1
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Garcia-Manero G, Podoltsev NA, Othus M, Pagel JM, Radich JP, Fang M, Rizzieri DA, Marcucci G, Strickland SA, Litzow MR, Savoie ML, Medeiros BC, Sekeres MA, Lin TL, Uy GL, Powell BL, Kolitz JE, Larson RA, Stone RM, Claxton D, Essell J, Luger SM, Mohan SR, Moseley A, Appelbaum FR, Erba HP. A randomized phase III study of standard versus high-dose cytarabine with or without vorinostat for AML. Leukemia 2024; 38:58-66. [PMID: 37935977 DOI: 10.1038/s41375-023-02073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
Prior experience indicated that use of higher doses of cytarabine during induction for acute myeloid leukemia (AML) with a histone deacetylase inhibitor resulted in high response rates. S1203 was a randomized multicenter trial for previously untreated patients aged 18-60 with AML which compared daunorubicin and cytarabine (DA), idarubicin with higher dose cytarabine (IA) and IA with vorinostat (IA + V). The primary endpoint was event free survival (EFS). 738 patients were randomized: 261 to each DA and IA arms and 216 to the IA + V arm. 96, 456, and 150 patients had favorable-, intermediate-, and unfavorable-risk cytogenetics, respectively. 152 were NPM1 and 158 FLT3 mutated. The overall remission rate was 77.5% including 62.5% CR and 15.0% CRi. No differences in remission, EFS, or overall survival were observed among the 3 arms except for the favorable cytogenetics subset who had improved outcomes with DA and postremission high dose cytarabine. A trend towards increased toxicity was observed with the IA and IA + V arms. The use of higher dose cytarabine during induction therapy in younger patients with AML, with or without vorinostat, does not result in improved outcomes. (Funded by the US National Institutes of Health and others, ClinicalTrials.gov number, NCT01802333.).
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Affiliation(s)
| | | | - Megan Othus
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | | | | | - Min Fang
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Guido Marcucci
- Ohio State University (Alliance), Columbus, OH, USA
- City of Hope, Duarte, CA, USA
| | - Stephen A Strickland
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- Sarah Cannon, Nashville, TN, USA
| | | | | | | | - Mikkael A Sekeres
- Cleveland Clinic, Cleveland, OH, USA
- University of Miami, Maiami, FL, USA
| | - Tara L Lin
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Geoffrey L Uy
- Washington University School of Medicine, St. Louis, USA
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | | | | | - David Claxton
- Pennsylvania State Milton S Hershey Medical Center, Hummelstown, USA
| | | | - Selina M Luger
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA
| | - Sanjay R Mohan
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- Sarah Cannon, Nashville, TN, USA
| | - Anna Moseley
- SWOG Statistics and Data Management Center, Seattle, WA, USA
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2
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Stein EM, de Botton S, Cluzeau T, Pigneux A, Liesveld JL, Cook RJ, Rousselot P, Rizzieri DA, Braun T, Roboz GJ, Lebon D, Heiblig M, Baker K, Volkert A, Paul S, Rajagopal N, Roth DA, Kelly M, Peterlin P. Use of tamibarotene, a potent and selective RARα agonist, in combination with azacitidine in patients with relapsed and refractory AML with RARA gene overexpression. Leuk Lymphoma 2023; 64:1992-2001. [PMID: 37571998 DOI: 10.1080/10428194.2023.2243356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
Tamibarotene-based therapy is a novel targeted approach for the treatment of relapsed/refractory (R/R) acute myeloid leukemia (AML) with retinoic acid receptor alpha (RARA) gene overexpression. Approximately, 50% of higher-risk myelodysplastic syndrome (MDS) patients and approximately 30% of AML patients are positive for RARA overexpression using a blood-based biomarker test that measures RARA expression in peripheral blasts. A phase 2 study investigating the activity of tamibarotene in patients with RARA overexpression was conducted in patients with AML and MDS (NCT02807558). In 28 patients with R/R AML and RARA overexpression treated with tamibarotene in combination with azacitidine, the median overall survival was 5.9 months. In 21 response-evaluable patients, the complete remission/complete remission with incomplete hematologic recovery (CR/CRi) rate was 19%, and median time to initial CR/CRi was 1.2 months. The favorable safety profile and preliminary clinical activity support the development of combination therapies with tamibarotene in myeloid malignancies with RARA overexpression.
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Affiliation(s)
- Eytan M Stein
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Thomas Cluzeau
- Côte d'Azur University, CHU de Nice Hôpital, Nice, France
| | - Arnaud Pigneux
- Hematology Clinic, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | | | - Rachel J Cook
- Division of Hematology/Medical Oncology, Oregon Health and Science University, Portland, OR
| | - Philippe Rousselot
- Centre Hospitalier de Versailles, Université Paris-Saclay, Versailles, France
| | | | - Thorsten Braun
- Centre Hospitalier Universitiaire Hôpital Avicenne, Bobigny, France
| | - Gail J Roboz
- Weill Cornell Medicine and the New York Presbyterian Hospital, New York, NY, USA
| | | | - Mael Heiblig
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | | | - Sofia Paul
- Syros Pharmaceuticals, Cambridge, MA, USA
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3
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Murthy HS, Zhang MJ, Chen K, Ahmed S, Deotare U, Ganguly S, Kansagra A, Michelis FV, Nishihori T, Patnaik M, Abid MB, Aljurf M, Arai Y, Bacher U, Badar T, Badawy SM, Ballen K, Battiwalla M, Beitinjaneh A, Bejanyan N, Bhatt VR, Brown VI, Martino R, Cahn JY, Castillo P, Cerny J, Chhabra S, Copelan E, Daly A, Dholaria B, Diaz Perez MA, Freytes CO, Grunwald MR, Hashmi S, Hildebrandt GC, Jamy O, Joseph J, Kanakry CG, Khera N, Krem MM, Kuwatsuka Y, Lazarus HM, Lekakis LJ, Liu H, Modi D, Munshi PN, Mussetti A, Palmisiano N, Patel SS, Rizzieri DA, Seo S, Shah MV, Sharma A, Sohl M, Solomon SR, Ulrickson M, Ustun C, van der Poel M, Verdonck LF, Wagner JL, Wang T, Wirk B, Zeidan A, Litzow M, Kebriaei P, Hourigan CS, Weisdorf DJ, Saber W, Kharfan-Dabaja MA. Allogeneic hematopoietic cell transplantation for blastic plasmacytoid dendritic cell neoplasm: a CIBMTR analysis. Blood Adv 2023; 7:7007-7016. [PMID: 37792849 PMCID: PMC10690553 DOI: 10.1182/bloodadvances.2023011308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy with a poor prognosis and considered incurable with conventional chemotherapy. Small observational studies reported allogeneic hematopoietic cell transplantation (allo-HCT) offers durable remissions in patients with BPDCN. We report an analysis of patients with BPDCN who received an allo-HCT, using data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). We identified 164 patients with BPDCN from 78 centers who underwent allo-HCT between 2007 and 2018. The 5-year overall survival (OS), disease-free survival (DFS), relapse, and nonrelapse mortality (NRM) rates were 51.2% (95% confidence interval [CI], 42.5-59.8), 44.4% (95% CI, 36.2-52.8), 32.2% (95% CI, 24.7-40.3), and 23.3% (95% CI, 16.9-30.4), respectively. Disease relapse was the most common cause of death. On multivariate analyses, age of ≥60 years was predictive for inferior OS (hazard ratio [HR], 2.16; 95% CI, 1.35-3.46; P = .001), and higher NRM (HR, 2.19; 95% CI, 1.13-4.22; P = .02). Remission status at time of allo-HCT (CR2/primary induction failure/relapse vs CR1) was predictive of inferior OS (HR, 1.87; 95% CI, 1.14-3.06; P = .01) and DFS (HR, 1.75; 95% CI, 1.11-2.76; P = .02). Use of myeloablative conditioning with total body irradiation (MAC-TBI) was predictive of improved DFS and reduced relapse risk. Allo-HCT is effective in providing durable remissions and long-term survival in BPDCN. Younger age and allo-HCT in CR1 predicted for improved survival, whereas MAC-TBI predicted for less relapse and improved DFS. Novel strategies incorporating allo-HCT are needed to further improve outcomes.
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Affiliation(s)
- Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Mei-Jie Zhang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Karen Chen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sairah Ahmed
- Department of Lymphoma/Myeloma and Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Uday Deotare
- London Health Sciences Centre, Toronto, ON, Canada
| | | | - Ankit Kansagra
- Blood and Marrow Transplant Program, UT Southwestern Medical Center, Dallas, TX
| | - Fotios V Michelis
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Muhammad Bilal Abid
- Divisions of Hematology/Oncology & Infectious Diseases, Bone and Marrow Transplant & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Yasuyuki Arai
- Kyoto University Hospital, Kyoto University, Kyoto, Japan
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Talha Badar
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Karen Ballen
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | | | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Valerie I Brown
- Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children's Hospital and College of Medicine, Hershey, PA
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Paul Castillo
- UF Health Shands Children's Hospital, Gainesville, FL
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA
| | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, AB, Canada
| | | | - Miguel Angel Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - César O Freytes
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Omer Jamy
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jacinth Joseph
- Methodist Healthcare Blood and Marrow Transplant Center, Memphis, TN
| | - Christopher G Kanakry
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Lazaros J Lekakis
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Hongtao Liu
- Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL
| | - Dipenkumar Modi
- Division of Oncology, Karmanos Cancer Center/Wayne State University, Detroit, MI
| | - Pashna N Munshi
- Stem Cell Transplant and Cellular Immunotherapy Program, MedStar Georgetown University Hospital, Washington, DC
| | - Alberto Mussetti
- Clinical Hematology Department, Catalan Institute of Oncology, Hospitalet, Barcelona, Spain
- Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Neil Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Sagar S Patel
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | | | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | | | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN
| | - Melhm Sohl
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA
| | - Scott R Solomon
- Blood and Marrow Transplant Program, Northside Hospital Cancer Institute, Atlanta, GA
| | | | - Celalettin Ustun
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, IL
| | - Marjolein van der Poel
- Division of Hematology, Department of Internal Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - John L Wagner
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Trent Wang
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | - Amer Zeidan
- Bridgeport Hospital, Yale University School of Medicine, New Haven, CT
| | | | - Partow Kebriaei
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher S Hourigan
- Laboratory of Myeloid Malignancies, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Daniel J Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
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4
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Murthy GSG, Kim S, Estrada-Merly N, Abid MB, Aljurf M, Assal A, Badar T, Badawy SM, Ballen K, Beitinjaneh A, Cerny J, Chhabra S, DeFilipp Z, Dholaria B, Perez MAD, Farhan S, Freytes CO, Gale RP, Ganguly S, Gupta V, Grunwald MR, Hamad N, Hildebrandt GC, Inamoto Y, Jain T, Jamy O, Juckett M, Kalaycio M, Krem MM, Lazarus HM, Litzow M, Munker R, Murthy HS, Nathan S, Nishihori T, Ortí G, Patel SS, Van der Poel M, Rizzieri DA, Savani BN, Seo S, Solh M, Verdonck LF, Wirk B, Yared JA, Nakamura R, Oran B, Scott B, Saber W. Association between the choice of the conditioning regimen and outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis. Haematologica 2023; 108:1900-1908. [PMID: 36779595 PMCID: PMC10316233 DOI: 10.3324/haematol.2022.281958] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative treatment for myelofibrosis. However, the optimal conditioning regimen either with reduced-intensity conditioning (RIC) or myeloablative conditioning (MAC) is not well known. Using the Center for International Blood and Marrow Transplant Research database, we identified adults aged ≥18 years with myelofibrosis undergoing allo-HCT between 2008-2019 and analyzed the outcomes separately in the RIC and MAC cohorts based on the conditioning regimens used. Among 872 eligible patients, 493 underwent allo-HCT using RIC (fludarabine/ busulfan n=166, fludarabine/melphalan n=327) and 379 using MAC (fludarabine/busulfan n=247, busulfan/cyclophosphamide n=132). In multivariable analysis with RIC, fludarabine/melphalan was associated with inferior overall survival (hazard ratio [HR]=1.80; 95% confidenec interval [CI]: 1.15-2.81; P=0.009), higher early non-relapse mortality (HR=1.81; 95% CI: 1.12-2.91; P=0.01) and higher acute graft-versus-host disease (GvHD) (grade 2-4 HR=1.45; 95% CI: 1.03-2.03; P=0.03; grade 3-4 HR=2.21; 95%CI: 1.28-3.83; P=0.004) compared to fludarabine/busulfan. In the MAC setting, busulfan/cyclophosphamide was associated with a higher acute GvHD (grade 2-4 HR=2.33; 95% CI: 1.67-3.25; P<0.001; grade 3-4 HR=2.31; 95% CI: 1.52-3.52; P<0.001) and inferior GvHD-free relapse-free survival (GRFS) (HR=1.94; 95% CI: 1.49-2.53; P<0.001) as compared to fludarabine/busulfan. Hence, our study suggests that fludarabine/busulfan is associated with better outcomes in RIC (better overall survival, lower early non-relapse mortality, lower acute GvHD) and MAC (lower acute GvHD and better GRFS) in myelofibrosis.
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Affiliation(s)
| | - Soyoung Kim
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI; CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Noel Estrada-Merly
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Muhammad Bilal Abid
- Divisions of Hematology/Oncology, and Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh
| | - Amer Assal
- Columbia University Irving Medical Center, Department of Medicine, Bone Marrow Transplant and Cell Therapy Program
| | | | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Karen Ballen
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Slyvester Comprehensive Cancer Center, Miami, FL
| | - Jan Cerny
- Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA
| | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital
| | | | | | - Shatha Farhan
- Henry Ford Health System Stem Cell Transplant and Cellular Therapy Program, Detroit, MI
| | - Cesar O Freytes
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS
| | - Vikas Gupta
- MPN Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | | | | | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center, Tokyo
| | - Tania Jain
- John Hopkins University School of Medicine, Baltimore, MD
| | - Omer Jamy
- University of Alabama at Birmingham, Birmingham, AL
| | - Mark Juckett
- University of Minnesota Blood and Marrow Transplant Program - Adults
| | - Matt Kalaycio
- Cleveland Clinic Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN
| | | | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, FL
| | | | - Sagar S Patel
- Blood and Marrow Transplant Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marjolein Van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Masstricht University Medical Center, Maastricht
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigo
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala, Clinic, Zwolle
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Jean A Yared
- Transplantation and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Betul Oran
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bart Scott
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Wael Saber
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee
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5
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de Botton S, Cluzeau T, Vigil C, Cook RJ, Rousselot P, Rizzieri DA, Liesveld JL, Fenaux P, Braun T, Banos A, Jurcic JG, Sekeres MA, Savona MR, Roboz GJ, Bixby D, Madigan K, Volkert A, Stephens K, Kang-Fortner Q, Baker K, Paul S, McKeown M, Carulli J, Eaton M, Hodgson G, Fiore C, Kelly MJ, Roth DA, Stein EM. Targeting RARA overexpression with tamibarotene, a potent and selective RARα agonist, is a novel approach in AML. Blood Adv 2023; 7:1858-1870. [PMID: 36477975 PMCID: PMC10165187 DOI: 10.1182/bloodadvances.2022008806] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/24/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
A superenhancer at the retinoic acid receptor alpha (RARA) gene is associated with RARA mRNA overexpression in ∼30% of non-acute promyelocytic leukemia acute myeloid leukemia (AML) and in ∼50% of myelodysplastic syndromes (MDS). RARA overexpression is an actionable target for treatment with tamibarotene, an oral potent and selective RARα agonist. Sensitivity to the RARα agonist tamibarotene was demonstrated in RARA-high but not RARA-low preclinical AML models. The combination of oral tamibarotene plus azacitidine was evaluated in a phase 2 clinical study in 51 newly diagnosed unfit patients with AML identified as RARA-positive (n = 22) or RARA-negative (n = 29) for RARA mRNA overexpression in peripheral blasts using a blood-based biomarker test. In 18 response-evaluable RARA-positive patients, complete remission (CR)/CR with incomplete hematologic recovery rate was 61%, CR rate was 50%, and time to initial composite CR was rapid at 1.2 months. Transfusion independence was attained by 72% of RARA-positive patients. In contrast, 28 response-evaluable RARA-negative patients had response rates that were consistent with azacitidine monotherapy. Tamibarotene in combination with azacitidine was well tolerated. The majority of nonhematologic adverse events were low grade and hematologic adverse events were comparable to single-agent azacitidine, demonstrating that there was no additional myelosuppression when tamibarotene was combined with azacitidine. These results support further evaluation of tamibarotene-based treatment strategies in patients with AML or MDS with RARA overexpression to provide a targeted approach with the goal of improving patient outcomes. This trial was registered at www.clinicaltrials.gov as #NCT02807558.
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Affiliation(s)
| | - Thomas Cluzeau
- Côte d’Azur Université, Centre Hospitalier Universitaire de Nice Hôpital, Nice, France
| | - Carlos Vigil
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rachel J. Cook
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Philippe Rousselot
- Hôpital André Mignot, Centre Hospitalier de Versailles, Le Chesnay, France
| | | | | | | | - Thorsten Braun
- Centre Hospitalier Universitaire Hôpital Avicenne, Bobigny, France
| | - Anne Banos
- Centre Hospitalier de la Côte Basque, Bayonne, France
| | | | | | - Michael R. Savona
- Vanderbilt Ingram Cancer Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN
| | | | - Dale Bixby
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | - Sofia Paul
- Syros Pharmaceuticals, Inc, Cambridge, MA
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6
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Poe JC, Fang J, Zhang D, Lee MR, DiCioccio RA, Su H, Qin X, Zhang JY, Visentin J, Bracken SJ, Ho VT, Wang KS, Rose JJ, Pavletic SZ, Hakim FT, Jia W, Suthers AN, Curry-Chisolm IM, Horwitz ME, Rizzieri DA, McManigle WC, Chao NJ, Cardones AR, Xie J, Owzar K, Sarantopoulos S. Single-cell landscape analysis unravels molecular programming of the human B cell compartment in chronic GVHD. JCI Insight 2023:169732. [PMID: 37129971 PMCID: PMC10393230 DOI: 10.1172/jci.insight.169732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Alloreactivity can drive autoimmune syndromes. After allogeneic hematopoietic stem cell transplantation (allo-HCT) chronic graft-versus-host disease (cGVHD), a B cell-mediated autoimmune-like syndrome, commonly occurs. Because donor-derived B cells continually develop under selective pressure from host alloantigens, aberrant B Cell Receptor (BCR)-activation and IgG production can emerge and contribute to cGVHD pathobiology. To better understand molecular programing of B cells under selective pressure of alloantigens, we performed scRNA-Seq analysis on high numbers of purified B cells from allo-HCT patients. An unsupervised analysis revealed 10 clusters, distinguishable by signature genes for maturation, activation and memory. We found striking transcriptional differences in the memory B cell compartment after allo-HCT compared to healthy or infected individuals. To identify intrinsic properties when B-cell tolerance is lost after allo-HCT, we then assessed clusters for differentially expressed genes (DEGs) between patients with vs. without autoimmune-like manifestations (Active cGVHD vs. No cGVHD, respectively). DEGs were found in Active cGVHD in both naive and BCR-activated clusters, suggesting functional diversity. Some DEGs were also differentially expressed across most clusters, suggesting common molecular programs that may promote B cell plasticity. Our study of human allo-HCT and cGVHD provides new understanding of B-cell memory in the face of chronic alloantigen stimulation.
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Affiliation(s)
- Jonathan C Poe
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Jiyuan Fang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Dadong Zhang
- Duke Cancer Institute, Duke University Medical Center, Durham, United States of America
| | - Marissa R Lee
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Rachel A DiCioccio
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Hsuan Su
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Xiaodi Qin
- Duke Cancer Institute, Duke University Medical Center, Durham, United States of America
| | - Jennifer Y Zhang
- Department of Dermatology, Duke University Medical Center, Durham, United States of America
| | - Jonathan Visentin
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Sonali J Bracken
- Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, United States of America
| | - Vincent T Ho
- Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Kathy S Wang
- Medical Oncology, Dana-Farber Cancer Institute, Boston, United States of America
| | - Jeremy J Rose
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, United States of America
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, United States of America
| | - Frances T Hakim
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, United States of America
| | - Wei Jia
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Amy N Suthers
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Itaevia M Curry-Chisolm
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Mitchell E Horwitz
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - David A Rizzieri
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - William C McManigle
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Nelson J Chao
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
| | - Adela R Cardones
- Department of Dermatology, Duke University Medical Center, Durham, United States of America
| | - Jichun Xie
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Kouros Owzar
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States of America
| | - Stefanie Sarantopoulos
- Department of Medicine, Division of Hematological Malignancies and Cellular, Duke University Medical Center, Durham, United States of America
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7
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Ai H, Chao NJ, Rizzieri DA, Huang X, Spitzer TR, Wang J, Guo M, Keating A, Krakow EF, Blaise D, Ma J, Wu D, Reagan J, Gergis U, Duarte RF, Chaudhary PM, Hu K, Yu C, Sun Q, Fuchs E, Cai B, Huang Y, Qiao J, Gottlieb D, Schultz KR, Liu M, Chen X, Chen W, Wang J, Zhang X, Li J, Huang H, Sun Z, Li F, Yang L, Zhang L, Li L, Liu K, Jin J, Liu Q, Liu D, Gao C, Fan C, Wei L, Zhang X, Hu L, Zhang W, Tian Y, Han W, Zhu J, Xiao Z, Zhou D, Zhang B, Jia Y, Zhang Y, Wu X, Shen X, Lu X, Zhan X, Sun X, Xiao Y, Wang J, Shi X, Zheng B, Chen J, Ding B, Wang Z, Zhou F, Zhang M, Zhang Y, Sun J, Xia B, Chen B, Ma L. Expert consensus on microtransplant for acute myeloid leukemia in elderly patients -report from the international microtransplant interest group. Heliyon 2023; 9:e14924. [PMID: 37089296 PMCID: PMC10119710 DOI: 10.1016/j.heliyon.2023.e14924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/05/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Recent studies have shown that microtransplant (MST) could improve outcome of patients with elderly acute myeloid leukemia (EAML). To further standardize the MST therapy and improve outcomes in EAML patients, based on analysis of the literature on MST, especially MST with EAML from January 1st, 2011 to November 30th, 2022, the International Microtransplant Interest Group provides recommendations and considerations for MST in the treatment of EAML. Four major issues related to MST for treating EAML were addressed: therapeutic principle of MST (1), candidates for MST (2), induction chemotherapy regimens (3), and post-remission therapy based on MST (4). Others included donor screening, infusion of donor cells, laboratory examinations, and complications of treatment.
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8
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Lin C, DiCioccio RA, Haykal T, McManigle WC, Li Z, Anand SM, Poe JC, Bracken SJ, Jia W, Alyea EP, Cardones AR, Choi T, Gasparetto C, Grunwald MR, Hennig T, Kang Y, Long GD, Lopez R, Martin M, Minor KK, Quinones VLP, Sung AD, Wiggins K, Chao NJ, Horwitz ME, Rizzieri DA, Sarantopoulos S. A Phase I Trial of SYK Inhibition with Fostamatinib in the Prevention and Treatment of Chronic Graft-Versus-Host Disease. Transplant Cell Ther 2023; 29:179.e1-179.e10. [PMID: 36577483 PMCID: PMC10433369 DOI: 10.1016/j.jtct.2022.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022]
Abstract
Despite the exciting advancement of novel therapies, chronic graft-versus-host disease (cGVHD) remains the most common cause of non-relapse mortality after allogeneic hematopoietic stem cell transplantation (HCT). Frontline treatment of cGVHD involves systemic steroids, which are associated with significant morbidities. We previously found that inhibition of spleen tyrosine kinase (SYK) with fostamatinib preferentially eradicated aberrantly activated B cells in both ex vivo studies of cGVHD patient B cells, as well as in vivo mouse studies. These and other preclinical studies implicated hyper-reactive B-cell receptor signaling and increased SYK expression in the pathogenesis of cGVHD and compelled this first in-human allogeneic HCT clinical trial. We investigated the safety and efficacy of the oral SYK inhibitor, fostamatinib, for both the prevention and treatment of cGVHD. The primary objective was to evaluate the safety of fostamatinib and determine its maximum tolerated dose in the post-HCT setting. Secondary objectives included assessing the efficacy of fostamatinib in preventing and treating cGVHD, as well as examining alterations in B-cell compartments with treatment. This was a single-institution phase I clinical trial that evaluated the use of fostamatinib in allogeneic HCT patients before the development of cGVHD or at the time of steroid-refractory cGVHD (SR-cGVHD). Patients received fostamatinib at one of three dose levels using a continual reassessment algorithm to determine the maximum tolerated dose. Multiparameter flow cytometry was used to evaluate changes in B cell subpopulations over the first year of treatment with fostamatinib. Nineteen patients were enrolled in this phase I trial, with 5 in the prophylaxis arm and 14 in the therapeutic arm. One patient (5%) required discontinuation of therapy for a dose-limiting toxicity. At a median follow-up of over 3 years, no patients had cancer relapse while on fostamatinib treatment, and recurrent malignancy was observed in 1 patient 2 years after the end of therapy. In the prophylaxis arm, 1 of 5 patients (20%) developed cGVHD while on fostamatinib. In the therapeutic arm, the overall response rate was 77%, with a complete response rate of 31%. The median duration of response was 19.3 months and the 12-month failure-free survival was 69% (95% confidence interval, 48-100). Patients were able to reduce their steroid dose by a median of 80%, with 73% remaining on a lower dose at 1 year compared to baseline. There was an early reduction in the proportion of IgD-CD38hi plasmablast-like cells with fostamatinib treatment, particularly in those SR-cGVHD patients who had an eventual response. B-cell reconstitution was not significantly impacted by fostamatinib therapy after allogeneic HCT. Fostamatinib featured a favorable safety profile in the post-HCT setting. Our data suggests an early efficacy signal that was associated with effects on expected cell targets in both the prophylaxis and treatment of cGVHD, providing rationale for a phase II investigation.
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Affiliation(s)
- Chenyu Lin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Rachel A DiCioccio
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Tarek Haykal
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - William C McManigle
- Division of Pulmonary and Critical Care, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sarah M Anand
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jonathan C Poe
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Sonali J Bracken
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Wei Jia
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Edwin P Alyea
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Adela R Cardones
- Division of Dermatology, Department of Internal Medicine, University of Kansas Medical Center, Lawrence, Kansas
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Therese Hennig
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Yubin Kang
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Melissa Martin
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kerry K Minor
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kristi Wiggins
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
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9
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Pemmaraju N, Sweet KL, Stein AS, Wang ES, Rizzieri DA, Vasu S, Rosenblat TL, Brooks CL, Habboubi N, Mughal TI, Kantarjian H, Konopleva M, Lane AA. Long-Term Benefits of Tagraxofusp for Patients With Blastic Plasmacytoid Dendritic Cell Neoplasm. J Clin Oncol 2022; 40:3032-3036. [PMID: 35820082 PMCID: PMC9462530 DOI: 10.1200/jco.22.00034] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically on the based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive myeloid malignancy. We report long-term results, including data from the continued access phase, of the largest prospective BPDCN trial evaluating the CD123-targeted therapy tagraxofusp (TAG) in adults with treatment-naive and relapsed/refractory BPDCN. The primary outcome was complete response (CR) + clinical CR (CRc: CR with residual skin abnormality not indicative of active disease). Eighty-four (65 treatment-naive and 19 relapsed/refractory) of 89 patients received TAG 12 μg/kg once daily; the median follow-up was 34.0 months. For treatment-naive patients, the overall response rate was 75%; 57% achieved CR + CRc. The median time to remission was 39 (range, 14-131) days, and the median CR + CRc duration was 24.9 (95% CI, 3.8 to not reached) months. Nineteen patients (51%) with CR + CRc were bridged to stem-cell transplant, with a median CR + CRc duration of 22.2 (range, 1.5-57.4) months. Most common adverse events were increased alanine (64%) or aspartate (60%) aminotransferase and hypoalbuminemia (51%); most occurred in cycle 1 and were transient. Capillary leak syndrome occurred in 21% of patients (grade ≥ 3: 7%). In first-line patients with BPDCN, TAG monotherapy resulted in high and durable responses, allowing many to bridge to stem-cell transplant. TAG was generally well-tolerated with a predictable and manageable safety profile.
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Affiliation(s)
| | | | | | - Eunice S Wang
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Sumithira Vasu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Todd L Rosenblat
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | | | | | - Tariq I Mughal
- Stemline Therapeutics, New York, NY.,Tufts University School of Medicine, Boston, MA
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10
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Lin KH, Rutter JC, Xie A, Killarney ST, Vaganay C, Benaksas C, Ling F, Sodaro G, Meslin PA, Bassil CF, Fenouille N, Hoj J, Washart R, Ang HX, Cerda-Smith C, Chaintreuil P, Jacquel A, Auberger P, Forget A, Itzykson R, Lu M, Lin J, Pierobon M, Sheng Z, Li X, Chilkoti A, Owzar K, Rizzieri DA, Pardee TS, Benajiba L, Petricoin E, Puissant A, Wood KC. P2RY2-AKT activation is a therapeutically actionable consequence of XPO1 inhibition in acute myeloid leukemia. Nat Cancer 2022; 3:837-851. [PMID: 35668193 PMCID: PMC9949365 DOI: 10.1038/s43018-022-00394-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 05/04/2022] [Indexed: 12/12/2022]
Abstract
Selinexor is a first-in-class inhibitor of the nuclear exportin XPO1 that was recently approved by the US Food and Drug Administration for the treatment of multiple myeloma and diffuse large B-cell lymphoma. In relapsed/refractory acute myeloid leukemia (AML), selinexor has shown promising activity, suggesting that selinexor-based combination therapies may have clinical potential. Here, motivated by the hypothesis that selinexor's nuclear sequestration of diverse substrates imposes pleiotropic fitness effects on AML cells, we systematically catalog the pro- and anti-fitness consequences of selinexor treatment. We discover that selinexor activates PI3Kγ-dependent AKT signaling in AML by upregulating the purinergic receptor P2RY2. Inhibiting this axis potentiates the anti-leukemic effects of selinexor in AML cell lines, patient-derived primary cultures and multiple mouse models of AML. In a syngeneic, MLL-AF9-driven mouse model of AML, treatment with selinexor and ipatasertib outperforms both standard-of-care chemotherapy and chemotherapy with selinexor. Together, these findings establish drug-induced P2RY2-AKT signaling as an actionable consequence of XPO1 inhibition in AML.
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Affiliation(s)
- Kevin H Lin
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Justine C Rutter
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Abigail Xie
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Shane T Killarney
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Camille Vaganay
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France
| | - Chaima Benaksas
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France
| | - Frank Ling
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France
| | - Gaetano Sodaro
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France
| | - Paul-Arthur Meslin
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France
| | | | - Nina Fenouille
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France
| | - Jacob Hoj
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Rachel Washart
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Hazel X Ang
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | | | | | | | | | - Antoine Forget
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France
| | - Raphael Itzykson
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France
| | - Min Lu
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Jiaxing Lin
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Mariaelena Pierobon
- Center for Applied Proteomics and Molecular Medicine, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Zhecheng Sheng
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Xinghai Li
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Ashutosh Chilkoti
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Kouros Owzar
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - David A Rizzieri
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Timothy S Pardee
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Lina Benajiba
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France
| | - Emanuel Petricoin
- Center for Applied Proteomics and Molecular Medicine, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Alexandre Puissant
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, CNRS, Paris, France.
| | - Kris C Wood
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC, USA.
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11
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Pollyea DA, DiNardo CD, Arellano ML, Pigneux A, Fiedler W, Konopleva M, Rizzieri DA, Smith BD, Shinagawa A, Lemoli RM, Dail M, Duan Y, Chyla B, Potluri J, Miller CL, Kantarjian HM. Impact of Venetoclax and Azacitidine in Treatment-Naïve Patients with Acute Myeloid Leukemia and IDH1/2 Mutations. Clin Cancer Res 2022; 28:2753-2761. [PMID: 35046058 PMCID: PMC9365354 DOI: 10.1158/1078-0432.ccr-21-3467] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/18/2021] [Accepted: 01/13/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate efficacy and safety of venetoclax + azacitidine among treatment-naïve patients with IDH1/2-mutant (mut) acute myeloid leukemia (AML). PATIENTS AND METHODS Data were pooled from patients enrolled in a phase III study (NCT02993523) that compared patients treated with venetoclax + azacitidine or placebo + azacitidine and a prior phase Ib study (NCT02203773) where patients were treated with venetoclax + azacitidine. Enrolled patients were ineligible for intensive therapy due to age ≥75 years and/or comorbidities. Patients on venetoclax + azacitidine received venetoclax 400 mg orally (days 1-28) and azacitidine (75 mg/m2; days 1-7/28-day cycle). RESULTS In the biomarker-evaluable population, IDH1/2mut was detected in 81 (26%) and 28 (22%) patients in the venetoclax + azacitidine and azacitidine groups. Composite complete remission [CRc, complete remission (CR)+CR with incomplete hematologic recovery (CRi)] rates (venetoclax + azacitidine/azacitidine) among patients with IDH1/2mut were 79%/11%, median duration of remission (mDoR) was 29.5/9.5 months, and median overall survival (mOS) was 24.5/6.2 months. CRc rates among patients with IDH1/2 wild-type (WT) were 63%/31%, mDoR 17.5/10.3 months, and mOS 12.3/10.1 months. In patients with IDH1mut, CRc rates (venetoclax + azacitidine/azacitidine) were 66.7%/9.1% and mOS 15.2/2.2 months. In patients with IDH2mut, CRc rates were 86.0%/11.1% and mOS not reached (NR)/13.0 months. Patients with IDH1/2 WT AML treated with venetoclax + azacitidine with poor-risk cytogenetics had inferior outcomes compared with patients with IDH1/2mut, who had superior outcomes regardless of cytogenetic risk (mOS, IDH1/2mut: intermediate-risk, 24.5 months; poor-risk, NR; IDH1/2 WT: intermediate, 19.2 and poor, 7.4 months). There were no unexpected toxicities in the venetoclax + azacitidine group. CONCLUSIONS Patients with IDH1/2mut who received venetoclax + azacitidine had high response rates, durable remissions, and significant OS; cytogenetic risk did not mitigate the favorable outcomes seen from this regimen for IDH1/2mut. See related commentary by Perl and Vyas, p. 2719.
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Affiliation(s)
- Daniel A. Pollyea
- Division of Hematology, School of Medicine, University of Colorado, Aurora, Colorado.,Corresponding Author: Daniel A. Pollyea, School of Medicine Division of Hematology, University of Colorado, 1665 Aurora Court, Mail Stop F754, Aurora, CO 80045. E-mail:
| | - Courtney D. DiNardo
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martha L. Arellano
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Arnaud Pigneux
- Department of Hematology, CHU de Bordeaux, Bordeaux, France
| | - Walter Fiedler
- Department of Hematology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marina Konopleva
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - B. Douglas Smith
- Department of Oncology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Atsushi Shinagawa
- Department of Hematology, Hitachi General Hospital, Hitachi-shi, Japan
| | - Roberto M. Lemoli
- Clinic of Hematology, Department of Internal Medicine, University of Genoa, Genoa, Italy.,San Martino Hospital IRCCS, Genoa, Italy
| | | | | | | | | | | | - Hagop M. Kantarjian
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Davis JA, Rizzieri DA, Lane AA, Taylor J, Faisal MS, Vasu S, Soong D, Li H, Herbst A, Greenwell IB. Treatment patterns and outcomes of patients with CNS involvement of blastic plasmacytoid dendritic cell neoplasm (BPDCN). Leuk Lymphoma 2022; 63:2757-2759. [DOI: 10.1080/10428194.2022.2090552] [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: 10/18/2022]
Affiliation(s)
- James A. Davis
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Andrew A. Lane
- Medical Oncology, Dana Farber – Harvard Institute, Boston, MA, USA
| | - Justin Taylor
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - Sumithira Vasu
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Deborah Soong
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda Herbst
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - I. Brian Greenwell
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Lin C, Morrison L, Alyea EP, Choi T, Gasparetto C, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sung A, Chao NJ, Galamidi-Cohen E, Schwarzbach A, Horwitz ME. Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) with Omidubicel: Long-Term Follow-up from a Single Center. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00482-1] [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: 10/18/2022]
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Kantarjian HM, Begna KH, Altman JK, Goldberg SL, Sekeres MA, Strickland SA, Arellano ML, Claxton DF, Baer MR, Gautier M, Berman E, Seiter K, Solomon SR, Schiller GJ, Luger SM, Butrym A, Gaidano G, Thomas XG, Montesinos P, Rizzieri DA, Quick DP, Venugopal P, Gaur R, Maness LJ, Kadia TM, Ravandi F, Buyse ME, Chiao JH. Results of a randomized phase 3 study of oral sapacitabine in elderly patients with newly diagnosed acute myeloid leukemia (SEAMLESS). Cancer 2021; 127:4421-4431. [PMID: 34424530 DOI: 10.1002/cncr.33828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is fatal in elderly patients who are unfit for standard induction chemotherapy. The objective of this study was to evaluate the survival benefit of administering sapacitabine, an oral nucleoside analogue, in alternating cycles with decitabine, a low-intensity therapy, to elderly patients with newly diagnosed AML. METHODS This randomized, open-label, phase 3 study (SEAMLESS) was conducted at 87 sites in 11 countries. Patients aged ≥70 years who were not candidates for or chose not to receive standard induction chemotherapy were randomized 1:1 to arm A (decitabine in alternating cycles with sapacitabine) received 1-hour intravenous infusions of decitabine 20 mg/m2 once daily for 5 consecutive days every 8 weeks (first cycle and subsequent odd cycles) and sapacitabine 300 mg twice daily on 3 consecutive days per week for 2 weeks every 8 weeks (second cycle and subsequent even cycles) or to control arm C who received 1-hour infusions of decitabine 20 mg/m2 once daily for 5 consecutive days every 4 weeks. Prior hypomethylating agent therapy for preexisting myelodysplastic syndromes or myeloproliferative neoplasms was an exclusion criterion. Randomization was stratified by antecedent myelodysplastic syndromes or myeloproliferative neoplasms, white blood cell count (<10 × 109 /L and ≥10 × 109 /L), and bone marrow blast percentage (≥50% vs <50%). The primary end point was overall survival (OS). Secondary end points were the rates of complete remission (CR), CR with incomplete platelet count recovery, partial remission, hematologic improvement, and stable disease along with the corresponding durations, transfusion requirements, number of hospitalized days, and 1-year survival. The trial is registered at ClinicalTrials.gov (NCT01303796). RESULTS Between October 2011 and December 2014, 482 patients were enrolled and randomized to receive decitabine administered in alternating cycles with sapacitabine (study arm, n = 241) or decitabine monotherapy (control arm, n = 241). The median OS was 5.9 months on the study arm versus 5.7 months on the control arm (P = .8902). The CR rate was 16.6% on the study arm and 10.8% on the control arm (P = .1468). In patients with white blood cell counts <10 × 109 /L (n = 321), the median OS was higher on the study arm versus the control arm (8.0 vs 5.8 months; P = .145), as was the CR rate (21.5% vs 8.6%; P = .0017). CONCLUSIONS The regimen of decitabine administered in alternating cycles with sapacitabine was active but did not significantly improve OS compared with decitabine monotherapy. Subgroup analyses suggest that patients with baseline white blood cell counts <10 × 109 /L might benefit from decitabine alternating with sapacitabine, with an improved CR rate and the convenience of an oral drug. These findings should be prospectively confirmed.
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Affiliation(s)
- Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jessica K Altman
- Department of Medicine, Northwestern University, Chicago, Illinois
| | | | - Mikkael A Sekeres
- Hematologic Oncology and Blood Disorders, Cleveland Clinic, Cleveland, Ohio
| | | | - Martha L Arellano
- Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - David F Claxton
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | - Marc Gautier
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ellin Berman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen Seiter
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Scott R Solomon
- Northside Hospital Cancer Institute, Leukemia Program, Atlanta, Georgia
| | - Gary J Schiller
- Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Selina M Luger
- Department of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aleksandra Butrym
- Department of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Gianluca Gaidano
- Division of Hematology, Maggiore della Carita University Hospital, Novara, Italy
| | | | - Pau Montesinos
- La Fe University and Polytechnic Hospital, Valencia, Spain
| | - David A Rizzieri
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Parameswaran Venugopal
- Department of Medicine, Hematology, and Oncology, Rush University Medical Center, Chicago, Illinois
| | - Rakesh Gaur
- St Luke's Cancer Institute, Kansas City, Missouri
| | - Lori J Maness
- Division of Hematology-Oncology Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marc E Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium
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15
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Zajc Petranović M, Rizzieri AE, Sivaraj D, Smolej Narančić N, Škarić-Jurić T, Celinšćak Ž, Stojanović Marković A, Peričić Salihović M, Kalászi J, Kalászi M, Lin JQ, Mehta S, Burleson J, Rizzieri DA. CVD Risk Factors in the Ukrainian Roma and Meta-Analysis of Their Prevalence in Roma Populations Worldwide. J Pers Med 2021; 11:jpm11111138. [PMID: 34834490 PMCID: PMC8622536 DOI: 10.3390/jpm11111138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
The Roma population suffers from severe poverty, social exclusion, and some of the worst health conditions in the industrialized world. Herein, we report on cardiovascular disease (CVD) risk factors in the Ukrainian Roma and present a meta-analysis of the prevalence of CVD risk factors in 16 Roma populations worldwide. The meta-analyses of CVD risk factors in Roma (n = 16,552) vs. non-Roma majority population of the same country (n = 127,874) included publicly available data. Ukrainian field survey included 339 adults of both sexes and outcomes of interest were hypertension, body mass index (BMI), smoking, education, and employment status. Furthermore, 35.7% of the Ukrainian Roma were hypertensive, 69.3% unemployed, and 48.4% never went to school. Ukrainian Roma women were more likely to be underweight and more prone to be hypertensive, with odds of hypertension increasing with age, BMI, and positive smoking status. Meta-analyses showed that, in comparison with non-Roma worldwide, the Roma bear significantly higher risk factor loads related to smoking (OR = 2.850), diabetes (OR = 1.433), abdominal obesity (OR = 1.276), and metabolic syndrome (OR = 1.975), with lower loads for hypertension (OR = 0.607) and BMI ≥ 25 kg/m2 (OR = 0.872). To conclude, the CVD risk factors which are more common in Roma than in the majority population may reflect their poor health-related behaviors and inadequate access to health education.
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Affiliation(s)
- Matea Zajc Petranović
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
- Correspondence: (M.Z.P.); (D.A.R.)
| | - Ashley Elizabeth Rizzieri
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - Dharshan Sivaraj
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA;
| | - Nina Smolej Narančić
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Tatjana Škarić-Jurić
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Željka Celinšćak
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Anita Stojanović Marković
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Marijana Peričić Salihović
- Institute for Anthropological Research, Gajeva 32, 10000 Zagreb, Croatia; (N.S.N.); (T.Š.-J.); (Ž.C.); (A.S.M.); (M.P.S.)
| | - Julia Kalászi
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - Marianna Kalászi
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - John Q. Lin
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA;
| | - Sanica Mehta
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - Jill Burleson
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
| | - David A. Rizzieri
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC 27708, USA; (A.E.R.); (D.S.); (J.K.); (M.K.); (S.M.); (J.B.)
- Correspondence: (M.Z.P.); (D.A.R.)
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16
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Percival ME, Wang HL, Zhang MJ, Saber W, de Lima M, Litzow M, Kebriaei P, Abdel-Azim H, Adekola K, Aljurf M, Bacher U, Badawy SM, Beitinjaneh A, Bejanyan N, Bhatt V, Byrne M, Cahn JY, Castillo P, Chao N, Chhabra S, Copelan E, Cutler C, DeFilipp Z, Dias A, Diaz MA, Estey E, Farhadfar N, Frangoul HA, Freytes CO, Gale RP, Ganguly S, Gowda L, Grunwald M, Hossain N, Kamble RT, Kanakry CG, Kansagra A, Kharfan-Dabaja MA, Krem M, Lazarus HM, Lee JW, Liesveld JL, Lin R, Liu H, McGuirk J, Munker R, Murthy HS, Nathan S, Nishihori T, Olsson RF, Palmisiano N, Passweg JR, Prestidge T, Ringdén O, Rizzieri DA, Rybka WB, Savoie ML, Schultz KR, Seo S, Sharma A, Solh M, Strair R, van der Poel M, Verdonck LF, Yared JA, Weisdorf D, Sandmaier BM. Impact of depth of clinical response on outcomes of acute myeloid leukemia patients in first complete remission who undergo allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2021; 56:2108-2117. [PMID: 33864019 PMCID: PMC8425595 DOI: 10.1038/s41409-021-01261-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/03/2021] [Accepted: 02/23/2021] [Indexed: 02/05/2023]
Abstract
Acute myeloid leukemia (AML) patients often undergo allogeneic hematopoietic cell transplantation (alloHCT) in first complete remission (CR). We examined the effect of depth of clinical response, including incomplete count recovery (CRi) and/or measurable residual disease (MRD), in patients from the Center for International Blood and Marrow Transplantation Research (CIBMTR) registry. We identified 2492 adult patients (1799 CR and 693 CRi) who underwent alloHCT between January 1, 2007 and December 31, 2015. The primary outcome was overall survival (OS). Multivariable analysis was performed to adjust for patient-, disease-, and transplant-related factors. Baseline characteristics were similar. Patients in CRi compared to those in CR had an increased likelihood of death (HR: 1.27; 95% confidence interval: 1.13-1.43). Compared to CR, CRi was significantly associated with increased non-relapse mortality (NRM), shorter disease-free survival (DFS), and a trend toward increased relapse. Detectable MRD was associated with shorter OS, shorter DFS, higher NRM, and increased relapse compared to absence of MRD. The deleterious effects of CRi and MRD were independent. In this large CIBMTR cohort, survival outcomes differ among AML patients based on depth of CR and presence of MRD at the time of alloHCT. Further studies should focus on optimizing post-alloHCT outcomes for patients with responses less than CR.
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Affiliation(s)
- Mary-Elizabeth Percival
- Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Hai-Lin Wang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mei-Jie Zhang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wael Saber
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kehinde Adekola
- Division of Hematology and Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Vijaya Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Paul Castillo
- UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Nelson Chao
- Department of Medicine, Division of Cell Therapy and Hematology, Duke University Medical Center, Durham, NC, USA
| | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Corey Cutler
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Westwood, KS, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Elihu Estey
- Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nosha Farhadfar
- Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | | | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | | | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nasheed Hossain
- Department of Medicine, Division of Hematology and Oncology, Stem Cell Transplant Program-Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Rammurti T Kamble
- Center for Cell and Gene Therapy, Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Christopher G Kanakry
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ankit Kansagra
- UT Southwestern Medical Center-BMT Program, Dallas, TX, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Maxwell Krem
- University of Louisville Hospital/James Brown Cancer Center, Louisville, KY, USA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jong Wook Lee
- Division of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jane L Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Richard Lin
- Memorial Sloan Kettering Cancer Center-Adults, New York, NY, USA
| | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | | | - Reinhold Munker
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | | | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Neil Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Olov Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm, Sweden
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | | | | | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Roger Strair
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | | | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Department of Medicine, Division of Hematology and Oncology, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Daniel Weisdorf
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Islam P, Tang H, Jin H, Cao F, Bohannon LM, Ren Y, Chao NJ, Choi T, Gasparetto C, Horwitz ME, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sung AD. Female Sex Is Associated with Improved Long-Term Survival Following Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2021; 27:784.e1-784.e7. [PMID: 34146734 DOI: 10.1016/j.jtct.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
Life expectancy for long-term survivors of allogeneic hematopoietic stem cell transplantation (alloHSCT), defined as those living ≥5 years post-transplantation, is significantly lower compared with that of the age-matched general population despite a relatively low primary disease relapse rate at >2 years post-transplantation. Among several factors, patient sex is increasingly recognized as a prognostic indicator of long-term survival. We examined the influence of patient sex and donor-recipient sex matching on overall survival (OS) in a landmark analysis of long-term survivors. Using our institutional database supplemented with individual patient record review, we retrospectively investigated the relative influence of recipient sex and donor-recipient sex matching on outcomes of long-term survivors of alloHSCT between 1994 and 2014. Over this 20-year period, 247 met inclusion criteria for analysis; males and females had similar demographic and treatment characteristics. However, significantly more deaths after the 5-year landmark occurred in male recipients. Interestingly, donor sex did not have a significant impact on OS in multivariate analysis, and differences in OS of donor-recipient sex pairs was driven by recipient sex. In addition to recipient sex, only chronic graft-versus-host disease (cGVHD) retained significance as a covariate with an impact on OS in multivariate analysis. Men experienced slightly higher, but statistically nonsignificant, rates and increased severity of cGVHD, and had higher cGVHD-related mortality compared with females. In this long-term survival analysis of adult alloHSCT recipients, one of the only to include follow-up to 15 years, our results show that women survive significantly longer than men irrespective of their age at transplantation. This outcome is independent of other common pretransplantation prognostic indicators, such as donor sex or performance status at transplantation. The inferior survival in males is consistent with survival outcomes described in the transplantation literature. Increasing evidence suggests a biological basis for long-term sex-determined outcomes, possibly owing to differing rates or severity of cGVHD or sustained alloimmune tolerance in females. Larger studies are warranted to validate these retrospective clinical results.
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Affiliation(s)
- Prioty Islam
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Helen Tang
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Haesu Jin
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Felicia Cao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Lauren M Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Yi Ren
- Duke Cancer Institute, Biostatistics Shared Resources, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina.
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Percival ME, Wang HL, Zhang MJ, Saber W, de Lima M, Litzow M, Kebriaei P, Abdel-Azim H, Adekola K, Aljurf M, Bacher U, Badawy SM, Beitinjaneh A, Bejanyan N, Bhatt V, Byrne M, Cahn JY, Castillo P, Chao N, Chhabra S, Copelan E, Cutler C, DeFilipp Z, Dias A, Diaz MA, Estey E, Farhadfar N, Frangoul HA, Freytes CO, Gale RP, Ganguly S, Gowda L, Grunwald M, Hossain N, Kamble RT, Kanakry CG, Kansagra A, Kharfan-Dabaja MA, Krem M, Lazarus HM, Lee JW, Liesveld JL, Lin R, Liu H, McGuirk J, Munker R, Murthy HS, Nathan S, Nishihori T, Olsson RF, Palmisiano N, Passweg JR, Prestidge T, Ringdén O, Rizzieri DA, Rybka WB, Savoie ML, Schultz KR, Seo S, Sharma A, Solh M, Strair R, van der Poel M, Verdonck LF, Yared JA, Weisdorf D, Sandmaier BM. Correction to: Impact of depth of clinical response on outcomes of acute myeloid leukemia patients in first complete remission who undergo allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2021; 56:2319. [PMID: 34017072 DOI: 10.1038/s41409-021-01353-3] [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: 11/09/2022]
Affiliation(s)
- Mary-Elizabeth Percival
- Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Hai-Lin Wang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mei-Jie Zhang
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wael Saber
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kehinde Adekola
- Division of Hematology and Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Vijaya Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Paul Castillo
- UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Nelson Chao
- Department of Medicine, Division of Cell Therapy and Hematology, Duke University Medical Center, Durham, NC, USA
| | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Corey Cutler
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Westwood, KS, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Elihu Estey
- Division of Hematology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nosha Farhadfar
- Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | | | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | | | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nasheed Hossain
- Department of Medicine, Division of Hematology and Oncology, Stem Cell Transplant Program-Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Rammurti T Kamble
- Center for Cell and Gene Therapy, Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Christopher G Kanakry
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ankit Kansagra
- UT Southwestern Medical Center-BMT Program, Dallas, TX, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Maxwell Krem
- University of Louisville Hospital/James Brown Cancer Center, Louisville, KY, USA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jong Wook Lee
- Division of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jane L Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Richard Lin
- Memorial Sloan Kettering Cancer Center-Adults, New York, NY, USA
| | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | | | - Reinhold Munker
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | | | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Neil Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Olov Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm, Sweden
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | | | | | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Roger Strair
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | | | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Department of Medicine, Division of Hematology and Oncology, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Daniel Weisdorf
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA.,CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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19
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Pabon CM, Li Z, Hennig T, de Castro C, Neff JL, Horwitz ME, LeBlanc TW, Long GD, Lopez RD, Sung AD, Chao N, Gasparetto C, Sarantopoulos S, Adams DB, Erba H, Rizzieri DA. Morphologic leukemia-free state in acute myeloid leukemia is sufficient for successful allogeneic hematopoietic stem cell transplant. Blood Cancer J 2021; 11:92. [PMID: 33994546 PMCID: PMC8126559 DOI: 10.1038/s41408-021-00481-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/05/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Cindy M Pabon
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Zhiguo Li
- Department of Biostatistics and Bioinfomatics, Duke University, Durham, NC, USA
| | - Therese Hennig
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Carlos de Castro
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jadee L Neff
- Department of Pathology, Divisions of Hematopathology and Molecular Pathology, Genetics and Genomics, Durham, NC, USA
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Nelson Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Donna B Adams
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Harry Erba
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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20
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Borthakur G, Odenike O, Aldoss I, Rizzieri DA, Prebet T, Chen C, Popovic R, Modi DA, Joshi RH, Wolff JE, Jonas BA. A phase 1 study of the pan-bromodomain and extraterminal inhibitor mivebresib (ABBV-075) alone or in combination with venetoclax in patients with relapsed/refractory acute myeloid leukemia. Cancer 2021; 127:2943-2953. [PMID: 33934351 PMCID: PMC8360206 DOI: 10.1002/cncr.33590] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/12/2021] [Accepted: 03/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a heterogenous malignancy driven by genetic and epigenetic factors. Inhibition of bromodomain and extraterminal (BET) proteins, epigenetic readers that play pivotal roles in the regulation of genes relevant to cancer pathogenesis, constitutes a novel AML treatment approach. METHODS In this first-in-human study of the pan-BET inhibitor mivebresib as monotherapy (MIV-mono) or in combination with venetoclax (MIV-Ven), the safety profile, efficacy, and pharmacodynamics of mivebresib were determined in patients with relapsed/refractory AML (ClinicalTrials.gov identifier NCT02391480). Mivebresib was administered at 3 monotherapy dose levels (1.5, 2.0, or 2.5 mg) or in combination with venetoclax (400 or 800 mg). RESULTS Forty-four patients started treatment: of 19 who started MIV-mono, 5 went on to receive MIV-Ven combination therapy after disease progression and a washout period. Twenty-five patients started MIV-Ven, resulting in a total of 30 patients treated with the combination. The most common mivebresib-related treatment-emergent adverse events were dysgeusia (74%), decreased appetite (42%), and diarrhea (42%) in the MIV-mono group and decreased appetite (44%), vomiting (44%), and nausea (40%) in the MIV-Ven group. Serious adverse events occurred in 14 patients (74%) who received MIV-mono and in 22 patients (88%) who received MIV-Ven. In the MIV-mono group, responses were complete remission with incomplete blood count recovery in 1 patient and resistant disease in 15 patients. In the MIV-Ven group, responses were complete remission in 2 patients, partial remission in 2 patients, morphologic leukemia-free state in 2 patients, resistant disease in 12 patients, and aplasia in 1 patient. The pharmacodynamic effects of mivebresib were proportional to dose and drug exposure. CONCLUSIONS Mivebresib was tolerated and showed antileukemic effects as monotherapy and in combination with venetoclax in patients with relapsed/refractory AML. LAY SUMMARY Mivebresib is a novel drug that influences the way cancer cells read genetic information. Mivebresib was tested together with venetoclax in patients with acute myeloid leukemia after standard medicines failed and the disease returned, or when standard medicine was unavailable. Adverse effects were described for different drug doses, and the dose that is tolerable was determined. In some patients, their leukemia improved for some time. More studies are necessary to determine whether mivebresib can be used to treat acute myeloid leukemia.
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Affiliation(s)
- Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Olatoyosi Odenike
- Section of Hematology/Oncology, The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Thomas Prebet
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut
| | | | | | | | | | | | - Brian A Jonas
- Division of Hematology and Oncology, Department of Internal Medicine, University of California-Davis School of Medicine, Sacramento, California
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21
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Rein L, Rizzieri DA. A Phase I Trial of Incorporating Natural Killer (K-NK) Cells for Patients with Chronic Myeloid Leukemia (CML) and Molecular Residual Disease after Tyrosine Kinase Inhibitor (TKI) Therapy. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00198-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Sung AD, Miller HM, Romero K, MacDonald G, Bohannon L, Molinger J, Ren Y, Bush A, Lew M, Cohen HJ, Pastva A, Jung SH, Shah NR, Smith PJ, Wischmeyer PE, Wood WA, Alyea E, Choi T, Gasparetto C, Horwitz ME, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sullivan KM, Chao NJ, Bartlett DB. A Phase 1 Study of the Safety and Feasibility of Improving Cardiorespiratory Fitness through a Remotely Monitored, Mobile Health Supported High Intensity Interval Training Program (REMM-HIIT). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00564-9] [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: 10/22/2022]
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23
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Racioppi A, Dalton T, Ramalingam S, Romero K, Ren Y, Bohannon L, Arellano C, Jonassaint J, Miller H, Barak I, Fish LJ, Choi T, Gasparetto C, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Horwitz ME, Chao NJ, Shah NR, Sung AD. Assessing the Feasibility of a Novel mHealth App in Hematopoietic Stem Cell Transplant Patients. Transplant Cell Ther 2021; 27:181.e1-181.e9. [PMID: 33830035 PMCID: PMC10522407 DOI: 10.1016/j.jtct.2020.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/22/2022]
Abstract
Hematopoietic stem cell transplantation (HCT) is a curative treatment option for patients with hematologic conditions but presents many complications that must be managed as a complex, chronic condition. Mobile health applications (mHealth apps) may permit tracking of symptoms in HCT. In seeking strategies to manage the complexities of HCT, our team collaborated with Sicklesoft, Inc., to develop an mHealth app specifically for HCT patients to allow for daily evaluation of patient health, Technology Recordings to better Understand Bone Marrow Transplantation (TRU-BMT). The primary value of this application is that of potentially enhancing the monitoring of symptoms and general health of patients undergoing HCT, with the ultimate goal of allowing earlier detection of adverse events, earlier intervention, and improving outcomes. To first evaluate patient interest in mHealth apps, we designed and administered an interest survey to patients at the 2017 BMT-InfoNet reunion. As a follow-up to the positive feedback received, we began testing the TRU-BMT app in a Phase 1 pilot study. Thirty patients were enrolled in this single-arm study and were given the TRU-BMT mHealth app on a smartphone device in addition to a wearable activity tracker. Patients were followed for up to 180 days, all the while receiving daily app monitoring. Adherence to TRU-BMT was approximately 30% daily and 44% weekly, and greater adherence was associated with increased meal completion, decreased heart rate, and shorter hospital stay. TRU-BMT assessments of symptom severity were significantly associated with duration of hospital stay and development of chronic graft-versus-host disease. Our findings suggest that using TRU-BMT throughout HCT is feasible for patients and established a proof-of-concept for a future randomized control trial of the TRU-BMT application in HCT. © 2021 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- Alessandro Racioppi
- Duke University School of Medicine, Durham, North Carolina; Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Tara Dalton
- Duke University School of Medicine, Durham, North Carolina
| | - Sendhilnathan Ramalingam
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Kristi Romero
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina
| | - Yi Ren
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Lauren Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Consuelo Arellano
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | - Jude Jonassaint
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Hilary Miller
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ian Barak
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Laura J Fish
- Family Medicine and Community Health, Duke University Medical Center, Durham, North, Carolina
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Richard D Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nirmish R Shah
- Duke Cancer Institute Biostatistics Shared Resources, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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24
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Kam AYF, Piryani SO, Lee CL, Rizzieri DA, Spector NL, Sarantopoulos S, Doan PL. Selective ERBB2 and BCL2 Inhibition Is Synergistic for Mitochondrial-Mediated Apoptosis in MDS and AML Cells. Mol Cancer Res 2021; 19:886-899. [PMID: 33514658 DOI: 10.1158/1541-7786.mcr-20-0973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
The ERBB2 proto-oncogene is associated with an aggressive phenotype in breast cancer. Its role in hematologic malignancies is incompletely defined, in part because ERBB2 is not readily detected on the surface of cancer cells. We demonstrate that truncated ERBB2, which lacks the extracellular domain, is overexpressed on primary CD34+ myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) cells compared with healthy hematopoietic cells. This overexpression of ERBB2 is associated with aberrant, oncogenic signaling with autophosphorylation of multiple tyrosine sites. Like in breast cancers, ERBB2 can exist as truncated isoforms p95ERBB2 and p110ERBB2 in MDS and AML. Neutralization of ERBB2 signaling with ERBB2 tyrosine kinase inhibitors (i.e., lapatinib, afatinib, and neratinib) increases apoptotic cell death and reduces human engraftment of MDS cells in mice at 21 weeks posttransplantation. Inhibition of ERBB2 modulates the expression of multiple pro- and anti-apoptotic mitochondrial proteins, including B-cell lymphoma 2 (BCL2). Dual blockade with ERBB2 and BCL2 inhibitors triggers additional reductions of BCL2 phosphorylation and myeloid cell leukemia-1 (MCL1) expression compared with single drug treatment. Dual therapy was synergistic at all tested doses, with a dose reduction index of up to 29 for lapatinib + venetoclax compared with venetoclax alone. Notably, these agents operated together and shifted cancer cells to a pro-apoptotic phenotype, resulting in increased mitochondrial cytochrome c release and activated caspase-3-mediated cell death. IMPLICATIONS: These findings warrant study of ERBB2 and BCL2 combination therapy in patients with MDS and AML. VISUAL OVERVIEW: http://mcr.aacrjournals.org/content/molcanres/19/5/886/F1.large.jpg.
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Affiliation(s)
- Angel Y F Kam
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Sadhna O Piryani
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Chang-Lung Lee
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.,Department of Pathology, Duke University Medical Center, Durham, North Carolina.,Duke Cancer Institute, Duke University, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina.,Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Neil L Spector
- Duke Cancer Institute, Duke University, Durham, North Carolina.,Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina.,Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Phuong L Doan
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina. .,Duke Cancer Institute, Duke University, Durham, North Carolina
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25
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Ghosh N, Ahmed S, Ahn KW, Khanal M, Litovich C, Aljurf M, Bacher VU, Bredeson C, Epperla N, Farhadfar N, Freytes CO, Ganguly S, Haverkos B, Inwards D, Kamble RT, Lazarus HM, Lekakis L, Murthy HS, Nishihori T, Ramakrishnan P, Rizzieri DA, Yared JA, Kharfan-Dabaja MA, Sureda A, Hamadani M. Association of Reduced-Intensity Conditioning Regimens With Overall Survival Among Patients With Non-Hodgkin Lymphoma Undergoing Allogeneic Transplant. JAMA Oncol 2021; 6:1011-1018. [PMID: 32496525 DOI: 10.1001/jamaoncol.2020.1278] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Reduced-intensity conditioning and nonmyeloablative conditioning (RIC-NMAC) regimens are frequently used in allogeneic hematopoietic cell transplant (HCT) for non-Hodgkin lymphoma. However, the optimal RIC-NMAC regimen in allogeneic HCT for non-Hodgkin lymphoma is not known. Objective To investigate whether RIC-NMAC regimens at a higher end of the intensity spectrum are associated with increased nonrelapse mortality and lower overall survival compared with RIC-NMAC regimens at the lower end of the intensity spectrum in patients with non-Hodgkin lymphoma undergoing allogeneic HCT. Design, Setting, and Participants This cohort study used data from 1823 adult patients with non-Hodgkin lymphoma in the Center for International Blood and Marrow Transplant Research registry. Included patients underwent allogeneic HCT using matched related or unrelated donors between January 2008 and December 2016. Statistical analysis was performed from June 1, 2019, to February 10, 2020. Interventions Patients received 1 of 4 RIC-NMAC regimens: fludarabine-intravenous busulfan (Flu-Bu), approximately 6.4 mg/kg (n = 458); fludarabine-melphalan (Flu-Mel140), 140 mg/m2 (n = 885); fludarabine-cyclophosphamide (Flu-Cy) (n = 391); or Flu-Cy with 2 Gy total body irradiation (Flu-Cy-2GyTBI) (n = 89). Main Outcomes and Measures The primary outcome was overall survival. Secondary outcomes were nonrelapse mortality, incidence of relapse, progression-free survival, and the incidence of acute and chronic graft-vs-host disease (GVHD). Results Of 1823 patients, 1186 (65%) were male, with a mean (SD) age of 54.8 (9.9) years. The 4-year adjusted OS was 58% in the Flu-Bu cohort, 67% in the Flu-Cy-2GyTBI cohort, 49% in the Flu-Mel140 cohort, and 63% in the Flu-Cy cohort (P < .001). After adjustment for age, Karnofsky performance score, HCT comorbidity index, NHL subtype, remission status at HCT, and the use of antithymocyte globulin or alemtuzumab, the regression analysis showed a significantly higher mortality risk associated with Flu-Mel140 compared with Flu-Bu (hazard ratio [HR], 1.34; 95% CI, 1.13-1.59; P < .001). Compared with the Flu-Cy cohort, the Flu-Mel140 cohort had a higher risk of chronic GVHD (HR, 1.38; 95% CI, 1.15-1.65; P < .001). The Flu-Mel140 regimen was associated with a higher nonrelapse mortality risk (HR, 1.78; 95% CI, 1.37-2.31; P < .001) compared with the Flu-Bu regimen. Conclusions and Relevance The findings suggest that use of the more intense RIC-NMAC regimen, Flu-Mel140, may have a negative association with overall survival and may be associated with higher nonrelapse mortality. The Flu-Bu and Flu-Cy regimens with or without 2GyTBI regimens appeared to provide comparable overall survival.
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Affiliation(s)
- Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Sairah Ahmed
- Department of Myeloma and Lymphoma, University of Texas, MD Anderson Cancer Center, Houston
| | - Kwang Woo Ahn
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee
| | - Manoj Khanal
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee
| | - Carlos Litovich
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus
| | - Nosha Farhadfar
- Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville
| | | | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City
| | - Bradley Haverkos
- Department of Medicine, University of Colorado Hospital, Aurora, Colorado
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Hillard M Lazarus
- Department of Hematology and Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | | | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic Florida, Jacksonville
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Praveen Ramakrishnan
- Lymphoma, Bone Marrow Transplant and Cellular Therapy Program, UT Southwestern Medical Center, Dallas, Texas
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Jean A Yared
- Division of Hematology and Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, Blood and Marrow Transplantation Program, University of Maryland, Baltimore
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic Florida, Jacksonville
| | - Anna Sureda
- Institut Català d'Oncologia-Hospitalet, Hematology Department, University of Barcelona, Barcelona, Spain
| | - Mehdi Hamadani
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee
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Maung KK, Chen BJ, Barak I, Li Z, Rizzieri DA, Gasparetto C, Sullivan KM, Long GD, Engemann AM, Waters-Pick B, Nichols KR, Lopez R, Kang Y, Sarantopoulos S, Sung AD, Chao NJ, Horwitz ME. Phase I dose escalation study of naive T-cell depleted donor lymphocyte infusion following allogeneic stem cell transplantation. Bone Marrow Transplant 2021; 56:137-143. [PMID: 32624583 PMCID: PMC10805111 DOI: 10.1038/s41409-020-0991-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022]
Abstract
Prophylactic donor lymphocyte infusions (DLI) are used to augment post-transplant immune recovery to reduce both infectious complications and disease recurrence. Preclinical studies implicate the naive T-cell subset as the primary driver of graft-versus-host disease (GvHD). In this phase I dose escalation study, we assessed the safety of a DLI that was depleted of CD45RA+ naive T cells. Sixteen adult patients received a prophylactic DLI at a median of 113 days (range 76-280 days) following an HLA-identical, non-myeloablative allogeneic hematopoietic stem cell transplantation. Three patients each received the naive T-cell depleted DLI with a CD3+ dose of 1 × 105/kg, 1 × 106/kg, and 5 × 106/kg. The maximum dose of 1 × 107/kg was expanded to 7 patients. No dose-limiting grade III/IV acute GvHD or adverse events attributable to the DLI were observed at any dose level. One patient developed grade 2 acute GvHD of skin and upper intestines, and another developed moderate chronic GvHD of the lungs following the DLI. With a median follow-up of 2.8 years, 2-year progression-free and overall survival is 50.0% and 68.8%, respectively. In conclusion, these data suggest that a DLI that has been depleted of CD45RA+ naive T cells is feasible and carries a low risk of acute or chronic GvHD.
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Affiliation(s)
- Ko K Maung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Benny J Chen
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Ian Barak
- Cancer Center Biostatistics, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Zhiguo Li
- Cancer Center Biostatistics, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Ashley M Engemann
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Barbara Waters-Pick
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Krista Rowe Nichols
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Yubin Kang
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA.
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Advani AS, Tse W, Li H, Jia X, Elson P, Cooper B, Ali-Osman F, Park J, Rao AV, Rizzieri DA, Wang ES, Cotta CV, Kalaycio M, Sobecks RM, Rouphail B, Maciejewski JP, Fensterl J, Carew JS, Foster B, Rush ML, Tripp B, Adams D, Corrigan D, Griffiths EA, Sekeres MA. A Phase II Trial of Imatinib Mesylate as Maintenance Therapy for Patients With Newly Diagnosed C-kit-positive Acute Myeloid Leukemia. Clin Lymphoma Myeloma Leuk 2020; 21:113-118. [PMID: 33422470 DOI: 10.1016/j.clml.2020.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adults with acute myeloid leukemia (AML) have a high rate of remission; however, more than 50% relapse. C-kit is expressed in approximately 60% of patients with de novo AML and represents a potential therapeutic target. MATERIALS AND METHODS Patients with newly diagnosed AML received 12 months of imatinib mesylate as maintenance therapy after the completion of post-remission therapy. The primary objective was to determine whether this approach improved progression-free survival (defined as no relapse and no death) compared with historical controls. RESULTS The median progression-free survival of patients < 60 years of age was 52.1 months (historical control, 13 months) and for patients ≥ 60 years of age was 10.7 months (historical control, 8 months). The median level of AF1q expression was high (9.59), and 84% of patients had moderate or high levels of drug-resistance factors. CONCLUSIONS Imatinib maintenance therapy may improve the outcome of newly diagnosed patients with AML who are < 60 years of age.
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Affiliation(s)
- Anjali S Advani
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH.
| | - William Tse
- Department of Hematology/ Oncology, Metro Health, Cleveland, OH
| | - Hong Li
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Xuefei Jia
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Paul Elson
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Brenda Cooper
- Department of Hematology/ Oncology, University Hospitals of Cleveland, Cleveland, OH
| | | | - Jino Park
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Arati V Rao
- Duke Cancer Institute, Duke University, Durham, NC; Current affiliation: PACT Pharma, South San Francisco, CA
| | | | - Eunice S Wang
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Matt Kalaycio
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Ronald M Sobecks
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Basel Rouphail
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Jaroslaw P Maciejewski
- Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Jaime Fensterl
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Jennifer S Carew
- University of Arizona Cancer Center, Leon Levy Cancer Center, Tuscon, AZ
| | - Bethany Foster
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Mary Lynn Rush
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Barbara Tripp
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | - Donna Adams
- Department of Hematology/ Oncology, Duke University, Durham, NC
| | - Donna Corrigan
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
| | | | - Mikkael A Sekeres
- Department of Hematology/ Oncology, Cleveland Clinic Taussig Cancer Institute Leukemia Program, Cleveland, OH
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28
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Smith P, Thompson JC, Perea E, Wasserman B, Bohannon L, Racioppi A, Choi T, Gasparetto C, Horwitz ME, Long G, Lopez R, Rizzieri DA, Sarantopoulos S, Sullivan KM, Chao NJ, Sung AD. Clinical and Neuroimaging Correlates of Post-Transplant Delirium. Biol Blood Marrow Transplant 2020; 26:2323-2328. [PMID: 32961373 DOI: 10.1016/j.bbmt.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/14/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
Delirium is common among adults undergoing hematopoietic stem cell transplantation (HCT), although the clinical and neuroimaging correlates of post-HCT delirium have not been adequately delineated. We therefore examined the frequency of delirium and neuroimaging correlates of post-transplant delirium in a retrospective cohort of 115 adults undergoing neuroimaging after allogeneic HCT. Delirium was established using previously validated methods for retrospective identification of chart-assessed postprocedural delirium. Chart reviews were independently conducted by a multidisciplinary team with expertise in HCT, psychiatry, and psychology on consecutive allogeneic HCT patients who underwent neuroimaging assessments and transplantation at a single center between January 2009 and December 2016. Neuroimaging markers of white matter damage and brain volume loss were also recorded. In total, 115 patients were included, ranging in age from 20 to 74 years (mean [SD] age, 49 [13]). Fifty-three patients (46%) developed post-HCT delirium. In an adjusted model, delirium incidence was associated with older age (odds ratio [OR], 1.92 [1.28, 2.87] per decade, P = .002), greater severity of white matter hyperintensities (OR, 1.95 [1.06, 3.57], P = .031), and conditioning intensity (OR, 6.37 [2.20, 18.45], P < .001) but was unrelated to cortical atrophy (P = .777). Delirium was associated with fewer hospital-free days (P = .023) but was not associated with overall survival (hazard ratio, 0.95 [0.56, 1.61], P = .844). Greater incidence of delirium following HCT was associated with greater age, microvascular burden, and conditioning intensity. Pre-HCT consideration of microvascular burden and other neuroimaging biomarkers of risk may be warranted.
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Affiliation(s)
- Patrick Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Jillian C Thompson
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Elena Perea
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Brian Wasserman
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Lauren Bohannon
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Alessandro Racioppi
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Taewoong Choi
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Gwynn Long
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Richard Lopez
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Keith M Sullivan
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
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29
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Maung K, Ramalingam S, Chaudhry M, Ren Y, Jung SH, Romero K, Corbet K, Chao NJ, Choi T, Diehl AM, Diehl L, Gasparetto C, Horwitz M, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sullivan KM, Bashir MR, Sung AD. Pre-transplant hepatic steatosis (fatty liver) is associated with chronic graft-vs-host disease but not mortality. PLoS One 2020; 15:e0238824. [PMID: 32915853 PMCID: PMC7485815 DOI: 10.1371/journal.pone.0238824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/23/2020] [Indexed: 12/17/2022] Open
Abstract
Allogeneic-HCT (allo-HCT), while potentially curative, can result in significant complications including graft versus host disease (GVHD). Prior studies suggest that metabolic syndrome may be one risk factor for GVHD. We hypothesized that hepatic steatosis on pre-HCT computed tomography (CT) scans may be a marker for development of GVHD and poor outcomes in allo-HCT. In this retrospective study, we reviewed the pre-HCT CT scans and transplant outcome data of patients who underwent allo-HCT at Duke University Medical Center from 2009 to 2017. The presence of steatosis was confirmed using CT attenuation measurements. We then assessed the association between pre-HCT hepatic steatosis and HCT-related outcomes including GVHD. 80 patients who had pre-HCT CT scans were included in the study. Pre-transplant hepatic steatosis was associated with the development of chronic GVHD (OR 4.2, p = 0.02), but was not associated with acute GVHD (OR 1.3, p = 0.7), non-relapse mortality (p = 0.81) or overall survival (p = 0.74). Based on this single center retrospective study, pre-transplant hepatic steatosis is associated with development of chronic GVHD. Further, prospective study with other imaging modalities including non-contrasted CT scans is needed to determine if this association is reproducible.
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Affiliation(s)
- Ko Maung
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sendhilnathan Ramalingam
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mohammad Chaudhry
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Yi Ren
- Duke Cancer Institute, Biostatistics Shared Resources, Duke University, Durham, North Carolina, United States of America
| | - Sin-Ho Jung
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kristi Romero
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kelly Corbet
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Nelson J. Chao
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Anna Mae Diehl
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Louis Diehl
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Mitchell Horwitz
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Gwynn Douglas Long
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Richard D. Lopez
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - David A. Rizzieri
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Keith M. Sullivan
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Mustafa R. Bashir
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Anthony D. Sung
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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30
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Markey KA, Schluter J, Gomes ALC, Littmann ER, Pickard AJ, Taylor BP, Giardina PA, Weber D, Dai A, Docampo MD, Armijo GK, Slingerland AE, Slingerland JB, Nichols KB, Brereton DG, Clurman AG, Ramos RJ, Rao A, Bush A, Bohannon L, Covington M, Lew MV, Rizzieri DA, Chao N, Maloy M, Cho C, Politikos I, Giralt S, Taur Y, Pamer EG, Holler E, Perales MA, Ponce DM, Devlin SM, Xavier J, Sung AD, Peled JU, Cross JR, van den Brink MRM. The microbe-derived short-chain fatty acids butyrate and propionate are associated with protection from chronic GVHD. Blood 2020; 136:130-136. [PMID: 32430495 PMCID: PMC7332893 DOI: 10.1182/blood.2019003369] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/19/2020] [Indexed: 01/10/2023] Open
Abstract
Studies of the relationship between the gastrointestinal microbiota and outcomes in allogeneic hematopoietic stem cell transplantation (allo-HCT) have thus far largely focused on early complications, predominantly infection and acute graft-versus-host disease (GVHD). We examined the potential relationship of the microbiome with chronic GVHD (cGVHD) by analyzing stool and plasma samples collected late after allo-HCT using a case-control study design. We found lower circulating concentrations of the microbe-derived short-chain fatty acids (SCFAs) propionate and butyrate in day 100 plasma samples from patients who developed cGVHD, compared with those who remained free of this complication, in the initial case-control cohort of transplant patients and in a further cross-sectional cohort from an independent transplant center. An additional cross-sectional patient cohort from a third transplant center was analyzed; however, serum (rather than plasma) was available, and the differences in SCFAs observed in the plasma samples were not recapitulated. In sum, our findings from the primary case-control cohort and 1 of 2 cross-sectional cohorts explored suggest that the gastrointestinal microbiome may exert immunomodulatory effects in allo-HCT patients at least in part due to control of systemic concentrations of microbe-derived SCFAs.
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Affiliation(s)
- Kate A Markey
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Antonio L C Gomes
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric R Littmann
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amanda J Pickard
- Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany
| | | | - Paul A Giardina
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Weber
- Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany
| | - Anqi Dai
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Melissa D Docampo
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gabriel K Armijo
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ann E Slingerland
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John B Slingerland
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine B Nichols
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel G Brereton
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Annelie G Clurman
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ruben J Ramos
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Arka Rao
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amy Bush
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC; and
| | - Lauren Bohannon
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC; and
| | - Megan Covington
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC; and
| | - Meagan V Lew
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC; and
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC; and
| | - Nelson Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC; and
| | - Molly Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Cho
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ying Taur
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Infectious Disease Service, Department of Medicine, and
| | - Eric G Pamer
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
- Infectious Disease Service, Department of Medicine, and
| | - Ernst Holler
- Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Doris M Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joao Xavier
- Program for Computational and Systems Biology, and
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC; and
| | - Jonathan U Peled
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Justin R Cross
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
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Sung AD, Jauhari S, Siamakpour‐Reihani S, Rao AV, Staats J, Chan C, Meyer E, Gadi VK, Nixon AB, Lyu J, Xie J, Bohannon L, Li Z, Hourigan CS, Dillon LW, Wong HY, Shelby R, Diehl L, Castro C, LeBlanc T, Brander D, Erba H, Galal A, Stefanovic A, Chao N, Rizzieri DA. Microtransplantation in older patients with AML: A pilot study of safety, efficacy and immunologic effects. Am J Hematol 2020; 95:662-671. [PMID: 32162718 DOI: 10.1002/ajh.25781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/24/2022]
Abstract
Older AML patients have low remission rates and poor survival outcomes with standard chemotherapy. Microtransplantation (MST) refers to infusion of allogeneic hematopoietic stem cells without substantial engraftment. MST has been shown to improve clinical outcomes compared with chemotherapy alone. This is the first trial reporting on broad correlative studies to define immunologic mechanisms of action of MST in older AML patients. Older patients with newly diagnosed AML were eligible for enrollment, receiving induction chemotherapy with cytarabine (100 mg/m2) on days 1-7 and idarubicin (12 mg/m2) on days 1-3 (7 + 3). MST was administered 24 hours later. Patients with complete response (CR) were eligible for consolidation with high dose cytarabine (HiDAC) and a second cycle of MST. Responses were evaluated according to standard criteria per NCCN. Immune correlative studies were performed. Sixteen patients were enrolled and received 7 + 3 and MST (median age 73 years). Nine (56%) had high-risk and seven (44%) had standard-risk cytogenetics. Ten episodes of CRS were observed. No cases of GVHD or treatment-related mortality were reported. Event-free survival (EFS) was 50% at 6 months and 19% at 1 year. Overall survival (OS) was 63% at 6 months and 44% at 1 year. Donor microchimerism was not detected. Longitudinal changes were noted in NGS, TCR sequencing, and cytokine assays. Addition of MST to induction and consolidation chemotherapy was well tolerated in older AML patients. Inferior survival outcomes in our study may be attributed to a higher proportion of very elderly patients with high-risk features. Potential immunologic mechanisms of activity of MST include attenuation of inflammatory cytokines and emergence of tumor-specific T cell clones.
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Affiliation(s)
- Anthony D. Sung
- Duke University School of Medicine Durham North Carolina USA
| | - Shekeab Jauhari
- Duke University School of Medicine Durham North Carolina USA
| | | | | | - Janet Staats
- Duke University School of Medicine Durham North Carolina USA
| | - Cliburn Chan
- Duke University School of Medicine Durham North Carolina USA
| | - Everett Meyer
- Stanford University Medical School Palo Alto California USA
| | | | - Andrew B. Nixon
- Duke University School of Medicine Durham North Carolina USA
| | - Jing Lyu
- Duke University School of Medicine Durham North Carolina USA
| | - Jichun Xie
- Duke University School of Medicine Durham North Carolina USA
| | - Lauren Bohannon
- Duke University School of Medicine Durham North Carolina USA
| | - Zhiguo Li
- Duke University School of Medicine Durham North Carolina USA
| | - Christopher S. Hourigan
- Laboratory of Myeloid MalignanciesHematology Branch, National Heart, Lung and Blood Institute Bethesda Maryland USA
| | - Laura W. Dillon
- Laboratory of Myeloid MalignanciesHematology Branch, National Heart, Lung and Blood Institute Bethesda Maryland USA
| | - Hong Yuen Wong
- Laboratory of Myeloid MalignanciesHematology Branch, National Heart, Lung and Blood Institute Bethesda Maryland USA
| | - Rebecca Shelby
- Duke University School of Medicine Durham North Carolina USA
| | - Louis Diehl
- Duke University School of Medicine Durham North Carolina USA
| | - Carlos Castro
- Duke University School of Medicine Durham North Carolina USA
| | - Thomas LeBlanc
- Duke University School of Medicine Durham North Carolina USA
| | | | - Harry Erba
- Duke University School of Medicine Durham North Carolina USA
| | - Ahmed Galal
- Duke University School of Medicine Durham North Carolina USA
| | | | - Nelson Chao
- Duke University School of Medicine Durham North Carolina USA
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32
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Smith PJ, Lew M, Lowder YP, Romero K, Thompson J, Bohannen L, Pittman A, Sullivan K, Choi T, Gasparetto C, Horwitz ME, Long GD, Lopez R, Rizzieri DA, Sarantopoulos S, Chao NJ, Sung AD. Cognitive Impairment in Candidates for Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ramalingam S, Siamakpour-Reihani S, Bohannon L, Ren Y, Sibley A, Nixon A, Lyu J, Xie J, Choi T, Gasparetto C, Horwitz ME, Long GD, Lopez R, Rizzieri DA, Sarantopoulos S, Chao NJ, Sung AD. Phase II Trial of Pasireotide to Prevent GI Toxicity and Acute Gvhd in Allogeneic HSCT. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.120] [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: 10/25/2022]
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Pagel JM, Othus M, Garcia-Manero G, Fang M, Radich JP, Rizzieri DA, Marcucci G, Strickland SA, Litzow MR, Savoie ML, Spellman SR, Confer DL, Chell JW, Brown M, Medeiros BC, Sekeres MA, Lin TL, Uy GL, Powell BL, Bayer RL, Larson RA, Stone RM, Claxton D, Essell J, Luger SM, Mohan SR, Moseley A, Erba HP, Appelbaum FR. Rapid Donor Identification Improves Survival in High-Risk First-Remission Patients With Acute Myeloid Leukemia. JCO Oncol Pract 2020; 16:e464-e475. [PMID: 32048933 DOI: 10.1200/jop.19.00133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
PURPOSE Patients with acute myeloid leukemia with high-risk cytogenetics in first complete remission (CR1) achieve better outcomes if they undergo allogeneic hematopoietic cell transplantation (HCT) compared with consolidation chemotherapy alone. However, only approximately 40% of such patients typically proceed to HCT. METHODS We used a prospective organized approach to rapidly identify donors to improve the allogeneic HCT rate in adults with high-risk acute myeloid leukemia in CR1. Newly diagnosed patients had cytogenetics obtained at enrollment, and those with high-risk cytogenetics underwent expedited HLA typing and were encouraged to be referred for consultation with a transplantation team with the goal of conducting an allogeneic HCT in CR1. RESULTS Of 738 eligible patients (median age, 49 years; range, 18-60 years of age), 159 (22%) had high-risk cytogenetics and 107 of these patients (67%) achieved CR1. Seventy (65%) of the high-risk patients underwent transplantation in CR1 (P < .001 compared with the historical rate of 40%). Median time to HCT from CR1 was 77 days (range, 20-356 days). In landmark analysis, overall survival (OS) among patients who underwent transplantation was significantly better compared with that of patients who did not undergo transplantation (2-year OS, 48% v 35%, respectively [P = .031]). Median relapse-free survival after transplantation in the high-risk cohort who underwent transplantation in CR1 (n = 70) was 11.5 months (range, 4-47 months), and median OS after transplantation was 14 months (range, 4-44 months). CONCLUSION Early cytogenetic testing with an organized effort to identify a suitable allogeneic HCT donor led to a CR1 transplantation rate of 65% in the high-risk group, which, in turn, led to an improvement in OS when compared with the OS of patients who did not undergo transplantation.
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Affiliation(s)
| | - Megan Othus
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Min Fang
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN.,National Marrow Donor Program, Minneapolis, MN
| | - Jeffrey W Chell
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN.,National Marrow Donor Program, Minneapolis, MN
| | - Maria Brown
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | | | | | - Geoffrey L Uy
- Washington University School of Medicine, St Louis, MO
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Ruthee-Lu Bayer
- Monter Cancer Center, Northwell Health System, Lake Success, NY
| | | | | | - David Claxton
- Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA
| | | | - Selina M Luger
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA
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35
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Guo M, Chao NJ, Li JY, Rizzieri DA, Sun QY, Mohrbacher A, Krakow EF, Sun WJ, Shen XL, Zhan XR, Wu DP, Liu L, Wang J, Zhou M, Yang LH, Bao YY, Dong Z, Cai B, Hu KX, Yu CL, Qiao JH, Zuo HL, Huang YJ, Sung AD, Qiao JX, Liu ZQ, Liu TQ, Yao B, Zhao HX, Qian SX, Liu WW, Forés R, Duarte RF, Ai HS. HLA-Mismatched Microtransplant in Older Patients Newly Diagnosed With Acute Myeloid Leukemia: Results From the Microtransplantation Interest Group. JAMA Oncol 2019; 4:54-62. [PMID: 28910431 DOI: 10.1001/jamaoncol.2017.2656] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance The outcome of older patients with acute myeloid leukemia (AML) remains unsatisfactory. Recent studies have shown that HLA-mismatched microtransplant could improve outcomes in such patients. Objective To evaluate outcomes in different age groups among older patients with newly diagnosed AML who receive HLA-mismatched microtransplant. Design, Setting, and Participants This multicenter clinical study included 185 patients with de novo AML at 12 centers in China, the United States, and Spain in the Microtransplantation Interest Group. Patients were divided into the following 4 age groups: 60 to 64 years, 65 to 69 years, 70 to 74 years, and 75 to 85 years. The study period was May 1, 2006, to July 31, 2015. Exposures Induction chemotherapy and postremission therapy with cytarabine hydrochloride with or without anthracycline, followed by highly HLA-mismatched related or fully mismatched unrelated donor cell infusion. No graft-vs-host disease prophylaxis was used. Main Outcomes and Measures The primary end point of the study was to evaluate the complete remission rates, leukemia-free survival, and overall survival in different age groups. Additional end points of the study included hematopoietic recovery, graft-vs-host disease, relapse rate, nonrelapse mortality, and other treatment-related toxicities. Results Among 185 patients, the median age was 67 years (range, 60-85 years), and 75 (40.5%) were female. The denominators in adjusted percentages in overall survival, leukemia-free survival, relapse, and nonrelapse mortality are not the sample proportions of observations. The overall complete remission rate was not significantly different among the 4 age groups (75.4% [52 of 69], 70.2% [33 of 47], 79.1% [34 of 43], and 73.1% [19 of 26). The 1-year overall survival rates were 87.7%, 85.8%, and 77.8% in the first 3 age groups, which were much higher than the rate in the fourth age group (51.7%) (P = .004, P = .008, and P = .04, respectively). The 2-year overall survival rates were 63.7% and 66.8% in the first 2 age groups, which were higher than the rates in the last 2 age groups (34.2% and 14.8%) (P = .02, P = .03, P < .001, and P < .001, respectively). The 1-year cumulative incidences of nonrelapse mortality were 10.2%, 0%, 3.4%, and 26.0% in the 4 age groups and 8.1% in all patients. The median times to neutrophil and platelet recovery were 12 days and 14 days after induction chemotherapy, respectively. Five patients had full or mixed donor engraftment, and 30.8% (8 of 26) of patients demonstrated donor microchimerism. Two patients (1.1%) developed severe acute graft-vs-host disease. Conclusions and Relevance Microtransplant achieved a high complete remission rate in AML patients aged 60 to 85 years and higher 1-year overall survival in those aged 60 to 74 years.
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Affiliation(s)
- Mei Guo
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Duke Cancer Institute, Durham, North Carolina
| | - Jian-Yong Li
- Department of Hematology, Jiangsu Province People's Hospital, Nanjing, China
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Duke Cancer Institute, Durham, North Carolina
| | - Qi-Yun Sun
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Ann Mohrbacher
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles
| | - Elizabeth F Krakow
- Division of Medical Oncology, University of Washington, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle
| | - Wan-Jun Sun
- Department of Hematology, The Second Artillery General Hospital, Beijing, China
| | - Xu-Liang Shen
- Department of Hematology, He Ping Central Hospital of the Changzhi Medical College, Changzhi, China
| | - Xin-Rong Zhan
- Department of Hematology, Central Hospital of Xinxiang City, Xinxiang, China
| | - De-Pei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Liu
- Department of Hematology, The Fourth Military Medical University, Xi'an, China
| | - Juan Wang
- Department of Hematology, Central Hospital of Cangzhou City, Cangzhou, China
| | - Min Zhou
- Department of Hematology, The Second People's Hospital of Changzhou City, Changzhou, China
| | - Lin-Hua Yang
- Department of Hematology, The Second Affiliated Hospital of Shanxi University, Taiyuan, China
| | - Yang-Yi Bao
- Department of Hematology, Central Hospital of Hefei City, Hefei, China
| | - Zheng Dong
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Bo Cai
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Kai-Xun Hu
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Chang-Lin Yu
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Jian-Hui Qiao
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Hong-Li Zuo
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Ya-Jing Huang
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Duke Cancer Institute, Durham, North Carolina
| | - Jun-Xiao Qiao
- Department of Hematology, The Second Artillery General Hospital, Beijing, China
| | - Zhi-Qing Liu
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Tie-Qiang Liu
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Bo Yao
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
| | - Hong-Xia Zhao
- Department of Hematology, The Second Artillery General Hospital, Beijing, China
| | - Si-Xuan Qian
- Department of Hematology, Jiangsu Province People's Hospital, Nanjing, China
| | - Wei-Wei Liu
- Statistics Department, The Academy of Military Medical Sciences, Beijing, China
| | - Rafael Forés
- Department of Hematology, Hospital Universitario Puerta de Hierro, Majadahonda, Comunidad de Madrid, Spain
| | - Rafael F Duarte
- Department of Hematology, Hospital Universitario Puerta de Hierro, Majadahonda, Comunidad de Madrid, Spain
| | - Hui-Sheng Ai
- Department of Hematology and Transplantation, Affiliated Hospital of The Academy of Military Medical Sciences, Beijing, China
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Lin KH, Xie A, Rutter JC, Ahn YR, Lloyd-Cowden JM, Nichols AG, Soderquist RS, Koves TR, Muoio DM, MacIver NJ, Lamba JK, Pardee TS, McCall CM, Rizzieri DA, Wood KC. Systematic Dissection of the Metabolic-Apoptotic Interface in AML Reveals Heme Biosynthesis to Be a Regulator of Drug Sensitivity. Cell Metab 2019; 29:1217-1231.e7. [PMID: 30773463 PMCID: PMC6506362 DOI: 10.1016/j.cmet.2019.01.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/28/2018] [Accepted: 01/17/2019] [Indexed: 12/16/2022]
Abstract
Crosstalk between metabolic and survival pathways is critical for cellular homeostasis, but the connectivity between these processes remains poorly defined. We used loss-of-function CRISPR/Cas9 knockout screening to identify metabolic genes capable of influencing cellular commitment to apoptosis, using sensitization to the BCL-2 inhibitor ABT-199 in BCL-2-dependent acute myeloid leukemia (AML) cell lines as a proxy for apoptotic disposition. This analysis revealed metabolic pathways that specifically cooperate with BCL-2 to sustain survival. In particular, our analysis singled out heme biosynthesis as an unappreciated apoptosis-modifying pathway. Although heme is broadly incorporated into the proteome, reduction of heme biosynthesis potentiates apoptosis through the loss of ETC activity, resulting in baseline depolarization of the mitochondrial membrane and an increased propensity to undergo apoptosis. Collectively, our findings chart the first apoptotic map of metabolism, motivating the design of metabolically engaged combination chemotherapies and nominating heme biosynthesis as an apoptotic modulator in AML.
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Affiliation(s)
- Kevin H Lin
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Abigail Xie
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Justine C Rutter
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Yeong-Ran Ahn
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | | | - Amanda G Nichols
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Ryan S Soderquist
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Timothy R Koves
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Deborah M Muoio
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Nancie J MacIver
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, NC, USA; Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Jatinder K Lamba
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Timothy S Pardee
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Chad M McCall
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - David A Rizzieri
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kris C Wood
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, NC, USA.
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37
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Pemmaraju N, Lane AA, Sweet KL, Stein AS, Vasu S, Blum W, Rizzieri DA, Wang ES, Duvic M, Sloan JM, Spence S, Shemesh S, Brooks CL, Balser J, Bergstein I, Lancet JE, Kantarjian HM, Konopleva M. Tagraxofusp in Blastic Plasmacytoid Dendritic-Cell Neoplasm. N Engl J Med 2019; 380:1628-1637. [PMID: 31018069 DOI: 10.1056/nejmoa1815105] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Blastic plasmacytoid dendritic-cell neoplasm (BPDCN) is an aggressive hematologic cancer that is caused by transformed plasmacytoid dendritic cells that overexpress interleukin-3 receptor subunit alpha (IL3RA or CD123). Tagraxofusp (SL-401) is a CD123-directed cytotoxin consisting of human interleukin-3 fused to truncated diphtheria toxin. METHODS In this open-label, multicohort study, we assigned 47 patients with untreated or relapsed BPDCN to receive an intravenous infusion of tagraxofusp at a dose of 7 μg or 12 μg per kilogram of body weight on days 1 to 5 of each 21-day cycle. Treatment continued until disease progression or unacceptable toxic effects. The primary outcome was the combined rate of complete response and clinical complete response among patients who had not received previous treatment for BPDCN. A secondary outcome was the duration of response. RESULTS Of the 47 patients, 32 were receiving tagraxofusp as first-line treatment and 15 had received previous treatment. The median age of the patients was 70 years (range, 22 to 84). Among the 29 previously untreated patients who received tagraxofusp at a dose of 12 μg per kilogram, the primary outcome occurred in 21 (72%), and the overall response rate was 90%; of these patients, 45% went on to undergo stem-cell transplantation. Survival rates at 18 and 24 months were 59% and 52%, respectively. Among the 15 previously treated patients, the response rate was 67%, and the median overall survival was 8.5 months. The most common adverse events were increased levels of alanine aminotransferase (64%) and aspartate aminotransferase (60%), hypoalbuminemia (55%), peripheral edema (51%), and thrombocytopenia (49%). Capillary leak syndrome was reported in 19% of the patients and was associated with one death in each of the dose subgroups. CONCLUSIONS In adult patients with untreated or relapsed BPDCN, the use of tagraxofusp led to clinical responses. Serious adverse events included capillary leak syndrome; hepatic dysfunction and thrombocytopenia were common. (Funded by Stemline Therapeutics and the Leukemia and Lymphoma Society Therapy Acceleration Program; ClinicalTrials.gov number, NCT02113982.).
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Affiliation(s)
- Naveen Pemmaraju
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Andrew A Lane
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Kendra L Sweet
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Anthony S Stein
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Sumithira Vasu
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - William Blum
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - David A Rizzieri
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Eunice S Wang
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Madeleine Duvic
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - J Mark Sloan
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Sharon Spence
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Shay Shemesh
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Christopher L Brooks
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - John Balser
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Ivan Bergstein
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Jeffrey E Lancet
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Hagop M Kantarjian
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
| | - Marina Konopleva
- From the University of Texas M.D. Anderson Cancer Center, Houston (N.P., M.D., H.M.K., M.K.); Dana-Farber Cancer Institute (A.A.L.) and Boston University School of Medicine (J.M.S.), Boston, and Veristat, Southborough (J.B.) - all in Massachusetts; H. Lee Moffitt Cancer Center, Tampa, FL (K.L.S., J.E.L.); City of Hope National Medical Center, Duarte, CA (A.S.S.); Ohio State University, Columbus (S.V.); Winship Cancer Institute of Emory University, Atlanta (W.B.); Duke University Medical Center, Durham, NC (D.A.R.); and Roswell Park Comprehensive Cancer Center, Buffalo (E.S.W.), and Stemline Therapeutics, New York (S. Spence, S. Shemesh, C.L.B., I.B.) - both in New York
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Kam AYF, Piryani SO, McCall CM, Park HS, Rizzieri DA, Doan PL. Targeting High Mobility Group Box-1 (HMGB1) Promotes Cell Death in Myelodysplastic Syndrome. Clin Cancer Res 2019; 25:4155-4167. [PMID: 30952643 PMCID: PMC6800136 DOI: 10.1158/1078-0432.ccr-18-3517] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/15/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Myelodysplastic syndrome (MDS) is associated with a dysregulated innate immune system. The purpose of this study was to determine whether modulation of the innate immune system via high mobility group box-1 (HMGB1) could reduce cell viability in MDS. EXPERIMENTAL DESIGN We quantified HMGB1 in an MDS cell line MDS-L and in primary MDS cells compared with nonmalignant hematopoietic cells. We performed loss-of-function studies of HMGB1 using pooled siRNAs and a small-molecule inhibitor sivelestat compared with standard chemotherapy. We measured levels of engraftment of MDS-L cells in NOD-scidIL2Rgnull (NSG) mice following treatment with sivelestat. Mechanistically, we interrogated cell survival pathways and 45 targets within the NFκB pathway using both protein analysis and a proteome profiler array. RESULTS We discovered that HMGB1 had increased expression in both MDS-L cells and in primary CD34+ MDS cells compared with healthy CD34+ hematopoietic cells. Sivelestat impaired MDS cell expansion, increased cellular death, and spared healthy hematopoietic cells. MDS-L marrow engraftment is reduced significantly at 17 weeks following treatment with sivelestat compared with control mice. Treatment of CD34+ MDS cells with sivelestat and azacitidine or decitabine was additive to increase apoptotic cell death compared with chemotherapy alone. Sivelestat promoted apoptosis with increased expression of PUMA, activated caspase 3, and increased DNA double-strand breaks. Inhibition of HMGB1 reduced levels of Toll-like receptors (TLR) and suppressed activation of NFκB in MDS-L cells. CONCLUSIONS Inhibition of HMGB1 could promote MDS cell death and alter innate immune responses via suppression of NFκB pathways.
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Affiliation(s)
- Angel Y F Kam
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Sadhna O Piryani
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Chad M McCall
- Department of Pathology, Duke University, Durham, North Carolina
| | - Hee Su Park
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina.,Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Phuong L Doan
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina. .,Duke Cancer Institute, Duke University, Durham, North Carolina
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Maung KK, Chen BJ, Rizzieri DA, Gasparetto C, Sullivan K, Long GD, Engemann AM, Waters-Pick B, Nichols KR, Lopez R, Kang Y, Sarantopoulos S, Sung AD, Chao NJ, Horwitz ME. Phase I, Dose Escalation Study of Naïve T-Cell Depleted Donor Lymphocyte Infusion Following Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.254] [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: 10/27/2022]
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Sivaraj D, Green MM, Kang Y, Long GD, Rizzieri DA, Li Z, Garrett AH, McIntyre JL, Chao NJ, Gasparetto C. Bendamustine, pomalidomide, and dexamethasone for relapsed and/or refractory multiple myeloma. Blood Cancer J 2018; 8:71. [PMID: 30065277 PMCID: PMC6068091 DOI: 10.1038/s41408-018-0104-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/10/2018] [Accepted: 06/15/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dharshan Sivaraj
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC, 27708, USA.
| | - Michael M Green
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC, 27708, USA
| | - Yubin Kang
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC, 27708, USA
| | - Gwynn D Long
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC, 27708, USA
| | - David A Rizzieri
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC, 27708, USA
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, 2424 Erwin Road Suite 1102 11086 Hock Plaza, Durham, NC, 27705, USA
| | - Anderson H Garrett
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC, 27708, USA
| | - Jackie L McIntyre
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC, 27708, USA
| | - Nelson J Chao
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC, 27708, USA
| | - Cristina Gasparetto
- Division of Cellular Therapy, Duke University, 2400 Pratt Street, Durham, NC, 27708, USA
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Wang M, Locke FL, Munoz J, Goy A, Holmes HE, Siddiqi T, Flinn I, McSweeney PA, Reagan PM, Hill BT, Jacobson CA, Rizzieri DA, Heffner LT, Jaglowski SM, Miklos DB, Shaughnessy P, Unabia S, Rossi JM, Jiang Y, Jain RK. ZUMA-2: Phase 2 multicenter study evaluating efficacy of kte-C19 in patients with relapsed/refractory mantle cell lymphoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps3102] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
Affiliation(s)
- Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Javier Munoz
- Cancer Immunology Program, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Andre Goy
- John Theurer Cancer Center, Hackensack, NJ
| | | | - Tanya Siddiqi
- City Of Hope National Medical Center, Duarte, CA, US
| | - Ian Flinn
- Sarah Cannon Research Institute, Nashville, TN
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Sivaraj D, Bacon W, Long GD, Rizzieri DA, Horwitz ME, Sullivan KM, Kang Y, Li Z, Chao NJ, Gasparetto C. High-dose BCNU/Melphalan conditioning regimen before autologous stem cell transplantation in newly diagnosed multiple myeloma. Bone Marrow Transplant 2017; 53:34-38. [DOI: 10.1038/bmt.2017.208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/08/2017] [Accepted: 08/16/2017] [Indexed: 01/31/2023]
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Anand S, Thomas S, Corbet K, Gasparetto C, Long GD, Lopez R, Morris AK, Rizzieri DA, Sullivan KM, Sung AD, Sarantopoulos S, Chao NJ, Horwitz ME. Adult Umbilical Cord Blood Transplantation Using Myeloablative Thiotepa, Total Body Irradiation, and Fludarabine Conditioning. Biol Blood Marrow Transplant 2017; 23:1949-1954. [PMID: 28729147 DOI: 10.1016/j.bbmt.2017.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/26/2017] [Indexed: 12/16/2022]
Abstract
Treatment-related mortality (TRM) remains elevated in adult patients undergoing umbilical cord blood transplantation (UCBT), including an early rise in TRM suggestive of excessive toxicity associated with the standard myeloablative total body irradiation (TBI), fludarabine, and cyclophosphamide regimen. In an attempt to reduce regimen-related toxicity, we previously studied a modified myeloablative regimen with TBI (1350 cGy) and fludarabine (160 mg/m2); TRM was decreased, but neutrophil engraftment was suboptimal. Therefore, to improve engraftment while still minimizing regimen-related toxicity, we piloted a myeloablative regimen with the addition of thiotepa (10 mg/kg) to TBI and fludarabine conditioning. Thirty-one adult patients (median age, 46 years; range, 19 to 65) with hematologic malignancies (acute leukemia/myelodysplastic syndrome, 77%; lymphoid malignancy, 23%) underwent single (n = 1) or double (n = 30) UCBT from 2010 to 2015 at our institution. The cumulative incidence of neutrophil engraftment was 90% (95% confidence interval [CI], 70% to 97%) by 60 days, with a median time to engraftment of 21 days (95% CI, 19 to 26). The cumulative incidence of platelet engraftment was 77% (95% CI, 57% to 89%) by 100 days, with a median time to engraftment of 47 days (95% CI, 37 to 73). Cumulative incidences of grades II to IV and grades III to IV acute graft-versus-host disease (GVHD) at day 100 were 45% (95% CI, 27% to 62%) and 10% (95% CI, 2% to 23%), respectively. The overall incidence of chronic GVHD at 2 years was 40% (95% CI, 22% to 57%), with 17% of patients (95% CI, 6% to 33%) experiencing moderate to severe chronic GVHD by 2 years. TRM at 180 days was 13% (95% CI, 4% to 27%), at 1 year 24% (95% CI, 10% to 41%), and at 3 years 30% (95% CI, 13% to 49%). Relapse at 1 year was 13% (95% CI, 4% to 27%) and at 3 years 19% (95% CI, 6% to 38%). With a median follow-up of 35.5 months (95% CI, 12.7 to 52.2), disease-free and overall survival at 3 years were 51% (95% CI, 29% to 69%) and 57% (95% CI, 36% to 73%), respectively. This regimen represents a reasonable alternative to myeloablative conditioning with TBI, fludarabine, and cyclophosphamide and warrants further study.
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Affiliation(s)
- Sarah Anand
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Samantha Thomas
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Kelly Corbet
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Ashley K Morris
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina.
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Anand S, Thomas S, Hyslop T, Adcock J, Corbet K, Gasparetto C, Lopez R, Long GD, Morris AK, Rizzieri DA, Sullivan KM, Sung AD, Sarantopoulos S, Chao NJ, Horwitz ME. Transplantation of Ex Vivo Expanded Umbilical Cord Blood (NiCord) Decreases Early Infection and Hospitalization. Biol Blood Marrow Transplant 2017; 23:1151-1157. [PMID: 28392378 DOI: 10.1016/j.bbmt.2017.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023]
Abstract
Delayed hematopoietic recovery contributes to increased infection risk following umbilical cord blood (UCB) transplantation. In a Phase 1 study, adult recipients of UCB stem cells cultured ex vivo for 3 weeks with nicotinamide (NiCord) had earlier median neutrophil recovery compared with historical controls. To evaluate the impact of faster neutrophil recovery on clinically relevant early outcomes, we reviewed infection episodes and hospitalization during the first 100 days in an enlarged cohort of 18 NiCord recipients compared with 86 standard UCB recipients at our institution. The median time to neutrophil engraftment was shorter in NiCord recipients compared with standard UCB recipients (12.5 days versus 26 days; P < .001). Compared with standard UCB recipients, NiCord recipients had a significantly reduced risk for total infection (RR, 0.69; P = .01), grade 2-3 (moderate to severe) infection (RR, 0.36; P < .001), bacterial infection (RR, 0.39; P = .003), and grade 2-3 bacterial infection (RR, 0.21; P = .003) by Poisson regression analysis; this effect persisted after adjustment for age, disease stage, and grade II-IV acute GVHD. NiCord recipients also had significantly more time out of the hospital in the first 100 days post-transplantation after adjustment for age and Karnofsky Performance Status (69.9 days versus 49.7 days; P = .005). Overall, transplantation of NiCord was associated with faster neutrophil engraftment, fewer total and bacterial infections, and shorter hospitalization in the first 100 days compared with standard UCB transplantation. In conclusion, rapid hematopoietic recovery from an ex vivo expanded UCB transplantation approach is associated with early clinical benefit.
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Affiliation(s)
- Sarah Anand
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Samantha Thomas
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Janet Adcock
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Kelly Corbet
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Ashley K Morris
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina.
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Michelis FV, Gupta V, Zhang MJ, Wang HL, Aljurf M, Bacher U, Beitinjaneh A, Chen YB, DeFilipp Z, Gale RP, Kebriaei P, Kharfan-Dabaja M, Lazarus HM, Nishihori T, Olsson RF, Oran B, Rashidi A, Rizzieri DA, Tallman MS, de Lima M, Khoury HJ, Sandmaier BM, Weisdorf D, Saber W. Cytogenetic risk determines outcomes after allogeneic transplantation in older patients with acute myeloid leukemia in their second complete remission: A Center for International Blood and Marrow Transplant Research cohort analysis. Cancer 2017; 123:2035-2042. [PMID: 28117898 DOI: 10.1002/cncr.30567] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/06/2016] [Accepted: 12/19/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) offers curative potential to a number of older patients with acute myeloid leukemia (AML) in their first complete remission. However, there are limited data in the literature concerning post-HCT outcomes for older patients in their second complete remission (CR2). METHODS The purpose of the current study was to retrospectively investigate within the Center for International Blood and Marrow Transplant Research database parameters influencing posttransplant outcomes for patients 60 years of age or older undergoing HCT for AML in CR2. RESULTS In total, 196 patients from 78 centers were identified; the median age was 64 years (range, 60-78 years). Seventy-one percent had a Karnofsky performance status ≥ 90 at the time of HCT. Reduced-intensity conditioning regimens were used in 159 patients (81%). A univariate analysis demonstrated a 3-year overall survival (OS) rate of 42% (95% confidence interval [CI], 35%-49%), a leukemia-free survival rate of 37% (95% CI, 30%-44%), a cumulative incidence of nonrelapse mortality of 25% (95% CI, 19%-32%), and a cumulative incidence of relapse (CIR) of 38% (95% CI, 31%-45%). A multivariate analysis demonstrated that cytogenetic risk was the only independent risk factor for OS (P = .023) with a hazard ratio (HR) of 1.14 (95% CI, 0.59-2.19) for intermediate-risk cytogenetics and an HR of 2.32 (95% CI, 1.05-5.14) for unfavorable-risk cytogenetics. For CIR, cytogenetic risk was also the only independent prognostic factor (P = .01) with an HR of 1.10 (95% CI, 0.47-2.56) for intermediate-risk cytogenetics and an HR of 2.98 (95% CI, 1.11-8.00) for unfavorable-risk cytogenetics. CONCLUSIONS Allogeneic HCT is a curative treatment option for older patients with AML in CR2, particularly for those with favorable or intermediate cytogenetic risk. Cancer 2017;123:2035-2042. © 2017 American Cancer Society.
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Affiliation(s)
- Fotios V Michelis
- Allogeneic Blood and Marrow Transplant Program, Princes Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Vikas Gupta
- Allogeneic Blood and Marrow Transplant Program, Princes Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hai-Lin Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Ulrike Bacher
- Department of Hematology/Oncology, University Medicine Gottingen, Gottingen, Germany
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | | | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mohamed Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hillard M Lazarus
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Betul Oran
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Armin Rashidi
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | | | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington, Seattle, Washington
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel Weisdorf
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare myeloid malignancy with no defined standard of care. BPDCN presents most commonly with skin lesions with or without extramedullary organ involvement before leukemic dissemination. As a result of its clinical ambiguity, differentiating BPDCN from benign skin lesions or those of acute myeloid leukemia with leukemia cutis is challenging. BPDCN is most easily defined by the phenotype CD4+CD56+CD123+lineage-MPO-, although many patients will present with variable expression of CD4, CD56, or alternate plasmacytoid markers, which compounds the difficulty in differentiating BPDCN from other myeloid or lymphoid malignancies. Chromosomal aberrations are frequent, and the mutational landscape of BPDCN is being rapidly characterized although no obvious molecular target for chemoimmunotherapy has been identified. Chemotherapy regimens developed for acute myeloid leukemia, acute lymphoid leukemia, and myelodysplastic syndrome have all been used to treat BPDCN. Relapse is frequent, and overall survival is quite poor. Allogeneic transplantation offers a chance at prolonged remission and possible cure for those who are eligible; unfortunately, relapse remains high ranging from 30% to 40%. Novel therapies such as SL-401, a diphtheria toxin conjugated to interleukin-3 (IL-3) is commonly overexpressed in BPDCN and other aggressive myeloid malignancies and has shown considerable promise in ongoing clinical trials. Future work with SL-401 will define its place in treating relapsed or refractory disease as well as its role as a first-line therapy or bridge to transplantation.
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Sivaraj D, Green MM, Li Z, Sung AD, Sarantopoulos S, Kang Y, Long GD, Horwitz ME, Lopez RD, Sullivan KM, Rizzieri DA, Chao NJ, Gasparetto C. Outcomes of Maintenance Therapy with Bortezomib after Autologous Stem Cell Transplantation for Patients with Multiple Myeloma. Biol Blood Marrow Transplant 2016; 23:262-268. [PMID: 27856369 DOI: 10.1016/j.bbmt.2016.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/10/2016] [Indexed: 12/21/2022]
Abstract
Comprehensive recommendations for maintenance therapy after autologous stem cell transplantation (ASCT) for patients with multiple myeloma (MM) have yet to be defined. Bortezomib has been utilized as maintenance therapy after ASCT, but data attesting to the safety and efficacy of this agent compared with lenalidomide in the post-ASCT setting are limited. Therefore, we retrospectively analyzed the outcomes of 102 patients with MM who received maintenance therapy with bortezomib after ASCT at Duke University's adult bone marrow transplant clinic between 2005 and 2015. Maintenance with bortezomib was initiated between 60 and 90 days after ASCT as a single agent 1.3 mg/m2 once every 2 weeks (n = 92) or in combination with lenalidomide (10 mg/day) (n = 10). The median age at ASCT was 64 (range, 31 to 78). Of the 99 patients with molecular data available, 42% had high-risk cytogenetics (including d17p, t(4;14), +1q, and t(14;16) by fluorescein in situ hybridization). Overall, 46% of patients experienced side effects from maintenance therapy, with 31% of all patients experiencing peripheral neuropathy. In total, 2% of patients required discontinuation of bortezomib maintenance because of adverse events. No secondary malignancies were reported from the therapy. The median progression-free survival (PFS) for patients receiving maintenance therapy with bortezomib after ASCT was 36.5 months (95% confidence interval [CI], 21.3 to not available) and median overall survival was 72.7 months (95% CI, 63.9 to not available). The PFS of patients with high-risk cytogenetics was not statistically significantly different from those with standard-risk cytogenetics, suggesting that maintenance with bortezomib may help overcome the impact of high-risk cytogenetics on early progression. These results indicate that maintenance therapy with bortezomib represents a safe, well-tolerated, and efficacious option for patients with high-risk cytogenetics, renal insufficiency, an inability to tolerate lenalidomide, or a previous history of another cancer.
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Affiliation(s)
- Dharshan Sivaraj
- Division of Cellular Therapy, Duke University, Durham, North Carolina.
| | - Michael M Green
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Anthony D Sung
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | | | - Yubin Kang
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - Gwynn D Long
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | | | - Richard D Lopez
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - Keith M Sullivan
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - David A Rizzieri
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Division of Cellular Therapy, Duke University, Durham, North Carolina
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Stephens SJ, Thomas S, Rizzieri DA, Horwitz ME, Chao NJ, Engemann AM, Lassiter M, Kelsey CR. Myeloablative conditioning with total body irradiation for AML: Balancing survival and pulmonary toxicity. Adv Radiat Oncol 2016; 1:272-280. [PMID: 28740897 PMCID: PMC5514157 DOI: 10.1016/j.adro.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/06/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of this study was to compare leukemia-free survival (LFS) and other clinical outcomes in patients with acute myelogenous leukemia who underwent a myeloablative allogeneic stem cell transplant with and without total body irradiation (TBI). Methods and materials Adult patients with acute myelogenous leukemia undergoing myeloablative allogeneic stem cell transplant at Duke University Medical Center between 1995 and 2012 were included. The primary endpoint was LFS. Secondary outcomes included overall survival (OS), nonrelapse mortality, and the risk of pulmonary toxicity. Kaplan-Meier survival estimates and Cox proportional hazards multivariate analyses were performed. Results A total of 206 patients were evaluated: 90 received TBI-based conditioning regimens and 116 received chemotherapy alone. Median follow-up was 36 months. For all patients, 2-year LFS and OS were 36% (95% confidence interval [CI], 29-43) and 39% (95% CI, 32-46), respectively. After adjusting for known prognostic factors using a multivariate analysis, TBI was associated with improved LFS (hazard ratio: 0.63; 95% CI: 0.44-0.91) and OS (hazard ratio: 0.63; 95% CI, 0.43-0.91). There was no difference in nonrelapse mortality between cohorts, but pulmonary toxicity was significantly more common with TBI (2-year incidence 42% vs 12%, P < .001). High-grade pulmonary toxicity predominated with both conditioning strategies (70% and 93% of cases were grade 3-5 with TBI and chemotherapy alone, respectively). Conclusions TBI-based regimens were associated with superior LFS and OS but at the cost of increased pulmonary toxicity.
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Affiliation(s)
- Sarah J. Stephens
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Samantha Thomas
- Department of Biostatistics and Bioinformatics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - David A. Rizzieri
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E. Horwitz
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nelson J. Chao
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Ashley M. Engemann
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Martha Lassiter
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Chris R. Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
- Corresponding author: Duke University Medical Center, DUMC Box 3085, Durham, NC 27710Duke University Medical CenterDUMC Box 3085DurhamNC27710
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Zahid MF, Patnaik MM, Gangat N, Hashmi SK, Rizzieri DA. Insight into the molecular pathophysiology of myelodysplastic syndromes: targets for novel therapy. Eur J Haematol 2016; 97:313-20. [DOI: 10.1111/ejh.12771] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 01/07/2023]
Affiliation(s)
| | - Mrinal M. Patnaik
- Division of Hematology; Mayo Clinic; Rochester MN USA
- Mayo Clinic Transplant Center; Blood and Marrow Transplant Program; Mayo Clinic; Rochester MN USA
| | | | - Shahrukh K. Hashmi
- Division of Hematology; Mayo Clinic; Rochester MN USA
- Mayo Clinic Transplant Center; Blood and Marrow Transplant Program; Mayo Clinic; Rochester MN USA
| | - David A. Rizzieri
- Division of Hematologic Malignancies & Cellular Therapy; Duke University Medical Center; Durham NC USA
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50
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Shaffer BC, Ahn KW, Hu ZH, Nishihori T, Malone AK, Valcárcel D, Grunwald MR, Bacher U, Hamilton B, Kharfan-Dabaja MA, Saad A, Cutler C, Warlick E, Reshef R, Wirk BM, Sabloff M, Fasan O, Gerds A, Marks D, Olsson R, Wood WA, Costa LJ, Miller AM, Cortes J, Daly A, Kindwall-Keller TL, Kamble R, Rizzieri DA, Cahn JY, Gale RP, William B, Litzow M, Wiernik PH, Liesveld J, Savani BN, Vij R, Ustun C, Copelan E, Popat U, Kalaycio M, Maziarz R, Alyea E, Sobecks R, Pavletic S, Tallman M, Saber W. Scoring System Prognostic of Outcome in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome. J Clin Oncol 2016; 34:1864-71. [PMID: 27044940 DOI: 10.1200/jco.2015.65.0515] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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
PURPOSE To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). PATIENTS AND METHODS We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. RESULTS Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 × 10(9)/L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high (≥ 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P < .001). Increasing score was predictive of increased relapse (P < .001) and treatment-related mortality (P < .001) in the HLA-matched set and relapse (P < .001) in the HLA-mismatched cohort. CONCLUSION The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS.
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Affiliation(s)
- Brian C Shaffer
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Kwang Woo Ahn
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Zhen-Huan Hu
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Taiga Nishihori
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Adriana K Malone
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - David Valcárcel
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Michael R Grunwald
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ulrike Bacher
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Betty Hamilton
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Mohamed A Kharfan-Dabaja
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ayman Saad
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Corey Cutler
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Erica Warlick
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ran Reshef
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Baldeep Mona Wirk
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Mitchell Sabloff
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Omotayo Fasan
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Aaron Gerds
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - David Marks
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Richard Olsson
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - William Allen Wood
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Luciano J Costa
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Alan M Miller
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Jorge Cortes
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Andrew Daly
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Tamila L Kindwall-Keller
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Rammurti Kamble
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - David A Rizzieri
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Jean-Yves Cahn
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Robert Peter Gale
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Basem William
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Mark Litzow
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Peter H Wiernik
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Jane Liesveld
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Bipin N Savani
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ravi Vij
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Celalettin Ustun
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Edward Copelan
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Uday Popat
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Matt Kalaycio
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Richard Maziarz
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Edwin Alyea
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Ron Sobecks
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Steven Pavletic
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Martin Tallman
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
| | - Wael Saber
- Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
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