PROJECT 1: ESTABLISHING STABLE MIXED HEMATOPOIETIC CHIMERISM INA CANINE MODEL We have established stable dog leukocyte antigen (DLA)-identical marrow grafts using sublethal conditioning with 2 Gy total body irradiation (TBI) before and a short course of immunosuppression with mycophenolate mofetil and cyclosporine after transplantation. The approach has been translated successfully into the clinic to treat patients with malignant (see Projects 3 and 4) and nonmalignant blood disorders. Project 1 will use the canine model to address three major issues of clinical allogeneic hematopoietic cell transplantation (HCT), avoiding long-term sequelae from conditioning regimens, controlling graft-vs.-host disease (GVHD) without need for and side effects from extended postgrafting immunosuppression, and enhancing graft-vs.- tumor effects without increasing the risk of GVHD. As for the first goal, we have both preclinical and clinical evidence that cytotoxic conditioning is not mandatory for allogeneic grafts to home. We will extend these observations and determine whether specific and non-toxic pretransplant tolerance induction, exploring six canine-specific blockers of T-cell co-stimulation and two agents affecting regulatory pathways, developed in our laboratory, can be substituted for the broad immunosuppression imparted by TBI and, this way, avoid short- and long-term radiation toxicities. As for the second goal, we will assess three alternative postgrafting manipulations for better control of both GVHD and HVG reactions which, if successful, would avert the need for extended postgrafting immunosuppression. To that end, we will study the immunosuppressive agent cyclophosphamide administered 3 days after marrow grafting, an astatine-211 (211At)-labeled monoclonal antibody against the T-cell activation antigen CD70, and an antagonist to the T-cell costimulatory blocker CD28 combined with an agonist to the down-regulatory molecule CTLA-4. The studies proposed under the first two goals are likely to generate stable mixed donor/host hematopoietic chimeras. Persistent host hematopoiesis can serve as model of persistent hematologic malignancy after HCT, a frequent problem encountered in patients transplanted under Projects 3 and 4. In collaboration with Project 2, we intend to identify minor non-DLA antigen disparities specific for hematopoietic cells (hematopoietic antigens) in given donor/recipient pairs using genomics approaches. This knowledge will provide the basis for future studies addressing the third goal in which donor lymphocytes rendered immune to host hematopoietic antigens will be infused in order to shift mixed to all-donor chimerism with no or minimal GVHD. If successful, we will test the efficacy of this approach in a canine model of experimentally induced acute leukemia. Results of these preclinical studies will be relevant for future clinical trials under Projects 3 and 4 and are likely to increase success and safety of allogeneic HCT in human patients.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Program Projects (P01)
Project #
5P01CA078902-15
Application #
8459331
Study Section
Special Emphasis Panel (ZCA1-RPRB-J)
Project Start
Project End
2015-01-31
Budget Start
2013-02-01
Budget End
2014-01-31
Support Year
15
Fiscal Year
2013
Total Cost
$610,796
Indirect Cost
$96,873
Name
Fred Hutchinson Cancer Research Center
Department
Type
DUNS #
078200995
City
Seattle
State
WA
Country
United States
Zip Code
98109
Green, Margaret L; Leisenring, Wendy; Xie, Hu et al. (2016) Cytomegalovirus viral load and mortality after haemopoietic stem cell transplantation in the era of pre-emptive therapy: a retrospective cohort study. Lancet Haematol 3:e119-27
Aki, S Z; Inamoto, Y; Carpenter, P A et al. (2016) Confounding factors affecting the National Institutes of Health (NIH) chronic Graft-Versus-Host Disease Organ-Specific Score and global severity. Bone Marrow Transplant 51:1350-1353
Rosinski, Steven Lawrence; Stone, Brad; Graves, Scott S et al. (2016) Minor Antigen Vaccine-Sensitized DLI: In Vitro Responses Do Not Predict In Vivo Effects. Transplant Direct 2:e71
Hoffmeister, P A; Storer, B E; Syrjala, K L et al. (2016) Physician-diagnosed depression and suicides in pediatric hematopoietic cell transplant survivors with up to 40 years of follow-up. Bone Marrow Transplant 51:153-6
Cassaday, Ryan D; Alan Potts Jr, D; Stevenson, Philip A et al. (2016) Evaluation of allogeneic transplantation in first or later minimal residual disease - negative remission following adult-inspired therapy for acute lymphoblastic leukemia. Leuk Lymphoma 57:2109-18
Johnston, Christine; Harrington, Robert; Jain, Rupali et al. (2016) Safety and Efficacy of Combination Antiretroviral Therapy in Human Immunodeficiency Virus-Infected Adults Undergoing Autologous or Allogeneic Hematopoietic Cell Transplantation for Hematologic Malignancies. Biol Blood Marrow Transplant 22:149-56
Storb, Rainer; Sandmaier, Brenda M (2016) Nonmyeloablative allogeneic hematopoietic cell transplantation. Haematologica 101:521-30
Crews, Leslie A; Balaian, Larisa; Delos Santos, Nathaniel P et al. (2016) RNA Splicing Modulation Selectively Impairs Leukemia Stem Cell Maintenance in Secondary Human AML. Cell Stem Cell 19:599-612
Khera, Nandita; Gooley, Ted; Flowers, Mary E D et al. (2016) Association of Distance from Transplantation Center and Place of Residence on Outcomes after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 22:1319-23
Mielcarek, Marco; Furlong, Terry; O'Donnell, Paul V et al. (2016) Posttransplantation cyclophosphamide for prevention of graft-versus-host disease after HLA-matched mobilized blood cell transplantation. Blood 127:1502-8

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