%), followed by non-Enterobacteriaceae Gram-negative Bacilli (GNB) (27.3%), with most Sphingomonas spp. and Pseudomonas spp. Fungal contamination (21.9%) was dominated by Candida (82.7%). Seventy-seven types of microorganisms were identified. The Staphylococcus rate tended to decrease, whereas non-Enterobacteriaceae GNB rate has increased in the past few years to reach 46% of bacteria. Most of the contaminations were detected in the early phase of organ culture at day 5 (89.2%). The second microbiological test found 44.8% of fungal contaminations (predominantly Candida spp.). CONCLUSIONS The annual contamination rate was stable and remains low, but the types of contaminating microorganisms varied from year to year. Staphylococcus spp. and non-Enterobacteriaceae GNB accounted for a significant proportion of the contaminations. We found a significant proportion of contamination, especially fungal, at the late phase of storage. Reassessing the antibiotics and antifungals in the storage medium may be useful to limit corneal disposal.

Purpose of the study Nocardia affects immunocompromised human host exhibiting an altered cell-mediated immunity. Infectious risk after allogeneic hematopoietic cell transplantation (AHCT) is significantly correlated to the recovery status of donor-derived immune system, especially CD4+ T-cells reconstitution and thymopoiesis. The purpose of this paper is to highlight a lack of cell-mediated immunity recovery for patients presenting a nocardiosis compared to a control cohort. Patients and methods This is a case control retrospective monocentric study. We retrospectively analyzed a monocentric cohort of 15 cases of nocardiosis after AHCT and we explored the degree of patients’ immunosuppression by phenotyping circulating lymphoid subpopulations, including NK cells, CD8+ T-cells, CD4+ T-cells and CD19+ B-cells. We focused on CD4+ T-cell subsets to appreciate thymic output, especially on naive CD4+ T-cells (NTE, CD45RA+/RO− CD4+ T-cells) and recent thymic emigrants (RTE, CD4+CD45RA+/RO−/CD31+). Infected patients were paired with a control cohort of patients with identical transplantation characteristics screened on hematological disease, AHCT conditioning, primary graft-versus-host disease (GHVD) prophylaxis, graft type, sex, age, and season at the AHCT and data concerning immunological reconstitution were compared. Results At onset of nocardiosis, circulating lymphocytes and CD4+ T-cells means count were respectively 730/μL and 162/μL. CD8+ T-cells, CD56+ NK cells and CD19+ B-cells means count were respectively 362/μL, 160/μL, 112/μL. CD4+ T-cells subpopulations, naive CD4+ T-cells production was impaired with NTE and RTE means count at 26/μL and 11/μL respectively. Comparison between nocardiosis cohort and control cohort over time highlight significant lower cellular count for lymphocytes, CD4+ T-cells, NTE and RTE with p = 0.001, p Conclusion Immune recovery monitoring follow-up after AHCT is of particular importance to identify patients susceptible to develop Nocardiosis. Efficient microbiological investigations toward Nocardia such PCR should be used in case of compatible clinical presentation.

International audience

Chimeric Antigen Receptor (CAR) therapy has led to great successes in patients with leukemia and lymphoma. Umbilical Cord Blood (UCB), stored in UCB banks, is an attractive source of T cells for CAR-T production. We used a third generation CD123 CAR-T (CD28/4-1BB), which was previously developed using an adult’s Peripheral Blood (PB), to test the ability of obtaining CD123 CAR-T from fresh or cryopreserved UCB. We obtained a cell product with a high and stable transduction efficacy, and a poorly differentiated phenotype of CAR-T cells, while retaining high cytotoxic functions in vitro and in vivo. Moreover, CAR-T produced from cryopreserved UCB are as functional as CAR-T produced from fresh UCB. Overall, these data pave the way for the clinical development of UCB-derived CAR-T. UCB CAR-T could be transferred in an autologous manner (after an UCB transplant) to reduce post-transplant relapses, or in an allogeneic setting, thanks to fewer HLA restrictions which ease the requirements for a match between the donor and recipient.

The management of hyperleukocytosis or thrombocytosis by therapeutic cytapheresis in the early 21 st century is far from codified (universal). Therapeutic cytapheresis have been proposed to achieve more rapid cytoreduction in peripheral blood than old universal support in order to quickly prevent potential complications. But, there are no randomized studies demonstrating the superiority of cytapheresis over other treatments alone. In this short review, based on our own experience (since 1980), we will give the indications and the role of cytapheresis procedures and we will try to answer the questions: when is therapeutic cytapheresis appropriate and do they still have a place in 2020, especially as a medical emergency?

The human amniotic membrane (hAM) is an attractive biomaterial for regenerative medicine, as it contains amniotic mesenchymal stromal cells (hAMSC), epithelial cells (hAEC) and growth factors. We examined the potential use of hAM in orthopaedic and maxillofacial bone surgery, integrating the requirements of current regulations regarding advanced therapy medicinal products (ATMP) in the European Union. Previous studies have described the potential osteodifferentiation of intact hAM during whole-tissue culture in osteogenic conditions. The present study aims to determine whether in vitro osteodifferentiation of hAM is needed in the context bone repair, and the influence of this process on tissue structure, cell phenotype and cell function. Different conditions (fresh or cultured hAM; intact or hAM-derived cells) were tested. Phenotypic and functional analyses were performed with standard approaches (cell culture and staining, histological and immunolabelling) as well as original approaches (tissue staining, energy dispersive X-ray and X-ray diffraction). In our study, non-osteodifferentiated hAM (i.e., fresh or native hAM) exhibited innate pre-osteoblastic potential. Osteodifferentiation of fresh hAM induced a change in tissue structure, cell phenotype and function. Therefore, we hypothesize that pre-osteodifferentiation may not be necessary, especially if it induces unwanted changes. To our surprise, in these osteogenic conditions, hAEC had a mesenchymal phenotype with osteocyte function, and even native synthesis of hydroxyapatite, focusing osteogenic potential mainly in this epithelial layer. In conclusion, in vitro osteodifferentiation by tissue culture does not appear to be necessary for hAM to be used as an innovative ATMP for bone repair.

To date, despite an existing regulatory framework and standards, there are no true technical recommendations. A survey of 23 cell processing facilities (France, Belgium and Switzerland) has allowed to overview current practices according to cellular products specifications upon arrival at the facility, with modalities for their preparation prior to cryopreservation, storage, thawing and finally for infusion to patient. Data analysis shows great variability of collected volumes and cell concentrations in cellular products. Despite homogeneous practices for handling cells at the facility, methods vary between centers, especially for the choice of cryoprotective solutions and thawing methods. During the workshop, practices have been discussed and summarized to write of recommendations about the following topics: processing and cryopreservation, thawing, bedside precautions (for infusion). This work identifies some improvements in terms of collection, choice of wash solution of thawed cells and validation of the conditions of carriage.

Nocardia affects immunocompromised human host exhibiting an altered cell-mediated immunity. Infectious risk after allogeneic hematopoietic cell transplantation (AHCT) is significantly correlated to the recovery status of donor-derived immune system, especially CD4This is a case control retrospective monocentric study. We retrospectively analyzed a monocentric cohort of 15 cases of nocardiosis after AHCT and we explored the degree of patients' immunosuppression by phenotyping circulating lymphoid subpopulations, including NK cells, CD8At onset of nocardiosis, circulating lymphocytes and CD4Immune recovery monitoring follow-up after AHCT is of particular importance to identify patients susceptible to develop Nocardiosis. Efficient microbiological investigations toward Nocardia such PCR should be used in case of compatible clinical presentation.

Despite successful introduction of NK-based cellular therapy in the treatment of myeloid leukemia, the potential use of NK alloreactivity in solid malignancies is still elusive. We performed a phase I clinical trial to assess the safety and efficacy of in situ delivery of allogeneic NK cells combined with cetuximab in liver metastasis of gastrointestinal origin. The conditioning chemotherapy was administrated before the allogeneic NK cells injection via hepatic artery. Three escalating doses were tested (3.10(6), 8.10(6) and 12.10(6) NK cells/kg) following by a high-dose interleukin-2 (IL-2). Cetuximab was administered intravenously every week for 7 weeks. Nine patients with liver metastases of colorectal or pancreatic cancers were included, three per dose level. Hepatic artery injection was successfully performed in all patients with no report of dose-limiting toxicity. Two patients had febrile aplasia requiring a short-term antibiotherapy. Grade 3/4 anemia and thrombopenia were also observed related to the chemotherapy. Objective clinical responses were documented in 3 patients and among them 2 occurred in patients injected with cell products harboring two KIR ligand mismatches and one in a patient with one KIR ligand mismatch. Immune monitoring revealed that most patients presented an increase but transient of IL-15 and IL-7 cytokines levels one week after chemotherapy. Furthermore, a high expansion of FoxP3(+)regulatory T cells and PD-1(+) T cells was observed in all patients, related to IL-2 administration. Our results demonstrated that combining allogeneic NK cells transfer via intra-hepatic artery, cetuximab and a high-dose IL-2 is feasible, well tolerated and may result in clinical responses.

Hematopoietic cell transplantation (HCT) is a curative treatment for hematological malignancies. This therapeutic approach is associated with a profound immune deficiency and an increased rate of opportunistic infections. Nocardiosis is a rare bacterial infection occurring mainly in patients with deficient cell-mediated immunity, such as AIDS patients or transplant recipients. Diagnosis of nocardiosis can be challenging, as signs and symptoms are non-specific. Routine prophylaxis with trimethoprin/sulfamethoxazole (TMP/SMZ) does not prevent the risk of infection. Between May 2001 and December 2009, five cases of nocardiosis were diagnosed from the 366 allogeneic HCT recipients in our centre. Four patients developed a disseminated nocardiosis within the first year after HCT. The fifth patient presented a localized cutaneous nocardiosis. In disseminated cases, median total CD4+ T-cells were below 100 cells/μL. Naive CD4+ CD45RA+/RO− T-cells were almost undetectable. CD8+ T-cells and NK cells were below the normal range and CD19+ B-cell reconstitution was completely deficient. In a localized case, we observed a lack of naive thymic emigrants CD4+ CD45RA+/RO− T-cells.

Pregnancy is the only natural source of anti-HLA immunization. The exact frequency of this immunization remains undetermined as prior studies either used methods with a low sensitivity or were performed late after delivery. We present here the first study on women at delivery evaluating anti-HLA immunization by Luminex. We also attempted to isolate factors influencing immunization, such as soluble HLA-G (sHLA-G) levels and genetic polymorphisms. With Luminex, anti-HLA immunization was observed in 54.4% of the women. As expected, immunization frequency increased with the number of children, reaching 74% in women with >2 deliveries. Among immunized women, strong cytotoxic Ab (as detected by Complement Dependent Cytotoxicity) were associated with a lower level of sHLA-G. None of the studied polymorphisms influenced immunization rate in the whole cohort. Among 94 first pregnant women with no history of miscarriage, the -174 IL-6 gene promoter mutation (G/C) appeared more frequently in non immunized women (69% vs. 45% in immunized ones, p = 0.02). Lastly, the occurrence of a miscarriage before the first live delivery significantly decreased immunization. These results may help to understand mechanisms of pregnancy induced immunization. They also have an impact in the management of previous pregnant women requiring organ or hematopoietic stem cell transplantation.

Purpose This study aims (1) to investigate the feasibility of robot-assisted penetrating keratoplasty (PK) using the new Da Vinci Xi Surgical System and (2) to report what we believe to be the first use of this system in experimental eye surgery. Methods Robot-assisted PK procedures were performed on human corneal transplants using the Da Vinci Xi Surgical System. After an 8-mm corneal trephination, four interrupted sutures and one 10.0 monofilament running suture were made. For each procedure, duration and successful completion of the surgery as well as any unexpected events were assessed. The depth of the corneal sutures was checked postoperatively using spectral-domain optical coherence tomography (SD-OCT). Results Robot-assisted PK was successfully performed on 12 corneas. The Da Vinci Xi Surgical System provided the necessary dexterity to perform the different steps of surgery. The mean duration of the procedures was 43.4 ± 8.9 minutes (range: 28.5-61.1 minutes). There were no unexpected intraoperative events. SD-OCT confirmed that the sutures were placed at the appropriate depth. Conclusions We confirm the feasibility of robot-assisted PK with the new Da Vinci Surgical System and report the first use of the Xi model in experimental eye surgery. Operative time of robot-assisted PK surgery is now close to that of conventional manual surgery due to both improvement of the optical system and the presence of microsurgical instruments. Translational relevance Experimentations will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.

To date, despite an existing regulatory framework and standards, there are no true technical recommendations. A survey of 23 cell processing facilities (France, Belgium and Switzerland) has allowed to overview current practices according to cellular products specifications upon arrival at the facility, with modalities for their preparation prior to cryopreservation, storage, thawing and finally for infusion to patient. Data analysis shows great variability of collected volumes and cell concentrations in cellular products. Despite homogeneous practices for handling cells at the facility, methods vary between centers, especially for the choice of cryoprotective solutions and thawing methods. During the workshop, practices have been discussed and summarized to write of recommendations about the following topics: processing and cryopreservation, thawing, bedside precautions (for infusion). This work identifies some improvements in terms of collection, choice of wash solution of thawed cells and validation of the conditions of carriage.

To analyze the data of the adverse events collected in a single major eye bank (EFS Bourgogne Franche Comte, Besancon, France) for the year 2013 and to report the French data of biovigilance provided by the French National Agency for Medicines and Health Products Safety (ANSM) between 2010 and 2013. we have set up a study of adverse events in 2013, in collaboration with a single eye bank (EFS Bourgogne Franche Comte, Besancon, France). A survey was sent to the surgeon for each delivered corneal button by the eye bank in 2013. They were asked for each grafted patient performed in their center, the type of graft (penetrating keratoplasty, anterior keratoplasty or endothelial keratoplasty), the occurrence of adverse events (primary failure, infectious keratis, endophthalmitis, immune rejection, and other events) and the time interval between surgery and events (Less than 1 postoperative month, between 1 month and 1 year postoperatively, >1 year postoperatively). In 2013, 407 corneal buttons were delivered by the eye bank of Besancon in 21 medical centers which performed corneal grafts and we sent 407 surveys. We received 243 completed questionnaires (59.75%) from 11 centers (52.38%). The global reported rate of adverse events was 27.54% of the graft (n = 65/236 corneal grafts performed in 11 centers in 2013; 20% of Primary graft failure, 11% of infectious keratitis, 1% of endophthalmitis, 34% of rejection, 34% of other incidents). 30.16% of complications were noticed before the first month after surgery versus 52.38% of complications noticed between the first month and the first year after surgery and 17.46% of complications noticed after the post-operative first year The most common causes of adverse events after PK were Immune rejection (13.17%), surgical causes (5.98%) and infection (4.79%) and after EK were Primary graft failure (8.2%) and surgical causes (19.67%). In 2013, in France 0.83% of adverse events were notified in ANSM. For the 236 performed graft issued from a major eye bank (EFS Besancon) in 2013 the global reported rate of post-graft adverse events was 27.54% of the grafts (20% of Primary graft failure, 11% of infectious keratitis, 1% of endophthalmitis, 34% of rejection and 34% of other incidents). Compared to the ANSM data (0.83% of adverse events reported in 2013) this rate is high. This difference can be explained by the low rate of annual notification to the ANSM and shows that biovigilance in France must be more developed. Since biovigilance needs constant improvement for the safety of the graft system, training, information for practitioners, simplifications of procedures and international standardization of the definition are the main points that could be improved.

Transplantation-related mortality (TRM) is high after HLA-mismatched umbilical cord blood (UCB) transplantation (UCBT). In utero, exposure to noninherited maternal antigen (NIMA) is recognized by the fetus, which induces T regulator cells to that haplotype. It is plausible that UCBTs in which recipients are matched to donor NIMAs may alleviate some of the excess mortality associated with this treatment. To explore this concept, we used marginal matched-pair Cox regression analysis to compare outcomes in 48 NIMA-matched UCBTs (ie, the NIMA of the donor UCB unit matched to the patient) and in 116 non–NIMA-matched UCBTs. All patients had a hematologic malignancy and received a single UCB unit. Cases and controls were matched on age, disease, disease status, transplantation-conditioning regimen, HLA match, and infused cell dose. TRM was lower after NIMA-matched UCBTs compared with NIMA-mismatched UCBTs (relative risk, 0.48; P = .05; 18% versus 32% at 5 years posttransplantation). Consequently, overall survival was higher after NIMA-matched UCBT. The 5-year probability of overall survival was 55% after NIMA-matched UCBTs versus 38% after NIMA-mismatched UCBTs (P = .04). When faced with the choice of multiple HLA-mismatched UCB units containing adequate cell doses, selecting an NIMA-matched UCB unit may improve survival after mismatched UCBT.

To the editor: We describe a successful salvage treatment with intensive chemotherapy and stem cell transplantation for a relapse of Hodgkin lymphoma (HL) after single umbilical cord blood transplantation with a reduced intensity-conditioning regimen (RIC).[1][1],[2][2] The originality of this

on behalf of Eurocord, Cord Blood Committee EBMT and Netcord; International audience; Umbilical cord blood transplant recipients are exposed to an increased risk of graft failure, a complication leading to a higher rate of transplant-related mortality. The decision and timing to offer a second transplant after graft failure is challenging. With the aim of addressing this issue, we analyzed engraftment kinetics and outcomes of 1268 patients (73% children) with acute leukemia (64% acute lymphoblastic leukemia, 36% acute myeloid leukemia) in remission who underwent single-unit umbilical cord blood transplantation after a myeloablative conditioning regimen. The median follow-up was 31 months. The overall survival rate at 3 years was 47%; the 100-day cumulative incidence of transplant-related mortality was 16%. Longer time to engraftment was associated with increased transplant-related mortality and shorter overall survival. The cumulative incidence of neutrophil engraftment at day 60 was 86%, while the median time to achieve engraftment was 24 days. Probability density analysis showed that the likelihood of engraftment after umbilical cord blood transplantation increased after day 10, peaked on day 21 and slowly decreased to 21% by day 31. Beyond day 31, the probability of engraftment dropped rapidly, and the residual probability of engrafting after day 42 was 5%. Graft failure was reported in 166 patients, and 66 of them received a second graft (allogeneic, n=45). Rescue actions, such as the search for another graft, should be considered starting after day 21. A diagnosis of graft failure can be established in patients who have not achieved neutrophil recovery by day 42. Moreover, subsequent transplants should not be postponed after day 42.

International audience; In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. Literature and intra-laboratories studies suggest that attached segment is representative of cord blood unit (CBU). Nevertheless, some discrepancies have been observed when analyzing large data registries. To address these issues, we have listed recommendations to increase the standardization of segment processing and quality control (QC), information on units of measurement and specifications and action to be taken in case of out of specifications QC results on segment.

International audience; BACKGROUND AIMS: Automated blood culture systems are widely used for the detection of microorganisms in cell therapy products. However, they are not validated by the manufacturers for this purpose. The aim of this study was to assess the ability of the Bactec system (Becton-Dickinson, Le Pont-De-Claix, France) to detect the microorganisms that could contaminate cell therapy products. METHODS: Three types of vials and conditions were tested: Plus Aerobic/F and Anaerobic/F media incubated at 35°C and Mycosis IC/F medium incubated at 30°C. All vials were incubated 10 days. We tested 18 microorganisms, including slow growers and some with fastidious nutritional requirements (10 bacteria, four yeasts, four filamentous fungi), each with four inocula (10-10(4) colony-forming units) performed in quintuplicate. RESULTS: The combination of Plus Aerobic/F and Plus Anaerobic/F vials detected all the tested pathogenic bacteria, all the tested Gram-positive skin commensal or environmental bacteria, all the tested yeasts, and three of four tested filamentous fungi. The addition of the Mycosis IC/F vial extended the range of detected microorganisms to one fungal environmental contaminant. Two bacterial environmental contaminants were not detected by our method. Low inocula of the skin contaminant Propionibacterium acnes were detected only after 7 days of incubation. CONCLUSIONS: These data suggest that (i) the prolongation of the incubation time of Plus Aerobic/F and Plus Anaerobic/F vials from 7 to 10 days and (ii) the use of Mycosis IC/F medium make minor contributions in the sterility testing of cell therapy products. We have validated the Bactec method using aerobic and anaerobic vials incubated 7 days at 35°C.

The French Health Products Agency (Afssaps) was created in 1998 within a national context of strengthened health monitoring and control. The Afssaps evaluates the safety, the efficacy and the quality of health products. The law 96-452 of May, 28th 1996 and the law 98-535 of July 1st 1998, published in the “Public Health Regulation” have established rules for the use of cell therapy products. The Laboratories and Controls Department (DLC) is in charge of external quality control of cell therapy products since 1999. In this French regular context and because haematopoietic cells are the main cellular products used in routine in Europe (Gratwohl et al., 2006) as they are in the US (Read & Sullivan, 2004), control was first developed for these. Haematopoietic stem cells are populations of primitive multipotent cells capable of self-renewal as well as differentiation and maturation into all haematopoietic lineages. They are found in small numbers in the bone marrow, in the mononuclear cell fraction of circulating blood (peripheral blood stem cells or PBSC) and in umbilical cord blood (umbilical or placental stem cells). For the twenty-five last years, important progresses have been obtained in the treatment of onco-hematology diseases, especially with the advent of therapeutic intensification following by a graft of haematopoietic stem cells (Copelan, 2006). The infused haematopoietic progenitor cell populations can originate from the recipient (autologous) or from another individual (allogeneic) but until now, most of the grafts are made in an autologous context. Also, 85% of the PBSC samples received for the control at Afssaps had an autologous status. Considering peripheral blood stem cells, the major criteria retained for clinical decision is the positive cell number for the CD34 antigen (Bender et al., 1993; Allan et al., 2002; Weaver et al., 1995). However, as there is no target value for CD34+ cells according to the nature of the product, there was a strong need for efficient methods to guarantee the CD34 value and thus make reliable the clinical decision. Numeration by flow cytometry method is currently

International audience; BACKGROUND: The short-term effects of granulocyte-colony-stimulating factor (G-CSF) have been extensively studied, but recent reports of G-CSF-induced genetic perturbations raised concerns regarding its long-term safety. In this respect, duration of G-CSF-induced perturbations has been less studied than short-term effects and needs to be evaluated. STUDY DESIGN AND METHODS: G-CSF mobilization-induced immunologic alterations were prospectively analyzed in a cohort of 24 healthy donors. Blood samples were taken before G-CSF administration; at the time of administration; and at 1, 3, 6, and 12 months and analyzed for blood cell counts and in vitro cytokines (interleukin [IL]-2, -8, and -10) and immunoglobulin production, quantified in the culture supernatant of peripheral blood mononuclear cells (PBMNCs) after, respectively, phytohemagglutinin and pokeweed mitogen stimulation. RESULTS: Platelet, granulocyte, monocyte, B, and dendritic blood cell counts as well as the IL-2, -8, and -10 secretion by PBMNCs, perturbed at the time of G-CSF mobilization, returned to baseline values at 1 month, with T-cell and natural killer cell counts recovering at 3 months. In vitro immunoglobulin production was increased up to 6 months after mobilization. CONCLUSION: Although assessment of the potential long-term risk of G-CSF administration will require prolonged observation of larger cohorts, our data show that the duration of immunologic perturbations may be more persistent than previously anticipated, especially for B-cell functional alterations. Most perturbations remain, however, transient with a return to baseline values within 1 year.

To the editor: Lymphocytes from granulocyte colony-stimulating factor (G-CSF)–mobilized donors display epigenetic and genetic alterations similar to those observed in leukemia patients.[1][1] To further evaluate the scope and duration of G-CSF–induced genetic alterations, 24 healthy donors were

Early immune reconstitution and efficient graft vs tumor effect after unrelated partially matched double cord blood transplantation in refractory 8p11 syndrome

International audience; INTRODUCTION: Spondylarthropathies (SpA) are characterized by abnormal immune responses including T cell activation. Cytotoxic T lymphocyte associated molecule-4 (CTLA-4) is involved in down-regulating immune responses. A soluble form of CTLA-4 (sCTLA-4), resulting from an alternative splicing, has been identified and was found increased in several autoimmune diseases. Here, we evaluated circulating levels of sCTLA-4 as a marker of immune dysregulation in SpA. Intracellular CTLA-4 and levels of CTLA-4 transcript expression in peripheral blood lymphocytes (PBL) were also studied. METHODS: Sera from 165 patients with SpA were evaluated for sCTLA-4 measurements. Results were compared with those from 71 patients with rheumatoid arthritis (RA) and 88 healthy subjects. In 32 patients with SpA, 22 patients with RA and 15 healthy controls, we analyzed the intracellular CTLA-4 expression in CD4+ T cells, CD8+ T cells, activated (HLA-DR+Foxp3-) CD4+ T cells, CD4+ regulatory (CD25+Foxp3+) T cells and in CD3 negative cells by flow cytometry. Expression of the full length (coding for membrane CTLA-4) and spliced form (coding for sCTLA-4) of CTLA-4 transcripts in PBL were analyzed by quantitative real-time polymerase chain reaction (QRT-PCR). RESULTS: High levels of sCTLA-4 were found in the SpA group compared to the RA group and healthy controls (P < 0.0001). Soluble CTLA-4 serum levels strongly correlated with clinical index of disease activity BASDAI (r = 0.42, P < 0.0001) and C-reactive protein (CRP) levels (r = 0.17, P = 0.037). In contrast to RA patients, SpA patients did not exhibit changes in intracellular CTLA-4 expression in the different PBL subsets tested. Finally, the SpA group showed a preferential expression of the spliced CTLA-4 mRNA (P = 0.0014) in PBL. CONCLUSIONS: SpA patients exhibit high levels of circulating sCTLA-4 that may result from an alternative splicing of CTLA-4 transcripts. This may influence immune activation and regulation in SpA.

Among the immunological problems met within platelet transfusion therapy, HLA alloimmunization represents a major, if not the major risk: the management of alloimmunized patients represents a difficult challenge, inciting clinicians and blood bankers to propose and apply several methods for preventing platelet alloimmunization. Among all the methods published in the literature and detailed in this paper, two are of particular interest: 1. (1) the use of leukocyte-poor blood components with less than 1 × 10 6 leukocytes per unit; 2. (2) the irradiation of platelet concentrates in UVB permeable plastic bags.

Introduction: Donor and recipient polymorphisms of immune defense and inflammatory cytokine genes have been associated with outcomes after bone marrow or peripheral blood stem cell transplantation (SCT), but have not been described in the setting of umbilical cord blood transplantation (CBT). Material and Methods: We evaluated the impact of genetic polymorphisms of recipients and CBU units on survival and other CBT outcomes using the following candidate genes related to immune response: NACHT-leucine-rich repeat with a pyrin domain at N-terminus (NLRP1-rs5862, NLRP2-rs043684, NLRP3-rs10754558), Toll-interleukin-1 receptor domain containing adaptor protein (TIRAP/Mal-rs8177374), interleukin-10 (IL10-rs1800872), V-rel reticuloendotheliosis viral oncogene homolog (REL-rs13031237), tumor necrosis factor receptor superfamily - member 1B (TNFRSF1B-rs1061622) and associated protein 4 of cytotoxic T lymphocyte (CTLA4-rs3087243). Seven Netcord banks provided pre-transplant DNA samples from 851 CBU units and 173 recipients. All patients underwent CBT at EBMT centers. Malignant (n=696) and non-malignant (n=155) diseases were analyzed separately. Results: Among the 851 recipients, 57% were male and 61% adults. Degree of HLA matching between CBU unit and recipient (HLA-A, -B at antigen level and -DRB1 at allele level) was 6/6 in 12%, 5/6 in 40%, and ≤4/6 in 48% of transplants. Myeloablative conditioning was used in 77% of cases and anti-thymocyte globulin or monoclonal antibodies in 82% of cases. Median infused total nucleated cells (TNC) and CD34+ cells were 3.7x107/kg and 1.6x105/kg, respectively. In the cohort with malignant diseases, multivariable analysis adjusted for patient-, donor- and disease-related variables showed that recipients of CBU with GG CTLA4 genotype had a poorer neutrophil engraftment (HR 1.24; 95% CI 1.09-1.40; p=0.03), increased NRM (HR 1.52; 95% CI 1.35-1.72%; p Conclusion: In this retrospective analysis, CBU gene polymorphisms CTLA4 and TNFSF1B impacted CBT outcomes. Importantly, CTLA4 GG genotype was associated with inferior survival and the AA genotype with lower relapse rate in patients with malignant disorders. The possible biological explanation of the impact of CTLA4 is that GG genotype is associated with decreased production of soluble CTLA4 (whose primarily functions is to inhibit T-cell activation) which contributes to decrease suppression of T-cell alloimune responses post CBT If these findings are confirmed in further studies, CTLA4 gene polymorphisms can be used among other factors to select CBU with the aim to improve survival after CBT. Disclosures No relevant conflicts of interest to declare.

Abstract 2301 Poster Board II-278 NK-cell alloreactivity in the setting of allogeneic transplantation is largely determined by the specificity of the killer immunoglobulin receptors (KIR) on donor NK cells for recipient HLA class I. We have recently shown that KIR ligand mismatch in the graft-versus-host (GvH) direction between donor and recipient is associated with improved outcomes after unrelated cord blood transplantation (UCBT) for patients with acute leukemia in complete remission. However, this finding was not confirmed in a series of reduced intensity conditioning and UCBT using 2 unrelated cord blood units. Therefore, those controversial results can raise some questions on the donor choice based on KIR ligand matching status. It is not known whether KIR ligand matching is associated with outcomes after UCBT for non-malignant disorders. To address this question we have analyzed patients with non-malignant disorders who had received a UCBT using a single cord blood unit and were reported to the Eurocord registry with sufficient HLA-A, -B, -C typing to assign KIR ligand groups. In agreement with previous studies in malignant diseases, KIR ligand mismatch (KIR+) in the GvH direction occurred when the donor expressed one or several of the following KIR ligands which were lacking in the recipient: HLA-Bw4, and HLA-C group 1 or 2. In addition patients and cord blood units were grouped according to HLA A-3/A-11 alleles, which are putative KIR ligands. One-hundred-thirty-seven eligible patients were selected, mostly children (n=124). UCBT was performed from January 2000 to December 2008 in 47 EBMT-centers. The frequency of KIR ligand mismatched (KIR+) pairs reported was 23% (n=31). Forty-three percent of patients had bone marrow failure syndromes (BMFS) (n=60), other diagnosis included metabolic disorders (n=41), SCID (n=32), hemoglobinopathies (n=2), autoimmune diseases (n=2). Median follow up was 24 months (4-101). Median recipient age was 3 years. UCB units were HLA matched at 6 of 6 (n=38), 5 of 6 (n=62), 4 of 6 (n=34) and 3 of 6 (n=3). Median cell dose infused was 5.6 ×10E7 TNC/Kg and 2.4 ×10E5 CD34 cells/Kg. Conditioning regimen was myeloablative in 48% of cases and reduced intensity in 52% and included ATG in 90% and fludarabine in 42%. Graft-versus-host disease (GvHD) prophylaxis consisted of cyclosporine (CsA) and corticosteroids, CsA alone and CsA and MMF in 47%, 23% and 14% of patients, respectively. Cumulative incidence (CI) of the day-60-neutrophil recovery was 76±3% (median time: 22 days) and it was not associated with KIR mismatch [(74±4% for KIR- and 80±6% for KIR+ group (p=0.9)]. CI of aGvHD was 21±3%, only 3 patients out of 31 with KIR+ presented aGvHD (II-IV). The estimated probability of 2-year overall survival (OS) was 63±4%; it was 64±5% in the group of KIR- and 63±3% in the KIR+ (p=0.5). The main cause of death was graft failure associated with infections (n=16, 32%). There was no statistical difference in frequency of causes of death between the 2 KIR ligand groups. We have also looked the association of KIR ligand mismatch in the host versus graft (HvG) direction. The frequency of KIR mismatched pairs in the HvG direction was 22% and it was not associated with neutrophil recovery (76±4% for KIR ligand matched in HvG direction versus 73±6% for KIR ligand mismatched in HvG direction, p=0.9) or OS (64±5% for KIR ligand matched in HvG direction versus 58±7% for KIR ligand mismatched in HvG direction, p=0.6) In conclusion KIR ligand mismatching in the GvH or HvG direction is not associated with outcomes after UCBT for children with non malignant disease. Therefore it is not useful in the algorithm of donor choice in this setting. Disclosures: No relevant conflicts of interest to declare.

The short-term immunological effects of granulocyte-colony stimulating factor (G-CSF) administration have been extensively studied, but concerns regarding its long-term safety have been raised by recent reports such as G-CSF-induced genetic perturbations (Nagler et al, Exp Hematol, 2004) as analyzed in a limited number of donors. In response to such concerns, we conducted a prospective study to further evaluate both short and long-term immunologic and cytogenetic alterations potentially induced by G-CSF mobilization in a cohort of 24 consecutive healthy donors. Blood samples were taken before and at time of G-CSF administration and of cytapheresis as well as 1, 3, 6 and 12 months after. G-CSF treatment followed by cytaphereris induced a significant blood platelet count decrease while granulocyte, monocyte, B as well as dendritic cell (monocyte-derived DC and even more so plasmocytoid DC) blood counts increased. Such perturbations were found to return to baseline values at one month. T-cell (both CD4 and CD8) as well as NK-cell counts decreased significantly after cytapheresis and did not recover normal values before 3 months. In vitro immunoglobulin G and M production by pokeweed mitogen-stimulated PBMC was found to be significantly (P < 10−5) increased of 63+/−7% and 84+/−7% over baseline values; increases that persisted up to 6 months after mobilization. Such an observation is in line with our previous findings pertaining to enhanced humoral immune reconstitution after allo- PBSCT (Lapierre et al, Blood 2001, Blood 2002; Tayebi et al., Br J Haematol 2001). Quite strikingly, G-CSF mobilization was also associated with significant (P < 10−6) increased PBMC aneuploidy, analyzed by in situ hybridization of chromosomes 8 and 17 centromere-specific fluorescent probes. Such increase in the frequency of aneuploïd cells was not observed in CD34+ selected cells, suggesting that G-CSF mobilization did not affect CD34+ cells with regard to cytogenetic abnormalities and that the increase in aneuploidy was induced in more mature cells. The frequency of chromosomes 8 and 17 aneuploidy increased an average of 4.5 and 4.3-fold, respectively, after G-CSF mobilization (before mobilization: 1.2+/−0.1% and 2.4+/−0.2%; after mobilization: 4.2+/− 0.4% and 8.8+/−0.4% for chromosome 8 and 17, respectively). Cells with multisomy, rare events before mobilization (recorded in 5/24 donors and at very low levels (< 0.2%)), were observed at significantly higher frequencies in all 24 donors after mobilization. On the other hand, cells with monosomy and cells with trisomy were detectable at baseline in all donors although at low frequencies which increased significantly after mobilization. The level of aneuploidy subsequently decreased after G-CSF mobilization, but, importantly remained significantly higher than baseline values at three and six months after mobilization. The frequency of cells with monosomy was higher, and returned to baseline values more gradually than the frequency of cells with trisomy or multisomy. In conclusion, our data show that immunological and cytogenetic perturbations induced by G-CSF administration in normal donors may be more pronounced and persistent than previously described. Such perturbations remain however transient with a return to baseline values within one year for most perturbations. Consequences, if any, of such alterations for the donor are presently unknown. Although EBMT and NMDP surveys have no shown any evidence in favor of an increased incidence of malignant hemopathies or solid tumors in mobilized normal donors, assessment of the potential long-term risk of G-CSF administration will require prolonged observation of large G-CSF-mobilized donor cohorts.