Project: Project 3 Allogeneic hematopoietic cell transplantation (HCT) is frequently curative for otherwise fatal leukemia. However, conventional T cell-replete HCT, using immunosuppressive drugs (IS) alone, is often complicated by graft-versus-host disease (GVHD), which is associated with mortality in 16% of HCT recipients. Quality-of-life is compromised by moderate or severe chronic GVHD. Moreover, prolonged GVHD precludes the use of T cell immunotherapy or vaccination to prevent or treat leukemia that recurs following HCT. T cell depletion is effective for preventing GVHD, but is complicated by slow immune recovery and high rates of opportunistic infection. The objective of this project is to develop an improved HCT strategy to prevent GVHD, rapidly reconstitute pathogen-specific immunity and facilitate future immunotherapeutic approaches to reduce relapse. The research ultimately aims to improve the health and survival of leukemia patients. To improve GVHD-free, relapse-free survival (GRFS), we developed two new HCT approaches: 1) peripheral blood stem cell transplantation (PBSCT) with depletion of nave T cells from the stem cell graft (TND) and 2) PBSCT followed by administration of cyclophosphamide 3-4 days after stem cell infusion (post-transplant Cy; PTCy). In single-arm clinical trials of either TND or PTCy, we observed substantially lower rates of chronic GVHD than is usual among recipients of PBSCT on conventional HCT plans. We now propose in Aim 1 a phase II randomized controlled trial (RCT), comparing PBSCT with TND or PTCy to PBSCT with anti-thymocyte globulin (ATG), the latter a standard GVHD prophylaxis approach, using a flexible, pick-the-winner trial design. Our goal is to select one novel PBSCT strategy to advance to a phase III RCT that will define the best approach for maximizing survival while minimizing relapse, GVHD and dependence on IS. T cell immunotherapy and other immune manipulations delivered in the early post-HCT period have the potential to reduce relapse and would be enabled by identification of bone marrow lymphocyte signatures that presage relapse. Exciting new technologies, including single cell RNA sequencing (scRNA-seq) and TCR deep sequencing (TCR-seq) should facilitate the acquisition of these data and will be evaluated in Aim 2.
The specific aims are:
Aim 1 : To conduct a phase II RCT for patients with acute leukemia comparing two novel strategies (TND and PTCy) to a standard HCT strategy (ATG), aiming to improve GVHD-free, relapse-free survival and avoid prolonged IS after myeloablative allogeneic PBSCT.
Aim 2 : To evaluate reconstitution and function of peripheral blood and bone marrow immune cell subsets in HCT recipients to determine if lymphocyte signatures are associated with opportunistic infection or AML relapse.

Public Health Relevance

Project: Project 3 Allogeneic hematopoietic cell transplantation (HCT) can cure otherwise fatal leukemia, but death and disability associated with graft-versus-host disease (GVHD) are common, as is post-HCT relapse. We developed two promising new strategies for peripheral blood stem cell transplantation (PBSCT), with nave T cell depletion (TND) or with post-transplantation cyclophosphamide (PTCy), evaluated them in single-arm clinical trials and found that each were associated with markedly lower chronic GVHD compared to historical controls. We now propose to compare these new strategies with a standard form of HCT in a phase II randomized controlled trial, and to perform state-of-the-art laboratory studies aimed at defining a bone marrow lymphocyte pattern that predicts leukemia recurrence early post-HCT and enables timely implementation of relapse-preventing immunotherapy.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Fred Hutchinson Cancer Research Center
United States
Zip Code
McCune, Jeannine S; Storer, Barry; Thomas, Sushma et al. (2018) Inosine Monophosphate Dehydrogenase Pharmacogenetics in Hematopoietic Cell Transplantation Patients. Biol Blood Marrow Transplant 24:1802-1807
Deegan, Anthony J; Talebi-Liasi, Faezeh; Song, Shaozhen et al. (2018) Optical coherence tomography angiography of normal skin and inflammatory dermatologic conditions. Lasers Surg Med 50:183-193
Leger, Kasey J; Baker, K Scott; Cushing-Haugen, Kara L et al. (2018) Lifestyle factors and subsequent ischemic heart disease risk after hematopoietic cell transplantation. Cancer 124:1507-1515
Schmitt, Michael W; Pritchard, Justin R; Leighow, Scott M et al. (2018) Single-Molecule Sequencing Reveals Patterns of Preexisting Drug Resistance That Suggest Treatment Strategies in Philadelphia-Positive Leukemias. Clin Cancer Res 24:5321-5334
Shaw, Bronwen E; Syrjala, Karen L; Onstad, Lynn E et al. (2018) PROMIS measures can be used to assess symptoms and function in long-term hematopoietic cell transplantation survivors. Cancer 124:841-849
Jamani, Kareem; Onstad, Lynn E; Bar, Merav et al. (2018) Quality of Life of Caregivers of Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 24:2271-2276
Ogimi, Chikara; Xie, Hu; Leisenring, Wendy M et al. (2018) Initial High Viral Load Is Associated with Prolonged Shedding of Human Rhinovirus in Allogeneic Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 24:2160-2163
Salter, Alexander I; Pont, Margot J; Riddell, Stanley R (2018) Chimeric antigen receptor-modified T cells: CD19 and the road beyond. Blood 131:2621-2629
Lee, Stephanie J; Nguyen, Tam D; Onstad, Lynn et al. (2018) Success of Immunosuppressive Treatments in Patients with Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 24:555-562
Bar, Merav; Flowers, Mary E D; Storer, Barry E et al. (2018) Reversal of Low Donor Chimerism after Hematopoietic Cell Transplantation Using Pentostatin and Donor Lymphocyte Infusion: A Prospective Phase II Multicenter Trial. Biol Blood Marrow Transplant 24:308-313

Showing the most recent 10 out of 1845 publications