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Kiser K, Cashen AF, Crees ZD, Ghobadi A, Yang JC. Impact of Salvage Versus Palliative Dose Bridging Radiation Therapy on Local Control and Overall Survival in Patients with DLBCL Receiving CD19 CAR T Cell Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e471-e472. [PMID: 37785500 DOI: 10.1016/j.ijrobp.2023.06.1680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL), radiation therapy (RT) can be used to "bridge" patients during the period of chimeric antigen receptor T cell (CAR T) manufacturing. Although RT has been shown to improve local control (LC) in patients who receive RT versus do not, it is unknown whether there is an optimal dose. MATERIALS/METHODS This was a retrospective study of patients with DLBCL who received bridging RT and CAR T cell therapy between 8/2021 and 12/2022 at a single institution (IRB #202103122). Patient, disease, and treatment characteristics were abstracted. PET/CT and laboratory data were collected at various time points. RT data including dose, planning target volume (PTV), and body volume receiving 2Gy and 4 Gy were tested for associations with LC, overall survival (OS), cytokine release syndrome (CRS) and immune effect cell-associated neurotoxicity syndrome (ICANS). Statistical tests were performed using Python libraries. RESULTS Twenty-two patients with DLBCL were included for analysis. The median patient age was 68 (range 35-82) and the median prior lines of failed therapies was two. All patients had successful apheresis and subsequent CAR T manufacturing. No patients died before CAR T infusion. All patients had a pre-radiation PET/CT scan that showed Deauville 5 disease. Patients with limited stage disease received salvage dose RT (EQD2∼40Gy, n = 8) while patients with advanced disease received palliative dose RT (n = 14). The median PTV volume was 1332 cm3. With a median follow-up of 156 days (IQR 63 - 252 days) from CAR T infusion, 10 patients had died and six progressed at an RT target. A higher salvage RT dose was not associated with LC at the day 30 PET or day 90 PET time points. In a Cox regression model, no independent variable, including RT dose, was significantly associated with LC or OS, but post-RT residual target SUV trended toward an association with OS (HR 6.2, 95% CI 0.9 - 471.0, p = 0.06). Post-RT LDH was associated with CRS grade (ρ = -0.39, p = 0.05). Other non-significant associative trends were noted between CRS grade and post-RT absolute lymphocyte count (ALC) (ρ = - 0.33, p = 0.09) and residual target SUV max (ρ = - 0.37, p = 0.08) and between ICANS grade and pre- to post-RT LDH change (ρ = -0.38, p = 0.06) and post-RT lymphocyte count (ρ = 0.36, p = 0.07). In an exploratory analysis of body volume receiving integral doses of 4Gy or 2Gy and pre- and post-RT ALC change, it appeared that higher integral dose did lead to larger decreases in ALC (ρ = -0.32, p = 0.15 and ρ = -0.3, p = 0.18, respectively). CONCLUSION In this small series of patients with r/r DLBCL treated with bridging RT prior to CAR T therapy, RT dose was not associated with LC. However, higher post-RT target residual SUV was associated with worse OS. The impact of post-RT LDH on CRS and ICANS grades should be explored further.
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Affiliation(s)
- K Kiser
- MD Anderson Cancer Center, Houston, TX
| | - A F Cashen
- Washington University in St. Louis, St. Louis, MO
| | - Z D Crees
- Washington University in St. Louis, St. Louis, MO
| | - A Ghobadi
- Washington University in St. Louis, St. Louis, MO
| | - J C Yang
- Washington University in St. Louis, St. Louis, MO
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Mead MD, Popplewell LL, Subklewe M, Ghobadi A, Kuruvilla J, Kimball A, Tuglus C, Agarwal S, Stieglmaier J. PHASE I STUDY OF THE CD19/CD3 HALF‐LIFE EXTENDED BITE
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MOLECULE AMG 562 IN RELAPSED/REFRACTORY DIFFUSE LARGE B CELL LYMPHOMA, MANTLE CELL LYMPHOMA AND FOLLICULAR LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.87_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M. D. Mead
- Ronald Reagan UCLA Medical Center Department of Hematology & Oncology Los Angeles California USA
| | - L. L. Popplewell
- City of Hope National Medical Center Department of Hematology & Hematopoietic Cell Transplantation Duarte USA
| | - M. Subklewe
- LMU – University Hospital Munich Department of Hematology & Oncology Munich Germany
| | - A. Ghobadi
- Washington University School of Medicine Division of Oncology St. Louis USA
| | - J. Kuruvilla
- Princess Margaret Cancer Centre University of Toronto Division of Medical Oncology and Hematology Toronto Canada
| | - A. Kimball
- Amgen Inc. Oncology TA Clinical Research Thousand Oaks USA
| | - C. Tuglus
- Amgen Inc. Global Biostatistical Science Thousand Oaks US
| | - S. Agarwal
- Amgen Inc Clinical Pharmacology Modeling and Simulation South San Francisco USA
| | - J. Stieglmaier
- Amgen Research (Munich) GmbH Early Development Hematology/Oncology Munich Germany
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Annunziata C, Dansky-Ullmann C, Ghobadi A, Weng D, Vanas J, Ekwede I, Pavelova M, Keefe R, Kuo M, Hassan R, Thaker P. A phase I study of intraperitoneal MCY-M11 Anti-mesothelin CAR for women with platinum resistant high grade serous adenocarcinoma of the ovary, primary peritoneum, or fallopian tube, or subjects with peritoneal mesothelioma with recurrence after prior chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sano D, Lekakis L, Feng L, Nastoupil L, Jain M, Spiegel J, Dahiya S, Lin Y, Ghobadi A, Lunning M, Hill B, Reagan P, Oluwole O, McGuirk J, Sehgal A, Deol A, Charalambos A, Goy A, Munoz J, Cashen A, Bennani N, Rapoport A, Vose J, Miklos D, Locke F, Neelapu S. SAFETY AND EFFICACY OF AXICABTAGENE CILOLEUCEL (AXI-CEL) IN OLDER PATIENTS: RESULTS FROM THE US LYMPHOMA CAR-T CONSORTIUM. Hematol Oncol 2019. [DOI: 10.1002/hon.113_2630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- D. Sano
- Lymphoma/Myeloma; MD Anderson Cancer Center; Houston United States
| | - L. Lekakis
- Bone Marrow Transplant/Hematology; University Of Miami; Miami United States
| | - L. Feng
- Lymphoma/Myeloma; MD Anderson Cancer Center; Houston United States
| | - L.J. Nastoupil
- Lymphoma/Myeloma; MD Anderson Cancer Center; Houston United States
| | - M.D. Jain
- Blood; Bone Marrow Transplant and Cellular Therapy, Moffitt Cancer Center; Tampa United States
| | - J.Y. Spiegel
- Hematology; Stanford University; Stanford United States
| | - S. Dahiya
- Hematology/Bone Marrow Transplant; University of Maryland Medical Center; Baltimore United States
| | - Y. Lin
- Hematology; Mayo Clinic; Rochester United States
| | - A. Ghobadi
- Bone Marrow Transplant; Washington University Medical Campus; Saint Louis United States
| | - M. Lunning
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - B.T. Hill
- Hematology and Medical Oncology; Cleveland Clinic; Cleveland United States
| | - P. Reagan
- Lymphoma; University of Rochester Medical Center/Wilmot Cancer institute; Rochester United States
| | - O. Oluwole
- Hematology and Oncology; Vanderbilt University Medical Center; Nashville United States
| | - J. McGuirk
- Hematological Malignancies and Cellular Therapeutic; The University of Kansas Health System; Kansas City United States
| | - A. Sehgal
- Hematology and Oncology; UPMC Hillman Cancer Center; Pittsburgh United States
| | - A. Deol
- Department of Oncology; Wayne State University/Karmanos Cancer Center; Detroit United States
| | - A. Charalambos
- Hematology and Bone Marrow Transplant; University of California San francisco; San Francisco United States
| | - A.H. Goy
- Hematology and Oncology; Hackensack University Medical Center; Hackensack United States
| | - J. Munoz
- Lymphoma/Myeloma; Banner MD Anderson Cancer Center; Gilbert United States
| | - A. Cashen
- Bone Marrow Transplantation & Leukemia; Washington University Medical School; St. Louis United States
| | - N.N. Bennani
- Hematology; Mayo Clinic; Rochester United States
| | - A.P. Rapoport
- Hematology/Bone Marrow Transplant; University of Maryland Medical Center; Baltimore United States
| | - J.M. Vose
- Hematology/Oncology; University of Nebraska Medical Center; Omaha United States
| | - D.B. Miklos
- Hematology; Stanford University; Stanford United States
| | - F.L. Locke
- Blood; Bone Marrow Transplant and Cellular Therapy, Moffitt Cancer Center; Tampa United States
| | - S.S. Neelapu
- Lymphoma/Myeloma; MD Anderson Cancer Center; Houston United States
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Popplewell L, Verhoef G, Kuruvilla J, Tuglus C, Kischel R, Stieglmaier J, Ghobadi A. A FIRST-IN-HUMAN STUDY OF A HALF-LIFE EXTENDED CD19-TARGETING BiTE IN RELAPSED/REFRACTORY DIFFUSE LARGE B CELL LYMPHOMA, MANTLE CELL LYMPHOMA OR FOLLICULAR LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.14_2632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- L. Popplewell
- Toni Stephenson Lymphoma Center; City of Hope; Duarte United States
| | - G. Verhoef
- Department of Oncology; UZ Leuven; Leuven Belgium
| | - J. Kuruvilla
- Princess Margaret Cancer Centre; Cancer Clinical Research Unit; Toronto Canada
| | - C. Tuglus
- Global Biostatistical Sciences; Amgen Inc.; Thousand Oaks United States
| | - R. Kischel
- BiTE Technology; Amgen Research (Munich) GmbH; Munich Germany
| | - J. Stieglmaier
- Translational Medicine; Amgen Research (Munich) GmbH; Munich Germany
| | - A. Ghobadi
- Center for Gene and Cellular Immunotherapy; Washington University School of Medicine; St. Louis United States
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Aftab B, Munson D, Rasor K, Foubert P, Tsai D, Kai Weng W, Ghobadi A, van Besien K, Sun Y, Hiremath M, Navarrow W, Prockop S. CORRELATION OF CIRCULATING EPSTEIN-BARR VIRUS-TARGETED CYTOTOXIC T LYMPHOCYTE PRECURSORS (EBV-CTLp) AND CLINICAL RESPONSE FOLLOWING TABELECLEUCEL (TAB-CEL) INFUSION IN PATIENTS WITH EBV-DRIVEN DISEASE. Hematol Oncol 2019. [DOI: 10.1002/hon.186_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- B. Aftab
- Preclinical and Translational Science; Atara Biotherapeutics; Thousand Oaks United States
| | - D. Munson
- Preclinical and Translational Science; Atara Biotherapeutics; Thousand Oaks United States
| | - K. Rasor
- Preclinical and Translational Science; Atara Biotherapeutics; Thousand Oaks United States
| | - P. Foubert
- Preclinical and Translational Science; Atara Biotherapeutics; Thousand Oaks United States
| | - D. Tsai
- Clinical; Loxo Oncology; Stamford United States
| | - W. Kai Weng
- Internal Medicine; Stanford; Palo Alto United States
| | - A. Ghobadi
- Internal Medicine; Saint Louis Children's Hospital; Saint Louis United States
| | | | - Y. Sun
- Biostatistics; Atara Biotherapeutics; Thousand Oaks United States
| | - M. Hiremath
- Clinical Development; Atara Biotherapuetics; San Francisco United States
| | - W. Navarrow
- Clinical Development; Atara Biotherapuetics; San Francisco United States
| | - S. Prockop
- Pediatric Hematology-Oncology; MSK; New York United States
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Kurlander L, Srinivasan A, Ghobadi A, Suser S, Doubrovina E, Boulad F, Mascarenhas L, Laquaglia M, Price A, Behr G, Shulkin B, Sudhindra A, Wei Y, Hiremath M, Navarro W, O'Reilly R, Prockop S. Efficacy and safety of tabelecleucel in patients with EpsteinBarr Virus-associated leiomyosarcomas (EBV+ LMS). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy485.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Menchine M, Van Winkle P, Ghobadi A, Chen Q, Axeen S, Sharp A. 249 Opioid Prescribing from Emergency Departments and Risk of Long-Term Use in a Large, Managed Care Network. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Neelapu S, Rossi J, Locke F, Xue A, Better M, Zhang X, Ghobadi A, Lekakis L, Miklos D, Jacobson C, Braunschweig I, Oluwole O, Siddiqi T, Lin Y, Timmerman J, Reagan P, Navale L, Go W, Wiezorek J, Bot A. PRODUCT CHARACTERISTICS ASSOCIATED WITH IN VIVO EXPANSION OF ANTI-CD19 CAR T CELLS IN PATIENTS TREATED WITH AXICABTAGENE CILOLEUCEL (AXI-CEL). Hematol Oncol 2017. [DOI: 10.1002/hon.2438_132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S.S. Neelapu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine; University of Texas MD Anderson Cancer Center; Houston USA
| | - J.M. Rossi
- Kite Pharma, Kite Pharma; Santa Monica USA
| | - F.L. Locke
- H. Lee Moffitt Cancer Center, H. Lee Moffitt Cancer Center; Tampa USA
| | - A. Xue
- Kite Pharma, Kite Pharma; Santa Monica USA
| | - M. Better
- Kite Pharma, Kite Pharma; Santa Monica USA
| | - X. Zhang
- Kite Pharma, Kite Pharma; Santa Monica USA
| | - A. Ghobadi
- Department of Medicine, Oncology Division, Bone Marrow Transplantation and Leukemia Section; Washington University School of Medicine in St. Louis; St. Louis USA
| | - L.J. Lekakis
- Hematology/Oncology; University of Miami Health System, Sylvester Comprehensive Cancer Center; Miami USA
| | - D. Miklos
- Blood and Marrow Transplantation; Stanford University School of Medicine; Stanford USA
| | - C.A. Jacobson
- Hematologic Oncology; Dana-Farber Cancer Institute; Boston USA
| | - I. Braunschweig
- Department of Oncology; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx USA
| | - O. Oluwole
- Vanderbilt-Ingram Cancer Center, Vanderbilt-Ingram Cancer Center; Nashville USA
| | - T. Siddiqi
- City of Hope National Medical Center, City of Hope National Medical Center, Duarte; USA
| | - Y. Lin
- Department of Hematology; Mayo Clinic; Rochester USA
| | - J. Timmerman
- UCLA David Geffen School of Medicine; UCLA David Geffen School of Medicine; Los Angeles USA
| | - P.M. Reagan
- Department of Medicine, Hematology/Oncology (SMD); University of Rochester Medical Center; Rochester USA
| | - L. Navale
- Kite Pharma, Kite Pharma; Santa Monica USA
| | - W.Y. Go
- Kite Pharma, Kite Pharma; Santa Monica USA
| | | | - A. Bot
- Kite Pharma, Kite Pharma; Santa Monica USA
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Wylie K, Blanco-Guzman M, Wylie T, Lawrence S, Ghobadi A, DiPersio J, Storch G. High-throughput sequencing of cerebrospinal fluid for diagnosis of chronicPropionibacterium acnesmeningitis in an allogeneic stem cell transplant recipient. Transpl Infect Dis 2016; 18:227-33. [DOI: 10.1111/tid.12512] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/18/2015] [Accepted: 12/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- K.M. Wylie
- Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri USA
- The McDonnell Genome Institute; Washington University School of Medicine; St. Louis Missouri USA
| | - M. Blanco-Guzman
- Department of Medicine; Washington University School of Medicine; St. Louis Missouri USA
| | - T.N. Wylie
- Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri USA
- The McDonnell Genome Institute; Washington University School of Medicine; St. Louis Missouri USA
| | - S.J. Lawrence
- Department of Medicine; Washington University School of Medicine; St. Louis Missouri USA
| | - A. Ghobadi
- Department of Medicine; Washington University School of Medicine; St. Louis Missouri USA
| | - J.F. DiPersio
- Department of Medicine; Washington University School of Medicine; St. Louis Missouri USA
| | - G.A. Storch
- Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri USA
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Ulusoy Ghobadi TG, Ghobadi A, Okyay T, Topalli K, Okyay AK. Controlling luminescent silicon nanoparticle emission produced by nanosecond pulsed laser ablation: role of interface defect states and crystallinity phase. RSC Adv 2016. [DOI: 10.1039/c6ra24412b] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In this study, we provide a systematic study on the origin of green and blue emission from luminescent silicon nanoparticles (Si-NPs) synthesized in water using a nanosecond pulsed laser ablation methodology.
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Affiliation(s)
- T. G. Ulusoy Ghobadi
- UNAM – National Nanotechnology Research Center
- Bilkent University
- 06800 Ankara
- Turkey
- Institute of Materials Science and Nanotechnology
| | - A. Ghobadi
- Institute of Materials Science and Nanotechnology
- Bilkent University
- 06800 Ankara
- Turkey
- Department of Electrical and Electronics Engineering
| | - T. Okyay
- OkyayTech R&D Ltd
- Cyberpark
- Bilkent University
- 06800 Ankara
- Turkey
| | - K. Topalli
- UNAM – National Nanotechnology Research Center
- Bilkent University
- 06800 Ankara
- Turkey
- Institute of Materials Science and Nanotechnology
| | - A. K. Okyay
- UNAM – National Nanotechnology Research Center
- Bilkent University
- 06800 Ankara
- Turkey
- Institute of Materials Science and Nanotechnology
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Ghobadi A, Nolley E, Liu J, McBride A, Stockerl-Goldstein K, Cashen A. Retrospective comparison of allogeneic vs autologous transplantation for diffuse large B-cell lymphoma with early relapse or primary induction failure. Bone Marrow Transplant 2014; 50:134-6. [PMID: 25243626 DOI: 10.1038/bmt.2014.198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A Ghobadi
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - E Nolley
- Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - J Liu
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO, USA
| | - A McBride
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - K Stockerl-Goldstein
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - A Cashen
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
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Bhamidipati PK, Ghobadi A, Bauer S, DiPersio JF, Pusic I. Conservative management of pneumatosis intestinalis after allogeneic hematopoietic SCT. Bone Marrow Transplant 2014; 49:1436-8. [DOI: 10.1038/bmt.2014.148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chawla J, Ghobadi A, Mosley J, Verkruyse L, Trinkaus K, Abboud C, Cashen A, Stockerl-Goldstein K, Uy G, Westervelt P, DiPersio J, Vij R. Oral valganciclovir versus ganciclovir as delayed pre-emptive therapy for patients after allogeneic hematopoietic stem cell transplant: a pilot trial (04-0274) and review of the literature. Transpl Infect Dis 2011; 14:259-67. [DOI: 10.1111/j.1399-3062.2011.00689.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/01/2011] [Accepted: 08/28/2011] [Indexed: 11/29/2022]
Affiliation(s)
- J.S. Chawla
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - A. Ghobadi
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - J. Mosley
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - L. Verkruyse
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - K. Trinkaus
- Biostatistics; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - C.N. Abboud
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - A.F. Cashen
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | | | - G.L. Uy
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - P. Westervelt
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - J.F. DiPersio
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - R. Vij
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
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Ghobadi A, Athar M, Dowell J. The incidence and impact of comorbidity on survival and selection of initial treatment in elderly patients (pts) with head and neck cancer (HNC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6065 Background: Comorbidity has been shown to be a determinant of survival and treatment selection in various cancers including HNC. Higher comorbidity index is associated with higher utilization of non-curative intent treatment. Methods: In this retrospective study we analyzed 182 consecutively treated HNC pts >65 years (y) old at the Dallas VAMC from January 2000 through June 2007. Comorbidity was assessed with the Charlson Comorbidity Index (CCI). Treatment was classified as curative intent versus non-curative intent. The goals were 1) to demonstrate burden of comorbidity and 2) to demonstrate the impact of comorbidity on overall survival and selection of initial treatment in elderly HNC pts. Results: Pts characteristics: 100% male; 80% white, 19.5% Black, 0.5% Hispanic; median age 72y (range 65–87); 3% stage 0, 26% stage I, 20% stage II, 18% stage III, 30% stage IV, 2% unknown; primary site - 30% oral cavity, 4% hypopharnyx, 22% oropharynx, 38% larynx, 4% other, 1% unknown; treatment - 26% radiation only, 44% surgery (S), 21% chemoradiation (CR), 9% no treatment; Median CCI -2 (range 0–11); 61% had CCI score 0–2 and 39% had CI score > 3. Median overall survival was 883 days (SE 19.31 days). Rate of curative vs. non-curative intent treatment was 80% vs. 20% respectively. Pts with CCI score 0–2 had a non-significant higher rate of curative intent treatment than pts with CCI score > 3 (83.8% vs. 74.6% p = 0.13). In multivariate analysis including CCI, age, race, alcohol use, primary site, treatment, and stage, only advanced clinical stage had significant prognostic importance (HR 1.66; 95% CI, 1.29 to 2.14; p < 0.0005). The HR for CCI was 1.11 (95% CI, .99–1.24; p = 0.08). In separate multivariate analyses of pts treated with S and pts treated with CR, CCI was not a significant predictor of survival with HR of .88 (95% CI, .69–1.11; p = 0.29) and 1.13 (95% CI, .83–1.53; p = 0.44), respectively. Conclusions: In our population of elderly HNC pts, CCI and age had no significant impact on survival or selection of curative intent treatment. Additional study is required to better define appropriate candidates for curative intent treatment in this population. No significant financial relationships to disclose.
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Affiliation(s)
- A. Ghobadi
- UT Southwestern Medical Center at Dallas, Dallas VAMC, Dallas, TX
| | - M. Athar
- UT Southwestern Medical Center at Dallas, Dallas VAMC, Dallas, TX
| | - J. Dowell
- UT Southwestern Medical Center at Dallas, Dallas VAMC, Dallas, TX
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Ghobadi A. Serum Lipase Level as a Predictor of Gallstones as the Etiology of Acute Pancreatitis. Acad Emerg Med 2005. [DOI: 10.1197/j.aem.2005.03.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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