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Meade MG, Bolaños-Meade J. The history of haploidentical stem cell transplantation: a trip from the bench to the bedside. Hematology 2024; 29:2346401. [PMID: 38687632 DOI: 10.1080/16078454.2024.2346401] [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: 03/26/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
Allogeneic bone marrow transplantation is a curative intervention for both neoplastic and non-malignant conditions. However, not all patients have an HLA-matched donor. Therefore, the development of an approach that expand the donor pool was of paramount relevance. The development of post-transplantation cyclophosphamide as graft versus host disease prophylaxis allows the safe use of haploidentical donors, solving the donor availability problem to the vast majority of patients in need. The present paper reviews the history of the development of haploidentical transplantation at Johns Hopkins University, from the bench to the bedside.
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Affiliation(s)
| | - Javier Bolaños-Meade
- Professor of Oncology, Johns Hopkins University School of Medicine, Clinical Director, BMT Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
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Klausner M, Phan B, Morsberger L, Parish R, Shane A, Park R, Gocke CD, Xian RR, Jones RJ, Bolaños-Meade J, Gondek LP, Phan M, Zou YS. Donor cell-derived genetic abnormalities after sex mismatched allogeneic cell transplantation: a unique challenge of donor cell leukemia. Blood Cancer J 2023; 13:163. [PMID: 37926709 PMCID: PMC10625970 DOI: 10.1038/s41408-023-00938-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Melanie Klausner
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian Phan
- The College of William and Mary, Williamsburg, VA, USA
| | - Laura Morsberger
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Parish
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison Shane
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Park
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher D Gocke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rena R Xian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rick John Jones
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Bolaños-Meade
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lukasz P Gondek
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Phan
- The Johns Hopkins University, Baltimore, MD, USA
| | - Ying S Zou
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Gooptu M, Bolaños-Meade J, Koreth J. Expanding post-transplant cyclophosphamide to matched unrelated donor transplants and beyond. Blood Rev 2023; 62:101053. [PMID: 36822991 DOI: 10.1016/j.blre.2023.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Mahasweta Gooptu
- Adult Stem-Cell Transplantation, Dana-Farber Cancer Institute, Harvard Medical School, 44 Binney Street, Boston 02215, USA
| | - Javier Bolaños-Meade
- Blood and Marrow Transplant Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N Broadway, Baltimore MD 21231, USA
| | - John Koreth
- Adult Stem-Cell Transplantation, Dana-Farber Cancer Institute, Harvard Medical School, 44 Binney Street, Boston 02215, USA.
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DeZern AE, Zahurak M, Symons HJ, Cooke KR, Huff CA, Jain T, Swinnen LJ, Imus PH, Wagner-Johnston ND, Ambinder RF, Levis M, Luznik L, Bolaños-Meade J, Fuchs EJ, Jones RJ, Brodsky RA. Alternative donor BMT with posttransplant cyclophosphamide as initial therapy for acquired severe aplastic anemia. Blood 2023; 141:3031-3038. [PMID: 37084383 DOI: 10.1182/blood.2023020435] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/23/2023] Open
Abstract
Severe aplastic anemia (SAA) is a marrow failure disorder with high morbidity and mortality. It is treated with bone marrow transplantation (BMT) for those with fully matched donors, or immunosuppressive therapy (IST) for those who lack such a donor, which is often the case for underrepresented minorities. We conducted a prospective phase 2 trial of reduced-intensity conditioning HLA-haploidentical BMT and posttransplantation cyclophosphamide (PTCy)-based graft-versus-host (GVHD) prophylaxis as initial therapy for patients with SAA. The median patient age was 25 years (range, 3-63 years), and the median follow-up time was 40.9 months (95% confidence interval [CI], 29.4-55.7). More than 35% of enrollment was from underrepresented racial/ethnic groups. The cumulative incidence of grade 2 or 4 acute GVHD on day 100 was 7% (95% CI, not applicable [NA]-17), and chronic GVHD at 2 years was 4% (95% CI, NA-11). The overall survival of 27 patients was 92% (95% CI, 83-100) at 1, 2, and 3 years. The first 7 patients received lower dose total body irradiation (200 vs 400 cGy), but these patients were more likely to have graft failure (3 of 7) compared with 0 of 20 patients in the higher dose group (P = .01; Fisher exact test). HLA-haploidentical BMT with PTCy using 400 cGy total body irradiation resulted in 100% overall survival with minimal GVHD in 20 consecutive patients. Not only does this approach avoid any adverse ramifications of IST and its low failure-free survival, but the use of haploidentical donors also expands access to BMT across all populations. This trial was registered at www.clinicaltrials.gov as NCT02833805.
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Affiliation(s)
- Amy E DeZern
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Marianna Zahurak
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Oncology Biostatistics, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Heather J Symons
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Kenneth R Cooke
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Carol Ann Huff
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Tania Jain
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Lode J Swinnen
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Philip H Imus
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Nina D Wagner-Johnston
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Richard F Ambinder
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Mark Levis
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Leo Luznik
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Javier Bolaños-Meade
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Ephraim J Fuchs
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Richard J Jones
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Robert A Brodsky
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Bolaños-Meade J, Hamadani M, Wu J, Al Malki MM, Martens MJ, Runaas L, Elmariah H, Rezvani AR, Gooptu M, Larkin KT, Shaffer BC, El Jurdi N, Loren AW, Solh M, Hall AC, Alousi AM, Jamy OH, Perales MA, Yao JM, Applegate K, Bhatt AS, Kean LS, Efebera YA, Reshef R, Clark W, DiFronzo NL, Leifer E, Horowitz MM, Jones RJ, Holtan SG. Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis. N Engl J Med 2023; 388:2338-2348. [PMID: 37342922 PMCID: PMC10575613 DOI: 10.1056/nejmoa2215943] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND In patients undergoing allogeneic hematopoietic stem-cell transplantation (HSCT), a calcineurin inhibitor plus methotrexate has been a standard prophylaxis against graft-versus-host disease (GVHD). A phase 2 study indicated the potential superiority of a post-transplantation regimen of cyclophosphamide, tacrolimus, and mycophenolate mofetil. METHODS In a phase 3 trial, we randomly assigned adults with hematologic cancers in a 1:1 ratio to receive cyclophosphamide-tacrolimus-mycophenolate mofetil (experimental prophylaxis) or tacrolimus-methotrexate (standard prophylaxis). The patients underwent HSCT from an HLA-matched related donor or a matched or 7/8 mismatched (i.e., mismatched at only one of the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci) unrelated donor, after reduced-intensity conditioning. The primary end point was GVHD-free, relapse-free survival at 1 year, assessed in a time-to-event analysis, with events defined as grade III or IV acute GVHD, chronic GVHD warranting systemic immunosuppression, disease relapse or progression, and death from any cause. RESULTS In a multivariate Cox regression analysis, GVHD-free, relapse-free survival was significantly more common among the 214 patients in the experimental-prophylaxis group than among the 217 patients in the standard-prophylaxis group (hazard ratio for grade III or IV acute GVHD, chronic GVHD, disease relapse or progression, or death, 0.64; 95% confidence interval [CI], 0.49 to 0.83; P = 0.001). At 1 year, the adjusted GVHD-free, relapse-free survival was 52.7% (95% CI, 45.8 to 59.2) with experimental prophylaxis and 34.9% (95% CI, 28.6 to 41.3) with standard prophylaxis. Patients in the experimental-prophylaxis group appeared to have less severe acute or chronic GVHD and a higher incidence of immunosuppression-free survival at 1 year. Overall and disease-free survival, relapse, transplantation-related death, and engraftment did not differ substantially between the groups. CONCLUSIONS Among patients undergoing allogeneic HLA-matched HSCT with reduced-intensity conditioning, GVHD-free, relapse-free survival at 1 year was significantly more common among those who received cyclophosphamide-tacrolimus-mycophenolate mofetil than among those who received tacrolimus-methotrexate. (Funded by the National Heart, Lung, and Blood Institute and others; BMT CTN 1703 ClinicalTrials.gov number, NCT03959241.).
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Affiliation(s)
- Javier Bolaños-Meade
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Mehdi Hamadani
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Juan Wu
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Monzr M Al Malki
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Michael J Martens
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Lyndsey Runaas
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Hany Elmariah
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Andrew R Rezvani
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Mahasweta Gooptu
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Karilyn T Larkin
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Brian C Shaffer
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Najla El Jurdi
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Alison W Loren
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Melhem Solh
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Aric C Hall
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Amin M Alousi
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Omer H Jamy
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Miguel-Angel Perales
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Janny M Yao
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Kristy Applegate
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Ami S Bhatt
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Leslie S Kean
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Yvonne A Efebera
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Ran Reshef
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - William Clark
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Nancy L DiFronzo
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Eric Leifer
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Mary M Horowitz
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Richard J Jones
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
| | - Shernan G Holtan
- From the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, and the Department of Oncology, Johns Hopkins University School of Medicine, Baltimore (J.B.-M., R.J.J.), Emmes, Rockville (J.W., K.A.), and the Division of Blood Diseases and Resources (N.L.D.) and the Office of Biostatistics Research (E.L.), National Heart, Lung, and Blood Institute, Bethesda - all in Maryland; the Blood and Marrow Transplant Program and Cellular Therapy Program (M.H.) and the Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine (M.H., M.M.H.), the CIBMTR Division of Biostatistics, Institute for Health and Equity (M.J.M.), and the Division of Hematology and Oncology, Department of Medicine (L.R.), Medical College of Wisconsin, Milwaukee, and the Division of Hematology and Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (A.C.H.) - both in Wisconsin; the Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford (A.R.R.), the Department of Hematology and Hematopoietic Cell Transplantation, City of Hope (M.M.A.M.), and the Department of Pharmacy, City of Hope National Medical Center (J.M.Y.), Duarte, and the Division of Hematology, Departments of Medicine and Genetics, Stanford University, Palo Alto (A.S.B.) - all in California; the Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer and Research Institute, Tampa, FL (H.E.); the Department of Hematology and Oncology, Dana-Farber Cancer Institute (M.G., L.S.K.), and the Department of Pediatrics, Harvard Medical School, and the Division of Pediatric Hematology and Oncology, Boston Children's Hospital (L.S.K.) - all in Boston; the Ohio State University Comprehensive Cancer Center, Columbus (K.T.L., Y.A.E.); Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (B.C.S., M.-A.P.), and the Blood and Marrow Transplantation Program, Columbia University Irving Medical Center (R.R.) - all in New York; the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (N.E.J., S.G.H.); the Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.W.L.); the Blood and Marrow Transplant Program at Northside Hospital, Atlanta (M.S.); the Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M.D. Anderson Cancer Center, Houston (A.M.A.); the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham (O.H.J.); and the Division of Hematology-Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond (W.C.)
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6
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Sterling CH, Hughes MS, Tsai HL, Yarkony K, Fuchs EJ, Swinnen LJ, Paul S, Bolaños-Meade J, Luznik L, Imus PH, Ali SA, Jain T, Ambinder A, DeZern A, Huff CA, Gocke CB, Varadhan R, Wagner-Johnston N, Jones RJ, Ambinder RF. Allogeneic Blood or Marrow Transplantation with Post-Transplantation Cyclophosphamide for Peripheral T Cell Lymphoma: The Importance of Graft Source. Transplant Cell Ther 2023; 29:267.e1-267.e5. [PMID: 36549386 PMCID: PMC10040425 DOI: 10.1016/j.jtct.2022.12.009] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
The use of post-transplantation cyclophosphamide (PTCy) for graft-versus host-disease (GVHD) prophylaxis has revolutionized allogeneic blood or marrow transplantation (alloBMT), but there is limited published experience in peripheral T cell lymphoma (PTCL). We sought to assess outcomes in patients with PTCL who underwent alloBMT with PTCy. We reviewed the charts of all adult patients age ≥18 years who underwent alloBMT with nonmyeloablative conditioning and PTCy-based GVHD prophylaxis at the Sidney Kimmel Comprehensive Cancer Center between January 2004 and December 2020. Sixty-five patients were identified. The median age was 59 years (range, 24 to 75 years). Lymphoma histology included PTCL not otherwise specified (n = 24), anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (n = 14), angioimmunoblastic T cell lymphoma (n = 7), enteropathy-associated T cell lymphoma (n = 6), hepatosplenic T cell lymphoma (n = 4), and others (n = 10). Eleven patients were in first complete remission (17%); the remaining patients were in first partial remission or underwent salvage therapy to at least PR prior to transplantation. Forty-eight patients underwent alloBMT from a haploidentical related donor (74%), 10 from a fully matched donor (15%), and 7 from a mismatched unrelated donor (11%). All patients received fludarabine, cyclophosphamide, and total body irradiation (TBI). The graft source was bone marrow (BM) in 46 patients (71%) and peripheral blood (PB) in 19 patients (29%); all patients in the BM cohort received 200 cGy TBI, and most patients in the PB cohort (15 of 19) received 400 cGy TBI. GVHD prophylaxis comprised PTCy, mycophenolate mofetil, and a calcineurin inhibitor or sirolimus. With a median follow-up of 2.8 years (range, 290 days to 14.2 years), the 2-year progression-free survival (PFS) for the entire cohort was 49% (95% confidence interval [CI], 38% to 64%), and the 2-year overall survival (OS) was 55% (95% CI, 44% to 69%). Outcomes were significantly improved in those receiving PB compared to those receiving BM, including a 2-year PFS of 79% (95% CI 63% to 100%) versus 39% (95% CI, 27% to 56%), 2-year OS of 84% (95% CI, 69% to 100%) versus 46% (95% CI, 33% to 63%), and 1-year cumulative incidence of relapse of 5% (95% CI, 0 to 16%) versus 33% (95% CI, 19% to 46%), with no difference in GVHD and nonrelapse mortality. AlloBMT with PTCy is safe and well-tolerated in patients with PTCL. Our data suggest that increasing the TBI dose to 400 cGy and using PB allografts may offer improved disease control and better survival outcomes, though additional studies are needed to confirm these findings.
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Affiliation(s)
- Cole H Sterling
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Michael S Hughes
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hua-Ling Tsai
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathryn Yarkony
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ephraim J Fuchs
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Suman Paul
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Philip H Imus
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed Abbas Ali
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tania Jain
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Ambinder
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy DeZern
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carol Ann Huff
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian B Gocke
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravi Varadhan
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nina Wagner-Johnston
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard F Ambinder
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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7
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Shaw BE, Jimenez-Jimenez AM, Burns LJ, Logan BR, Khimani F, Shaffer BC, Shah NN, Mussetter A, Tang XY, McCarty JM, Alavi A, Farhadfar N, Jamieson K, Hardy NM, Choe H, Ambinder RF, Anasetti C, Perales MA, Spellman SR, Howard A, Komanduri KV, Luznik L, Norkin M, Pidala JA, Ratanatharathorn V, Confer DL, Devine SM, Horowitz MM, Bolaños-Meade J. Three-Year Outcomes in Recipients of Mismatched Unrelated Bone Marrow Donor Transplants Using Post-Transplantation Cyclophosphamide: Follow-Up from a National Marrow Donor Program-Sponsored Prospective Clinical Trial. Transplant Cell Ther 2023; 29:208.e1-208.e6. [PMID: 36584941 PMCID: PMC9992261 DOI: 10.1016/j.jtct.2022.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
The use of post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis has resulted in reductions in GVHD and improved outcomes in allogeneic hematopoietic cell transplantation (HCT) using HLA-mismatched related donors. We report the 3-year outcomes of the first multicenter prospective clinical trial using PTCy in the setting of mismatched unrelated donor (MMUD) bone marrow HCT. The study enrolled 80 patients, treated with either myeloablative conditioning (MAC; n = 40) or reduced-intensity conditioning (RIC; n = 40), with the primary endpoint of 1-year overall survival (OS). The median follow-up for this study was 34 months (range, 12 to 46 months) in the RIC group and 36 months (range, 18 to 49 months) in the MAC group. Three-year OS and nonrelapse mortality were 70% and 15%, respectively, in the RIC group and 62% and 10% in the MAC group. No GVHD was reported after 1 year. The incidence of relapse was 29% in the RIC group and 51% in the MAC group. OS did not differ based on HLA match grade (63% in the 7/8 strata and 71% in the 4 to 6/8 strata). These encouraging outcomes, which were sustained for 3 years post-HCT, support the continued exploration of MMUD HCT using a PTCy platform. Important future areas to address include relapse reduction and furthering our understanding of optimal donor selection based on HLA and non-HLA factors.
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Affiliation(s)
- Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | | | - Linda J Burns
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Farhad Khimani
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Brian C Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nirav N Shah
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alisha Mussetter
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Xiao-Ying Tang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John M McCarty
- Cellular Immunotherapies and Transplant Program, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Asif Alavi
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Katarzyna Jamieson
- University of North Carolina Hospitals-Chapel Hill, Chapel Hill, North Carolina
| | - Nancy M Hardy
- Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Hannah Choe
- Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Richard F Ambinder
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Claudio Anasetti
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Alan Howard
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Krishna V Komanduri
- Division of Hematology and Oncology, UCSF Health and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Leo Luznik
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Maxim Norkin
- Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Joseph A Pidala
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Steven M Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
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8
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Saad A, Loren A, Bolaños-Meade J, Chen G, Couriel D, Di Stasi A, El-Jawahri A, Elmariah H, Farag S, Gundabolu K, Gutman J, Ho V, Hoeg R, Horwitz M, Hsu J, Kassim A, Kharfan Dabaja M, Magenau J, Martin T, Mielcarek M, Moreira J, Nakamura R, Nieto Y, Ninos C, Oliai C, Patel S, Randolph B, Schroeder M, Tzachanis D, Varshavsky-Yanovsky AN, Vusirikala M, Algieri F, Pluchino LA. NCCN Guidelines® Insights: Hematopoietic Cell Transplantation, Version 3.2022. J Natl Compr Canc Netw 2023; 21:108-115. [PMID: 36791762 DOI: 10.6004/jnccn.2023.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The NCCN Guidelines for Hematopoietic Cell Transplantation (HCT) provide an evidence- and consensus-based approach for the use of autologous and allogeneic HCT in the management of malignant diseases in adult patients. HCT is a potentially curative treatment option for patients with certain types of malignancies; however, recurrent malignancy and transplant-related complications often limit the long-term survival of HCT recipients. The purpose of these guidelines is to provide guidance regarding aspects of HCT, including pretransplant recipient evaluation, hematopoietic cell mobilization, and treatment of graft-versus-host disease-a major complication of allogeneic HCT-to enable the patient and clinician to assess management options in the context of an individual patient's condition. These NCCN Guidelines Insights provide a summary of the important recent updates to the NCCN Guidelines for HCT, including the incorporation of a newly developed section on the Principles of Conditioning for HCT.
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Affiliation(s)
- Ayman Saad
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Alison Loren
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | | | | | - Sherif Farag
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | | | - Vincent Ho
- Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | | | | | - Thomas Martin
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Jonathan Moreira
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Yago Nieto
- The University of Texas MD Anderson Cancer Center
| | | | | | - Seema Patel
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Brion Randolph
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Mark Schroeder
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
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9
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Hughes MS, Sterling CH, Varadhan R, Ambinder RF, Jones RJ, Sweren RJ, Rozati S, Bolaños-Meade J, Luznik L, Imus PH, Ali SA, Borrello IM, Huff CA, Jain T, Ambinder A, DeZern AE, Gocke CB, Gladstone DE, Swinnen LJ, Wagner-Johnston ND, Fuchs EJ. Mismatched donor transplantation with post-transplantation cyclophosphamide for advanced cutaneous T-cell lymphoma: a single-center retrospective study. Leuk Lymphoma 2022; 63:2987-2991. [PMID: 35915978 DOI: 10.1080/10428194.2022.2105330] [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: 01/11/2023]
Affiliation(s)
- Michael S Hughes
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cole H Sterling
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ravi Varadhan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard F Ambinder
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronald J Sweren
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sima Rozati
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philip H Imus
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Syed Abbas Ali
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan M Borrello
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol Ann Huff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tania Jain
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander Ambinder
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy E DeZern
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian B Gocke
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas E Gladstone
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lode J Swinnen
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nina D Wagner-Johnston
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Porter TJ, Lazarevic A, Ziggas JE, Fuchs E, Kim K, Byrnes H, Luznik L, Bolaños-Meade J, Ali SA, Shah NN, Wagner-Johnston N, Jain T. Hyperinflammatory syndrome resembling haemophagocytic lymphohistiocytosis following axicabtagene ciloleucel and brexucabtagene autoleucel. Br J Haematol 2022; 199:720-727. [PMID: 36111395 PMCID: PMC10661175 DOI: 10.1111/bjh.18454] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
Haemophagocytic lymphohistiocytosis-like toxicity following chimeric antigen receptor T cells (CAR-HLH) is being increasingly recognized, while published data are limited and criteria for recognition are elusive. We describe three patients who developed CAR-HLH after infusion of brexucabtagene autoleucel (n = 2) or axicabtagene ciloleucel (n = 1). All three patients presented following cytokine release syndrome, with fever, recurrent or worsening cytopenias, hyperferritinaemia, elevated soluble interleukin (IL)-2 receptor, hypofibrinogenaemia, hypertriglyceridaemia, elevated liver transaminases, and decreasing C-reactive protein and IL-6. Clinical improvement following treatment with anakinra (n = 2) and ruxolitinib (n = 1) was observed. Our report offers an opportunity for prompt recognition and initiation of potentially life-saving treatment for CAR-HLH.
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Affiliation(s)
- Timothy J. Porter
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ana Lazarevic
- Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jamie E. Ziggas
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ephraim Fuchs
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kiryoung Kim
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Helen Byrnes
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leo Luznik
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Javier Bolaños-Meade
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Syed Abbas Ali
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nirali N. Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Nina Wagner-Johnston
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
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11
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Ambinder A, Smith M, Tsai HL, Varadhan R, DeZern A, Dalton W, Gocke C, Webster J, Gondek L, Gojo I, Ali SA, Huff CA, Swinnen L, Wagner-Johnston N, Showel M, Prince G, Borrello I, Bolaños-Meade J, Luznik L, Jain T, Imus P, Fuchs E, Ambinder R, Gladstone DE, Levis M, Jones R, Ghiaur G, Smith BD. Nonmyeloablative Allogeneic Transplantation With Post-Transplant Cyclophosphamide for Acute Myeloid Leukemia With IDH Mutations: A Single Center Experience. Clin Lymphoma Myeloma Leuk 2022; 22:260-269. [PMID: 34750086 DOI: 10.1016/j.clml.2021.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Mutations in the IDH1 or IDH2 genes are detected in approximately 20% of cases of acute myeloid leukemia (AML). Few studies have examined the impact of IDH mutations in AML on allogeneic bone marrow transplant (alloBMT) outcomes. PATIENTS AND METHODS In this single center study, alloBMT outcomes for 61 patients with IDH-mutated (mIDH) AML were compared to those for 146 patients with IDH-wildtype (wtIDH) AML. RESULTS Patients with mIDH AML had a 2-year overall survival (OS) of 85% (95% CI 76%-95%), 2-year relapse free survival (RFS) of 71% (95% CI 59%-85%), 1-year cumulative incidence of relapse (CIR) of 14% (95% CI 5%-23%) and a 1-year cumulative incidence of transplant related mortality (CITRM) of 3% (95% CI 0%-8%). Patients with wtIDH had a 2-year OS of 61% (95% CI 53%-70%), 2-year RFS of 58% (95% CI 50%-67%), 1-year CIR of 27% (95% CI 20%-35%), and a 1-year CITRM of 9% (95% CI 5%-14%). In a univariate analysis cox-proportional hazard model, mIDH was associated with significantly better OS (HR 0.52, 95% CI 0.29-0.96) and a trend toward better RFS (HR 0.60, 95% CI 0.35-1.01). After controlling for donor age, diagnosis, and ELN risk category, mIDH was associated with a nonsignificantly improved OS (HR 0.54, 95% CI 0.29-1.01) and RFS (HR 0.67, 95% CI 0.39-1.15). CONCLUSION Among patients with mIDH AML, patients who received a peritransplant IDH inhibitor had improved OS (P = .03) compared to those who did not, but there was no detectable difference for RFS (P = .29).
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Affiliation(s)
- Alexander Ambinder
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Matthew Smith
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hua-Ling Tsai
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ravi Varadhan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amy DeZern
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William Dalton
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian Gocke
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan Webster
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lukasz Gondek
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ivana Gojo
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Syed Abbas Ali
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carol Ann Huff
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lode Swinnen
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nina Wagner-Johnston
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Margaret Showel
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gabrielle Prince
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ivan Borrello
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Javier Bolaños-Meade
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leo Luznik
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tania Jain
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Philip Imus
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ephraim Fuchs
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard Ambinder
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Douglas E Gladstone
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark Levis
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard Jones
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gabriel Ghiaur
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - B Douglas Smith
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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12
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Rappazzo KC, Zahurak M, Bettinotti M, Ali SA, Ambinder AJ, Bolaños-Meade J, Borrello I, Dezern AE, Gladstone D, Gocke C, Fuchs E, Huff CA, Imus PH, Jain T, Luznik L, Rahmat L, Swinnen LJ, Wagner-Johnston N, Jones RJ, Ambinder RF. Nonmyeloablative, HLA-Mismatched Unrelated Peripheral Blood Transplantation with High-Dose Post-Transplantation Cyclophosphamide. Transplant Cell Ther 2021; 27:909.e1-909.e6. [PMID: 34425261 PMCID: PMC8717359 DOI: 10.1016/j.jtct.2021.08.013] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
High-dose post-transplantation cyclophosphamide (PTCy) is an effective platform for prevention of severe graft-versus-host disease (GVHD) after allogeneic bone marrow (BM) transplantation with mismatched unrelated donors (mMUDs). Previous studies evaluating PTCy with mMUDs favored BM allografts over peripheral blood stem cell transplantation (PBSCT) due to concerns that PBSCT may be associated with an increased risk of acute and chronic GVHD. In addition, haploidentical PBSCT is associated with high rates of cytokine release syndrome (CRS), which is another concern with mMUD PBSCT. This study was conducted to determine the feasibility and safety of using mMUD PBSCT with PTCy as GVHD prophylaxis. Patients who received mMUD PBSCT using a PTCy-based GVHD prophylaxis at Johns Hopkins Hospital as part of a prospective clinical trial of mMUD and non-first-degree relative haploidentical transplantation with PTCy (ClinicalTrials.gov identifier NCT01203722) were included. All patients underwent T cell-replete PBSCT between November 2012 and August 2020. Statistical analyses were performed using the Kaplan-Meier method and proportional subdistribution hazard regression model for competing risks. The 29 patients in the study had a median age of 54 years, with 10 patients (34%) age ≥60 years. Nineteen grafts (66%) were matched for 9/10 HLA loci, 6 (21%) were match for 8/10, and 4 (14%) were matched for 7/10. No primary or secondary graft failure occurred. The median time to neutrophil recovery (≥500/µL) was 17 days, and that to platelet recovery (≥20,000/µL) was 28 days. Full donor chimerism was achieved in all patients by day +60. The cumulative incidence (CuI) of grade II-IV acute GVHD at 180 days was 15% (90% confidence interval [CI], 3% to 26%). There were no cases of severe chronic GVHD, 3 cases of mild chronic GVHD, and 1 case of moderate chronic GVHD. The CuI of nonrelapse mortality (NRM) was 7% (90% CI, NA to 18%) at 1 year. Eighteen patients (62%) experienced mild CRS (grade 1-2), and 1 patient (3%) experienced severe CRS (grade 3-5). At 1 year, the CuI of relapse was 29% (90% CI, 8% to 50%), overall survival was 93% (90% CI, 85% to 100%), progression-free survival was 64% (90% CI, 46% to 88%), GVHD-free relapse-free survival was 41% (90% CI, 23% to 73%), and chronic GVHD-free relapse-free survival was 64% (90% CI, 46% to 88%). Our data indicate that mMUD PBSCT using PTCy-based GVHD prophylaxis is safe and feasible. All patients engrafted, and rates of NRM (7%) and acute GVHD (15%) at 1 year were low. There was only 1 case (3%) of severe CRS. Compared with previously published outcomes, mMUD PBSCT using PTCy-based GVHD prophylaxis has a safety and efficacy profile that may not be different from that of PBSCT from matched donors. These results further solidify that all patients who require blood or BM transplantation should be able to find an acceptable donor.
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Affiliation(s)
- Katherine C Rappazzo
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Marianna Zahurak
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Maria Bettinotti
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Syed Abbas Ali
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Alex J Ambinder
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Ivan Borrello
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Amy E Dezern
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Doug Gladstone
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Christian Gocke
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Ephraim Fuchs
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Carol Ann Huff
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Philip H Imus
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Tania Jain
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Leena Rahmat
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Lode J Swinnen
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Nina Wagner-Johnston
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland
| | - Richard F Ambinder
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital University School of Medicine, Baltimore, Maryland.
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13
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Abu Al Hamayel N, Waldfogel JM, Hannum SM, Brodsky RA, Bolaños-Meade J, Gamper CJ, Jones RJ, Dy SM. Pain Experiences of Adults With Sickle Cell Disease and Hematopoietic Stem Cell Transplantation: A Qualitative Study. Pain Med 2021; 22:1753-1759. [PMID: 33674866 DOI: 10.1093/pm/pnaa464] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Despite increasing use of hematopoietic stem cell transplantation (HSCT) for adults with sickle cell disease (SCD), little is known about pain management experiences throughout this process. The objective of this study was to explore patients' experiences with pain and pain management during and after HSCT for SCD. METHODS We conducted a qualitative interview study with 10 patients who underwent HSCT for SCD. We transcribed interviews verbatim and inductively identified codes. We used thematic analysis alongside a constant comparative method to develop and refine a codebook that aided in the identification of themes. RESULTS Four key themes emerged. (1) The pain trajectory: patients described a fluctuating course of pain during HSCT, which often extended long afterwards and impacted all aspects of life, particularly affected by pre-HSCT experiences; (2) The role of opioids-a double-edged sword: patients described opioids as reducing pain but insufficiently to balance significant adverse effects and burden; (3) Patient-centered decision making in pain management: patients described insufficient agency in decisions about opioid use and weaning; and (4) Consequences of health-related stigma: patients described experiences with stigma, mainly related to opioid use and weaning, as similar to pre-HSCT. CONCLUSIONS From the perspective of patients who have undergone HSCT for SCD, clinicians should use a patient-centered approach, integrating non-opioid approaches into pain management, particularly psychosocial support. As transplant for SCD becomes increasingly available, incorporating patient perspectives may improve health care delivery and overall patient experiences.
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Affiliation(s)
- Nebras Abu Al Hamayel
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Medical Education, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Julie M Waldfogel
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert A Brodsky
- Hematologic Malignancies and Bone Marrow Transplantation Program, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Javier Bolaños-Meade
- Hematologic Malignancies and Bone Marrow Transplantation Program, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher J Gamper
- Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and Johns Hopkins University School of Medicine
| | - Richard J Jones
- Hematologic Malignancies and Bone Marrow Transplantation Program, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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14
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Lazaryan A, Dolan M, Zhang MJ, Wang HL, Kharfan-Dabaja MA, Marks DI, Bejanyan N, Copelan E, Majhail NS, Waller EK, Chao N, Prestidge T, Nishihori T, Kebriaei P, Inamoto Y, Hamilton B, Hashmi SK, Kamble RT, Bacher U, Hildebrandt GC, Stiff PJ, McGuirk J, Aldoss I, Beitinjaneh AM, Muffly L, Vij R, Olsson RF, Byrne M, Schultz KR, Aljurf M, Seftel M, Savoie ML, Savani BN, Verdonck LF, Cairo MS, Hossain N, Bhatt VR, Frangoul HA, Abdel-Azim H, Al Malki M, Munker R, Rizzieri D, Khera N, Nakamura R, Ringdén O, Van der Poel M, Murthy HS, Liu H, Mori S, De Oliveira S, Bolaños-Meade J, Elsawy M, Barba P, Nathan S, George B, Pawarode A, Grunwald M, Agrawal V, Wang Y, Assal A, Caro PC, Kuwatsuka Y, Seo S, Ustun C, Politikos I, Lazarus HM, Saber W, Sandmaier BM, De Lima M, Litzow M, Bachanova V, Weisdorf D. Impact of cytogenetic abnormalities on outcomes of adult Philadelphia-negative acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: a study by the Acute Leukemia Working Committee of the Center for International Blood and Marrow Transplant Research. Haematologica 2021; 106:2295-2296. [PMID: 34333962 PMCID: PMC8327734 DOI: 10.3324/haematol.2021.279046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Michelle Dolan
- University of Minnesota Medical Center, Minneapolis, MN, 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
| | - Hai-Lin Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Edward Copelan
- Levine Cancer Institute, Atrium Health, Carolinas HealthCare System, Charlotte, NC, USA
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Nelson Chao
- Division of Cell Therapy and Hematology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Betty Hamilton
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, MN, USA; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, Switzerland
| | | | | | | | - Ibrahim Aldoss
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, 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, British Columbia, Canada
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, the Netherlands
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Nasheed Hossain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Monzr Al Malki
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Reinhold Munker
- Section of Hematology/Oncology, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Olle Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm Sweden
| | | | | | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | - Shahram Mori
- Blood and Marrow Transplant Center, Florida Hospital Medical Group, Orlando, FL, USA
| | | | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Mahmoud Elsawy
- QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pere Barba
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Vaibhav Agrawal
- Division of Hematology- Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Youjin Wang
- National Cancer Institute (NCI), Rockville, MD, USA
| | - Amer Assal
- New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Celalettin Ustun
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, IL, USA
| | | | | | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 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
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA; CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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15
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Sterling CH, Tsai HL, Holdhoff M, Bolaños-Meade J, Luznik L, Fuchs EJ, Huff CA, Gocke CB, Ali SA, Borrello IM, Varadhan R, Jones RJ, Gladstone DE, Ambinder RF, Wagner-Johnston N, Swinnen LJ, Imus PH. Allogeneic Blood or Marrow Transplantation with Nonmyeloablative Conditioning and High-Dose Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis for Secondary Central Nervous System Lymphoma. Transplant Cell Ther 2021; 27:863.e1-863.e5. [PMID: 34293518 DOI: 10.1016/j.jtct.2021.07.015] [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: 03/18/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Secondary central nervous system (CNS) lymphoma is a rare and often fatal complication of non-Hodgkin lymphoma (NHL). Treatment options include radiation therapy, high-dose systemic chemotherapy, intrathecal chemotherapy, and high-dose chemotherapy with autologous stem cell rescue, but outcomes remain poor. Allogeneic blood or marrow transplantation (alloBMT) is widely used in patients with relapsed/refractory systemic NHL. We sought to understand whether a graft-versus-lymphoma effect could maintain remission in CNS disease. We reviewed outcomes in 20 consecutive patients with secondary CNS lymphoma who underwent alloBMT with nonmyeloablative conditioning using fludarabine, cyclophosphamide, and 200 cGy total body irradiation. For graft-versus-host disease prophylaxis, all patients received post-transplantation cyclophosphamide, mycophenolate mofetil, and a calcineurin inhibitor. With a median follow up of 4.1 years, the median overall survival for the entire cohort was not reached. Median progression-free survival was 3.8 years (95% confidence interval [CI], 5.3 months to not reached). The cumulative incidence of relapse was 25% (95% CI, 5% to 45%), and nonrelapse mortality was 30% (95% CI, 5% to 54%) at 4 years. Of the 5 patients who relapsed, 2 were CNS only, 1 was systemic only, and 2 were combined CNS/systemic. The use of alloBMT in CNS lymphoma merits further investigation.
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Affiliation(s)
- Cole H Sterling
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Hua-Ling Tsai
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthias Holdhoff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carol Ann Huff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian B Gocke
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed Abbas Ali
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ivan M Borrello
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravi Varadhan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Douglas E Gladstone
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard F Ambinder
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nina Wagner-Johnston
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lode J Swinnen
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Philip H Imus
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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16
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Shaw BE, Jimenez-Jimenez AM, Burns LJ, Logan BR, Khimani F, Shaffer BC, Shah NN, Mussetter A, Tang XY, McCarty JM, Alavi A, Farhadfar N, Jamieson K, Hardy NM, Choe H, Ambinder RF, Anasetti C, Perales MA, Spellman SR, Howard A, Komanduri KV, Luznik L, Norkin M, Pidala JA, Ratanatharathorn V, Confer DL, Devine SM, Horowitz MM, Bolaños-Meade J. National Marrow Donor Program-Sponsored Multicenter, Phase II Trial of HLA-Mismatched Unrelated Donor Bone Marrow Transplantation Using Post-Transplant Cyclophosphamide. J Clin Oncol 2021; 39:1971-1982. [PMID: 33905264 PMCID: PMC8260905 DOI: 10.1200/jco.20.03502] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [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: 12/03/2020] [Revised: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Hematopoietic cell transplantation (HCT) is curative for hematologic disorders, but outcomes are historically inferior when using HLA-mismatched donors. Despite unrelated donor registries listing > 38 million volunteers, 25%-80% of US patients lack an HLA-matched unrelated donor, with significant disparity across ethnic groups. We hypothesized that HCT with a mismatched unrelated donor (MMUD) using post-transplant cyclophosphamide (PTCy), a novel strategy successful in overcoming genetic disparity using mismatched related donors, would be feasible and increase access to HCT. PATIENTS AND METHODS We performed a prospective phase II study of MMUD bone marrow HCT with PTCy for patients with hematologic malignancies. The primary end point was 1-year overall survival (OS), hypothesized to be 65% or better. 80 patients enrolled at 11 US transplant centers (December 2016-March 2019). Following myeloablative or reduced-intensity conditioning-based HCT, patients received PTCy on days +3, +4, with sirolimus and mycophenolate mofetil starting on day +5. We compared outcomes to Center for International Blood and Marrow Transplant Research contemporary controls receiving PTCy. RESULTS Notably, 48% of patients enrolled were ethnic minorities. 39% of pairs were matched for 4-6 out of 8 HLA alleles. The primary end point was met, with 1-year OS of 76% (90% CI, 67.3 to 83.3) in the entire cohort, and 72% and 79% in the myeloablative and reduced-intensity conditioning strata, respectively. Secondary end points related to engraftment and graft-versus-host-disease were reached. Multivariate analysis comparing the study group with other mismatched HCT controls found no significant differences in OS. CONCLUSION Our prospective study demonstrates the feasibility and effectiveness of HCT with an MMUD in the setting of PTCy. Remarkably, nearly half of the study participants belonged to an ethnic minority population, suggesting this approach may significantly expand access to HCT.
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Affiliation(s)
- Bronwen E. Shaw
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
| | | | - Linda J. Burns
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
| | - Brent R. Logan
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
| | - Farhad Khimani
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Brian C. Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nirav N. Shah
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Alisha Mussetter
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | - Xiao-Ying Tang
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
| | - John M. McCarty
- Massey Cancer Center Bone Marrow Transplant Program, Virginia Commonwealth University, Richmond, VA
| | - Asif Alavi
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL
| | | | - Nancy M. Hardy
- Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Hannah Choe
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Richard F. Ambinder
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen R. Spellman
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | - Alan Howard
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | | | - Leo Luznik
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Maxim Norkin
- LifeSouth Community Blood Centers, Baptist MD Anderson Cancer Center, Jacksonville, FL
| | | | - Voravit Ratanatharathorn
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Dennis L. Confer
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | - Steven M. Devine
- Center for International Blood and Marrow Transplant Research/National Marrow Donor Program, Minneapolis, MN
| | - Mary M. Horowitz
- Center for International Blood and Marrow Transplant Research/Medical College of Wisconsin, Milwaukee, WI
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17
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Reshef R, Saber W, Bolaños-Meade J, Chen G, Chen YB, Ho VT, Ponce DM, Nakamura R, Martens MJ, Hansen JA, Levine JE. Acute GVHD Diagnosis and Adjudication in a Multicenter Trial: A Report From the BMT CTN 1202 Biorepository Study. J Clin Oncol 2021; 39:1878-1887. [PMID: 33507810 DOI: 10.1200/jco.20.00619] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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 Accurate and reproducible methods to diagnose, grade, and report acute graft-versus-host disease (GVHD) are critical for the evaluation of therapies and biomarkers. PATIENTS AND METHODS The Blood and Marrow Transplant Clinical Trials Network 1202 study is an observational study of 1,709 allogeneic hematopoietic cell transplantation recipients that implemented weekly data reporting and near real-time data adjudication by an end point review committee (ERC), assigning a confidence level (confirmed, probable, possible, or negative) to the diagnosis of acute GVHD at onset. RESULTS During the first 100 days, symptoms consistent with GVHD developed in 90% of cases but were often determined by centers to be due to causes other than GVHD. Indeed, GVHD was under consideration in only 23% of cases at symptom onset. Diagnostic biopsies were obtained in 40% of cases, but treatment often was incongruous with biopsy findings and 10.5% of biopsies were equivocal. Importantly, more than 40% of steroid courses were started for reasons other than GVHD. The ERC modified the determination of GVHD diagnosis and/or grade in 12.3% of onset cases. The cumulative incidence of acute GVHD as reported by the centers was 62%. When the ERC adjudicated GVHD onset to be present only if the confidence level was probable or confirmed, the incidence of GVHD declined to 49%. CONCLUSION This study demonstrates that the incidence of GVHD may be overestimated at symptom onset, establishes a contemporary benchmark for acute GVHD, and suggests a structured framework for reporting and adjudication of GVHD that could be used in prospective trials.
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Affiliation(s)
- Ran Reshef
- Blood and Marrow Transplantation and Cell Therapy Program, Columbia University Irving Medical Center, New York, NY
| | - Wael Saber
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - George Chen
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Yi-Bin Chen
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Vincent T Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Doris M Ponce
- Adult Bone Marrow Transplant Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Michael J Martens
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - John A Hansen
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - John E Levine
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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18
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Imus PH, Tsai HL, DeZern AE, Jerde K, Swinnen LJ, Bolaños-Meade J, Luznik L, Fuchs EJ, Wagner-Johnston N, Huff CA, Gladstone DE, Ambinder RF, Gocke CB, Ali SA, Borrello IM, Varadhan R, Brodsky R, Jones RJ. Thrombotic Microangiopathy after Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis. Biol Blood Marrow Transplant 2020; 26:2306-2310. [PMID: 32961372 DOI: 10.1016/j.bbmt.2020.09.018] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022]
Abstract
Transplant-associated thrombotic microangiopathy (taTMA) is a systemic vascular illness associated with significant morbidity and mortality, resulting from a convergence of risk factors after allogeneic blood or marrow transplantation (alloBMT). The diagnosis of taTMA has been a challenge, but most criteria include an elevated lactate dehydrogenase (LDH), low haptoglobin, and schistocytes on peripheral blood smear. We performed a retrospective review of the 678 consecutive adults who received high-dose post-transplantation cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis between January 1, 2015, and August 31, 2018. In April 2016, we initiated a monitoring program of weekly LDH and haptoglobin measurements and blood smears when those 2 parameters were both abnormal on all of our adult patients undergoing alloBMT for hematologic malignancies. During the entire period, the 1-year cumulative incidence of taTMA was 1.4% (95% confidence interval, 0.5% to 2.3%). Eight patients were taking tacrolimus at the time of diagnosis, and 1 was not on any immunosuppression. Eight of 9 patients (89%) were hypertensive. Four patients had invasive infections at the time of diagnosis, 4 patients required renal replacement therapy, and 5 of 9 patients were neurologically impaired. Eculizumab was given to 6 patients (0.9%), of whom 2 died and 4 recovered with resolution of end-organ dysfunction. The paucity of events made the determination of risk factors difficult; however, the low incidence of taTMA in this cohort may be related to the limited use of myeloablative conditioning regimens, low incidence of severe GVHD, and use of PTCy. PTCy-based GVHD prophylaxis appears to be associated with a low incidence of severe taTMA.
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Affiliation(s)
- Philip H Imus
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland.
| | - Hua-Ling Tsai
- Department of Oncology Biostatistics, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Amy E DeZern
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Kevin Jerde
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Lode J Swinnen
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | | | - Leo Luznik
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Ephraim J Fuchs
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | | | - Carol Ann Huff
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | | | - Richard F Ambinder
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Christian B Gocke
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Syed Abbas Ali
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Ivan M Borrello
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Ravi Varadhan
- Department of Oncology Biostatistics, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Robert Brodsky
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Richard J Jones
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
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19
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Durand CM, Capoferri AA, Redd AD, Zahurak M, Rosenbloom DIS, Cash A, Avery RK, Bolaños-Meade J, Bollard CM, Bullen CK, Flexner C, Fuchs EJ, Gallant J, Gladstone DE, Gocke CD, Jones RJ, Kasamon YL, Lai J, Levis M, Luznik L, Marr KA, McHugh HL, Mehta Steinke S, Pham P, Pohlmeyer C, Pratz K, Shoham S, Wagner-Johnston N, Xu D, Siliciano JD, Quinn TC, Siliciano RF, Ambinder RF. Allogeneic bone marrow transplantation with post-transplant cyclophosphamide for patients with HIV and haematological malignancies: a feasibility study. Lancet HIV 2020; 7:e602-e610. [PMID: 32649866 PMCID: PMC7484204 DOI: 10.1016/s2352-3018(20)30073-4] [Citation(s) in RCA: 8] [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: 10/18/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Allogeneic blood or marrow transplantation (alloBMT) is a potentially life-saving treatment for individuals with HIV and haematological malignancies; challenges include identifying donors and maintaining antiretroviral therapy (ART). The objectives of our study were to investigate interventions to expand donor options and to prevent ART interruptions for patients with HIV in need of alloBMT. METHODS This single-arm, interventional trial took place at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center (Baltimore, MD, USA). Individuals with HIV who were at least 18 years of age and referred for alloBMT for a standard clinical indication were eligible. The only exclusion criterion was a history of documented resistance to enfuvirtide. We used post-transplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis to expand donor options and an optimised ART strategy of avoiding pharmacoenhancers and adding subcutaneous enfuvirtide during post-transplant cyclophosphamide and during oral medication intolerance. Our primary outcome was the proportion of participants who maintained ART through day 60 after alloBMT. We measured the HIV latent reservoir using a quantitative viral outgrowth assay. This study is registered on ClinicalTrials.gov, NCT01836068. FINDINGS Between June 1, 2013, and August 27, 2015, nine patients who were referred for transplant provided consent. Two patients had relapsed malignancy before donor searches were initiated. Seven patients had suitable donors identified (two matched sibling, two matched unrelated, two haploidentical, and one single-antigen mismatched unrelated) and proceeded to alloBMT. All patients maintained ART through day 60 and required ART changes (median 1, range 1-3) in the first 90 days. One patient stopped ART and developed HIV rebound with grade 4 meningoencephalitis at day 146. Among six patients who underwent alloBMT and had longitudinal measurements available, the HIV latent reservoir was not detected post-alloBMT in four patients with more than 95% donor chimerism, consistent with a 2·06-2·54 log10 reduction in the HIV latent reservoir. In the two patients with less than 95% donor chimerism, the HIV latent reservoir remained stable. INTERPRETATION By using post-transplant cyclophosphamide as GVHD prophylaxis, we successfully expanded alloBMT donor options for patients with HIV. Continuing ART with a regimen that includes enfuvirtide post-alloBMT was safe, but life-threatening viral rebound can occur with ART interruption. FUNDING amfAR (the Foundation for AIDS Research), Johns Hopkins University Center for AIDS Research, and National Cancer Institute.
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Affiliation(s)
- Christine M Durand
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Cancer Center, Baltimore, MD, USA.
| | | | - Andrew D Redd
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Daniel I S Rosenbloom
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co, Kenilworth, NJ, USA
| | - Ayla Cash
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robin K Avery
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Bolaños-Meade
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Catherine M Bollard
- Sidney Kimmel Cancer Center, Baltimore, MD, USA; Program for Cell Enhancement and Technologies for Immunotherapy Children's National Health System, George Washington University Washington, DC, USA
| | - C Korin Bullen
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Flexner
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Joel Gallant
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Gilead Sciences, Foster City, CA, USA
| | | | | | | | | | - Jun Lai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Levis
- Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Leo Luznik
- Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Kieren A Marr
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Holly L McHugh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Paul Pham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Keith Pratz
- Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Daniel Xu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Thomas C Quinn
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert F Siliciano
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Howard Hughes Medical Institute, Baltimore, MD, USA
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20
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DeZern AE, Elmariah H, Zahurak M, Rosner GL, Gladstone DE, Ali SA, Huff CA, Swinnen LJ, Imus P, Borrello I, Wagner-Johnston ND, Ambinder RF, Brodsky RA, Cooke K, Luznik L, Fuchs EJ, Bolaños-Meade J, Jones RJ. Shortened-Duration Immunosuppressive Therapy after Nonmyeloablative, Related HLA-Haploidentical or Unrelated Peripheral Blood Grafts and Post-Transplantation Cyclophosphamide. Biol Blood Marrow Transplant 2020; 26:2075-2081. [PMID: 32818556 DOI: 10.1016/j.bbmt.2020.07.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/04/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/16/2022]
Abstract
With post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis, nonmyeloablative (NMA) HLA-haploidentical (haplo) and HLA-matched blood or marrow transplantation (BMT) have comparable outcomes. Previous reports have shown that discontinuation of immunosuppression (IS) as early as day 60 after infusion of a bone marrow (BM) haplo allograft with PTCy is feasible. There are certain diseases in which peripheral blood (PB) may be favored over BM, but given the higher rates of GVHD with PB, excessive GVHD is of increased concern. We report a completed, prospective single-center trial of stopping IS at days 90 and 60 after NMA PB stem cell transplantation (PBSCT). Between 12/2015-7/2018, 117 consecutive patients with hematologic malignancies associated with higher rates of graft failure after NMA conditioned BMT and PTCy, received NMA PB allografts on trial. The primary objective of this study was to evaluate the safety and feasibility of reduced-duration IS (from day 5 through day 90 in the D90 cohort and through day 60 in the D60 cohort). Of the 117 patients (median age, 64 years; range, 22 to 78 years), the most common diagnoses were myelodysplastic syndrome (33%), acute myelogenous leukemia (with minimal residual disease or arising from an antecedent disorder) (32%), myeloproliferative neoplasms (19%), myeloma (9%), and chronic lymphoblastic leukemia (7%). Shortened IS was feasible in 75 patients (64%) overall. Ineligibility for shortened IS resulted most commonly from GVHD (17 patients), followed by early relapse (11 patients), nonrelapse mortality (NRM) (7 patients), patient/ physician preference (4 patients) or graft failure (3 patients). Of the 57 patients in the D90 cohort, 33 (58%) stopped IS early as planned, and among the 60 patients in the D60 cohort, 42 (70%) stopped IS early as planned. The graft failure rate was 2.6%. After IS cessation, the median time to diagnosis of grade II-IV acute GVHD was 21 days in the D90 cohort and 32 days in the D60 cohort, with almost all cases developing within 40 days. Approximately one-third of these patients resumed IS. All outcome measures were similar in the 2 cohorts and our historical outcomes with 180 days of IS. The cumulative incidence of grade III-IV acute GVHD was low, 2% in the D90 cohort and 7% in the D60 cohort. The incidence of severe chronic GVHD at 2 years was 9% in the D90 cohort and 5% in the D60 cohort. The 2-year overall survival was 67% for both the D90 and D60 cohorts. The 2-year progression-free survival was 47% for the D90 cohort and 52% for the D60 cohort, and the GVHD-free, relapse-free survival was <35% for both cohorts. These data suggest that reduced-duration IS in patients undergoing NMA PBSCT with PTCy is feasible and has an acceptable safety profile. © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Amy E DeZern
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland.
| | - Hany Elmariah
- Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Department of Blood and Marrow Transplantation and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Marianna Zahurak
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Department of Oncology Biostatistics, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Gary L Rosner
- Department of Oncology Biostatistics, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Douglas E Gladstone
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Syed Abbas Ali
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Carol Ann Huff
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Lode J Swinnen
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Phil Imus
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Ivan Borrello
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Nina D Wagner-Johnston
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Richard F Ambinder
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Robert A Brodsky
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Kenneth Cooke
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Leo Luznik
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Ephraim J Fuchs
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Javier Bolaños-Meade
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Richard J Jones
- Department of Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland; Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Pediatric Oncology, Sidney Kimmel Cancer Center, Baltimore, Maryland
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21
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Paul S, Tsai HL, Lowery P, Fuchs EJ, Luznik L, Bolaños-Meade J, Swinnen LJ, Shanbhag S, Wagner-Johnston N, Varadhan R, Ambinder RF, Jones RJ, Gladstone DE. Allogeneic Haploidentical Blood or Marrow Transplantation with Post-Transplantation Cyclophosphamide in Chronic Lymphocytic Leukemia. Biol Blood Marrow Transplant 2019; 26:502-508. [PMID: 31730920 DOI: 10.1016/j.bbmt.2019.11.008] [Citation(s) in RCA: 5] [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: 08/15/2019] [Revised: 10/28/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
Abstract
Allogeneic blood or marrow transplantation (allo-BMT) remains the only treatment for chronic lymphocytic leukemia (CLL) with curative potential. Although post-transplantation cyclophosphamide (PTCy) reduces allo-BMT toxicity by decreasing the risk of graft-versus-host disease (GVHD), its effect on CLL allo-BMT outcomes is unknown. We studied 64 consecutive patients with CLL who underwent nonmyeloablative (NMA) haploidentical allo-BMT at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. In this cohort, the 4-year overall survival was 52% (95% confidence interval [CI], 40% to 68%), and progression-free survival was 37% (95% CI, 26% to 54%). Six patients experienced engraftment failure. PTCy prophylaxis was associated with a modest cumulative incidence of 1-year grade II-IV acute GVHD (27%; %95% CI, 15% to 38%) and %%%2-year chronic GVHD (17%; 95% CI, 7% to 26%). We demonstrate that NMA haploidentical allo-BMT with PTCy is a safe and effective treatment option.
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Affiliation(s)
- Suman Paul
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hua-Ling Tsai
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick Lowery
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lode J Swinnen
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Satish Shanbhag
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nina Wagner-Johnston
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravi Varadhan
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard F Ambinder
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Douglas E Gladstone
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, Maryland.
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22
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Lazaryan A, Dolan M, Zhang MJ, Wang HL, Kharfan-Dabaja MA, Marks DI, Bejanyan N, Copelan E, Majhail NS, Waller EK, Chao N, Prestidge T, Nishihori T, Kebriaei P, Inamoto Y, Hamilton B, Hashmi SK, Kamble RT, Bacher U, Hildebrandt GC, Stiff PJ, McGuirk J, Aldoss I, Beitinjaneh AM, Muffly L, Vij R, Olsson RF, Byrne M, Schultz KR, Aljurf M, Seftel M, Savoie ML, Savani BN, Verdonck LF, Cairo MS, Hossain N, Bhatt VR, Frangoul HA, Abdel-Azim H, Malki MA, Munker R, Rizzieri D, Khera N, Nakamura R, Ringdén O, van der Poel M, Murthy HS, Liu H, Mori S, De Oliveira S, Bolaños-Meade J, Elsawy M, Barba P, Nathan S, George B, Pawarode A, Grunwald M, Agrawal V, Wang Y, Assal A, Caro PC, Kuwatsuka Y, Seo S, Ustun C, Politikos I, Lazarus HM, Saber W, Sandmaier BM, De Lima M, Litzow M, Bachanova V, Weisdorf D. Impact of cytogenetic abnormalities on outcomes of adult Philadelphia-negative acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: a study by the Acute Leukemia Working Committee of the Center for International Blood and Marrow Transplant Research. Haematologica 2019; 105:1329-1338. [PMID: 31558669 PMCID: PMC7193485 DOI: 10.3324/haematol.2019.220756] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/12/2019] [Accepted: 09/20/2019] [Indexed: 11/11/2022] Open
Abstract
Cytogenetic risk stratification at diagnosis has long been one of the most useful tools to assess prognosis in acute lymphoblastic leukemia (ALL). To examine the prognostic impact of cytogenetic abnormalities on outcomes after allogeneic hematopoietic cell transplantation, we studied 1731 adults with Philadelphia-negative ALL in complete remission who underwent myeloablative or reduced intensity/non-myeloablative conditioning transplant from unrelated or matched sibling donors reported to the Center for International Blood and Marrow Transplant Research. A total of 632 patients had abnormal conventional metaphase cytogenetics. The leukemia-free survival and overall survival rates at 5 years after transplantation in patients with abnormal cytogenetics were 40% and 42%, respectively, which were similar to those in patients with a normal karyotype. Of the previously established cytogenetic risk classifications, modified Medical Research Council-Eastern Cooperative Oncology Group score was the only independent prognosticator of leukemia-free survival (P=0.03). In the multivariable analysis, monosomy 7 predicted post-transplant relapse [hazard ratio (HR)=2.11; 95% confidence interval (95% CI): 1.04-4.27] and treatment failure (HR=1.97; 95% CI: 1.20-3.24). Complex karyotype was prognostic for relapse (HR=1.69; 95% CI: 1.06-2.69), whereas t(8;14) predicted treatment failure (HR=2.85; 95% CI: 1.35-6.02) and overall mortality (HR=3.03; 95% CI: 1.44-6.41). This large study suggested a novel transplant-specific cytogenetic scheme with adverse [monosomy 7, complex karyotype, del(7q), t(8;14), t(11;19), del(11q), tetraploidy/near triploidy], intermediate (normal karyotype and all other abnormalities), and favorable (high hyperdiploidy) risks to prognosticate leukemia-free survival (P=0.02). Although some previously established high-risk Philadelphia-negative cytogenetic abnormalities in ALL can be overcome by transplantation, monosomy 7, complex karyotype, and t(8;14) continue to pose significant risks and yield inferior outcomes.
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Affiliation(s)
| | - Michelle Dolan
- University of Minnesota Medical Center, Minneapolis, MN, 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
| | - Hai-Lin Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Edward Copelan
- Levine Cancer Institute, Atrium Health, Carolinas HealthCare System, Charlotte, NC, USA
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Nelson Chao
- Division of Cell Therapy and Hematology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Betty Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, MN, USA.,Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, Switzerland
| | | | | | | | - Ibrahim Aldoss
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, 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, British Columbia, Canada
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, the Netherlands
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Nasheed Hossain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, 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
| | - Monzr Al Malki
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Reinhold Munker
- Section of Hematology/Oncology, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Olle Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm Sweden
| | | | | | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | - Shahram Mori
- Blood & Marrow Transplant Center, Florida Hospital Medical Group, Orlando, FL, USA
| | | | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Mahmoud Elsawy
- QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pere Barba
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Vaibhav Agrawal
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Youjin Wang
- National Cancer Institute (NCI), Rockville, MD, USA
| | - Amer Assal
- New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Celalettin Ustun
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, IL, USA
| | | | | | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 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
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
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23
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Eapen M, Brazauskas R, Walters MC, Bernaudin F, Bo-Subait K, Fitzhugh CD, Hankins JS, Kanter J, Meerpohl JJ, Bolaños-Meade J, Panepinto JA, Rondelli D, Shenoy S, Williamson J, Woolford TL, Gluckman E, Wagner JE, Tisdale JF. Effect of donor type and conditioning regimen intensity on allogeneic transplantation outcomes in patients with sickle cell disease: a retrospective multicentre, cohort study. Lancet Haematol 2019; 6:e585-e596. [PMID: 31495699 DOI: 10.1016/s2352-3026(19)30154-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Donors other than matched siblings and low-intensity conditioning regimens are increasingly used in haematopoietic stem cell transplantation. We aimed to compare the relative risk of donor type and conditioning regimen intensity on the transplantation outcomes of in patients with sickle cell disease. METHODS For this retrospective cohort study, we collected data from 90 US centres reported to the Center for International Blood and Marrow Transplant Research. Eligible patients were younger than 50 years, had genetically confirmed sickle cell disease (Hb SS) or sickle beta thalassemia (Hb Sβ), and underwent allogeneic haematopoietic cell transplantation between Jan 15, 2008, and Dec 28, 2017. We considered transplants from donor-recipient pairs matched at the allele-level (HLA-A, HLA-B, HLA-C, and HLA-DRB1), including HLA-matched sibling donors, haploidentical related donors, matched unrelated donors, or mismatched unrelated donors. The main outcome was event-free survival. The effect of donor type, conditioning regimen intensity (myeloablative, non-myeloablative, and reduced-intensity regimens), age (≤12 or 13-49 years), sex, performance score, comorbidity index, recipient cytomegalovirus serostatus, graft type (bone marrow, peripheral blood, or umbilical cord blood), and transplantation period (2008-12 and 2013-17) on outcomes was studied using Cox regression models. FINDINGS Of 996 patients with sickle cell disease and who underwent transplantation in 2008-17, 910 (91%) were included (558 [61%] patients had HLA-matched sibling donors, 137 [15%] haploidentical related donors, 111 [12%] matched unrelated donors, and 104 [11%] mismatched unrelated donors). The median follow-up was 36 months (IQR 18-60) after transplantation from HLA-matched siblings, 25 months (12-48) after transplantation from haploidentical related donors, 37 months (23-60) after transplantation from HLA-matched unrelated donors, and 47 months (24-72) after transplantation from mismatched unrelated donors. Event-free survival was worse in recipients aged 13 years or older than in those younger than 13 years (hazard ratio 1·74, 95% CI 1·24-2·45; p=0·0014) and in those who received a transplant from haploidentical related donors (5·30, 3·17-8·86; p<0·0001), matched unrelated donors (3·71, 2·39-5·75; p<0·0001), and mismatched unrelated donors (4·34, 2·58-7·32; p<0·0001) than in patients who received a transplant from matched siblings. There was no significant difference in event-free survival between recipients of transplants from non-sibling donors: haploidentical related donors (1·43, 0·81-2·50; p=0·21) or mismatched unrelated donors (1·17, 0·67-2·05; p=0·58) versus HLA-matched unrelated donors, or mismatched unrelated donors versus haploidentical related donors (1·22, 0·65-2·27; p=0·98). Event-free survival was also worse in patients conditioned with reduced-intensity regimens (1·97, 1·15-3·36; p=0·013) than in those conditioned with non-myeloablative regimens, but did not differ between those who received myeloablative compared with non-myeloablative regimens (1·57, 0·95-2·61; p=0·079). Interpretation Our data suggest that event-free survival is improved in patients with sickle cell disease who receive an allogenic transplantation at age 12 years or younger and those with an HLA-matched sibling donor. For patients without a matched sibling available for transplantation, our data do not favour one alternative donor type over another in this setting. FUNDING National Institutes of Health and US Health Services Research Administration, Department of Health and Human Services.
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Affiliation(s)
- Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Ruta Brazauskas
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mark C Walters
- University of California San Francisco Benioff Children's hospital, Oakland, CA, USA
| | - Françoise Bernaudin
- Referral Center for Sickle Cell Disease, CHIC, Creteil Hospital, Paris, France
| | - Khalid Bo-Subait
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Courtney D Fitzhugh
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research hospital, Memphis, TN, USA
| | | | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie A Panepinto
- Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Damiano Rondelli
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Shalini Shenoy
- Department of Pediatrics, Washington University, St Louis, MO, USA
| | | | | | - Eliane Gluckman
- Eurocord, Hôpital Saint Louis, Université Paris Diderot, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - John E Wagner
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - John F Tisdale
- Cellular and Molecular Therapeutics Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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24
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Ahmed S, Kanakry JA, Ahn KW, Litovich C, Abdel-Azim H, Aljurf M, Bacher VU, Bejanyan N, Cohen JB, Farooq U, Fuchs EJ, Bolaños-Meade J, Ghosh N, Herrera AF, Hossain NM, Inwards D, Kanate AS, Martino R, Munshi PN, Murthy H, Mussetti A, Nieto Y, Perales MA, Romee R, Savani BN, Seo S, Wirk B, Yared JA, Sureda A, Fenske TS, Hamadani M. Lower Graft-versus-Host Disease and Relapse Risk in Post-Transplant Cyclophosphamide-Based Haploidentical versus Matched Sibling Donor Reduced-Intensity Conditioning Transplant for Hodgkin Lymphoma. Biol Blood Marrow Transplant 2019; 25:1859-1868. [PMID: 31132455 PMCID: PMC6755039 DOI: 10.1016/j.bbmt.2019.05.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 02/26/2019] [Revised: 04/30/2019] [Accepted: 05/20/2019] [Indexed: 11/21/2022]
Abstract
Classic Hodgkin lymphoma (cHL) patients with relapsed or refractory disease may benefit from allogeneic hematopoietic cell transplantation (allo-HCT), but many lack a matched sibling donor (MSD). Herein, we compare outcomes of 2 reduced-intensity conditioning (RIC) HCT platforms in cHL: T cell-replete related donor haploidentical (haplo) HCT with a post-transplant cyclophosphamide (PTCy)-based approach versus an MSD/calcineurin inhibitor (CNI)-based approach. The study included 596 adult patients who underwent a first RIC allo-HCT for cHL between 2008 and 2016 using either a haplo-PTCy (n = 139) or MSD/CNI-based (n = 457) approach. Overall survival (OS) was the primary endpoint. Secondary endpoints included acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD), nonrelapse mortality (NRM), relapse/progression, and progression-free survival (PFS). On multivariate analysis, there was no significant difference between haplo/PTCy and MDS/CNI-based approaches in terms of OS (hazard ratio [HR], 1.07; 95% confidence interval [CI], .79 to 1.45; P = .66) or PFS (HR, .86; 95% CI, .68 to 1.10; P = .22). Haplo/PTCy was associated with a significantly higher risk of grades II to IV aGVHD (odds ratio [OR], 1.73, 95% CI, 1.16 to 2.59; P = .007), but the risk of grades III to IV aGVHD was not significantly different between the 2 cohorts (OR, .61; 95% CI, .29 to 1.27; P = .19). The haplo/PTCy platform provided a significant reduction in cGVHD risk (HR, .45; 95% CI, .32 to .64; P < .001), and a significant reduction in relapse risk (HR, .74; 95% CI, .56 to .97; P = .03). There was a statistically nonsignificant trend toward higher NRM with a haplo/PTCy approach (HR, 1.65; 95% CI, .99 to 2.77; P = .06). Haplo/PTCy-based approaches are associated with lower incidences of cGVHD and relapse, with PFS and OS outcomes comparable with MSD/CNI-based approaches. There was a leaning toward higher NRM with a haplo/PTCy-based platform. These data show that haplo/PTCy allo-HCT in cHL results in survival comparable with MSD/CNI-based allo-HCT.
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Affiliation(s)
- Sairah Ahmed
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Kanakry
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kwang W Ahn
- 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
| | - Carlos Litovich
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California; University of Southern California Keck School of Medicine, Los Angeles, California
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Ephraim J Fuchs
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Nasheed M Hossain
- Department of Medicine, Division of Hematology/Oncology, Loyola University Chicago-Stritch School of Medicine, Maywood, Illinois
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Abraham S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Rodrigo Martino
- Divison of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Hemant Murthy
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Alberto Mussetti
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Yago Nieto
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rizwan Romee
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sachiko Seo
- Department of Haematology and Oncology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Ana Sureda
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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25
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Gusdon AM, Cho SM, Mayasi Y, Malani R, Püttgen HA, Duffield A, Bolaños-Meade J, Lim M. Chronic Lymphocytic Leukemia Resulting in Hemorrhagic Brain Masses After Sepsis. Neurohospitalist 2019; 10:64-68. [PMID: 31839869 DOI: 10.1177/1941874419859758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/01/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) rarely results in central nervous system (CNS) involvement. When CLL does affect the CNS, it typically manifests as leptomeningeal involvement, not commonly causing parenchymal involvement unless having undergone a higher grade transformation. We report a case of a patient with untreated CLL who presented with a large right frontal hemorrhagic mass along with additional bilateral masses after being found unresponsive. He had recently been hospitalized with Staphylococcus aureus sepsis. His neurological examination improved after resection of the largest mass however deteriorated again with accumulation of blood in the resection cavity requiring evacuation of the blood products and placement of an external ventricular drain. Pathology from the initial resection revealed sheets of CD20 consistent with untransformed CLL. Additionally, there were areas of necrosis and gram-positive organisms. Given the unusual presentation with large hemorrhagic brain masses, we suspect that the antecedent bacteremia may have resulted in blood-brain barrier breakdown and seeding of the CNS parenchyma with CLL cells.
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Affiliation(s)
- Aaron M Gusdon
- Division of Neurocritical Care, Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sung-Min Cho
- Division of Neurocritical Care, Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yunis Mayasi
- Division of Neurocritical Care, Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachna Malani
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans A Püttgen
- Division of Neurocritical Care, Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Duffield
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Bolaños-Meade
- Division of Hematologic Malignancies, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Lim
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bolaños-Meade J, Reshef R, Fraser R, Fei M, Abhyankar S, Al-Kadhimi Z, Alousi AM, Antin JH, Arai S, Bickett K, Chen YB, Damon LE, Efebera YA, Geller NL, Giralt SA, Hari P, Holtan SG, Horowitz MM, Jacobsohn DA, Jones RJ, Liesveld JL, Logan BR, MacMillan ML, Mielcarek M, Noel P, Pidala J, Porter DL, Pusic I, Sobecks R, Solomon SR, Weisdorf DJ, Wu J, Pasquini MC, Koreth J. Three prophylaxis regimens (tacrolimus, mycophenolate mofetil, and cyclophosphamide; tacrolimus, methotrexate, and bortezomib; or tacrolimus, methotrexate, and maraviroc) versus tacrolimus and methotrexate for prevention of graft-versus-host disease with haemopoietic cell transplantation with reduced-intensity conditioning: a randomised phase 2 trial with a non-randomised contemporaneous control group (BMT CTN 1203). Lancet Haematol 2019; 6:e132-e143. [PMID: 30824040 PMCID: PMC6503965 DOI: 10.1016/s2352-3026(18)30221-7] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [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: 10/18/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prevention of graft-versus-host disease (GvHD) without malignant relapse is the overall goal of allogeneic haemopoietic cell transplantation (HCT). We aimed to evaluate regimens using either maraviroc, bortezomib, or post-transplantation cyclophosphamide for GvHD prophylaxis compared with controls receiving the combination of tacrolimus and methotrexate using a novel composite primary endpoint to identify the most promising intervention to be further tested in a phase 3 trial. METHODS In this prospective multicentre phase 2 trial, adult patients aged 18-75 years who received reduced-intensity conditioning HCT were randomly assigned (1:1:1) by random block sizes to tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide (cyclophosphamide 50 mg/kg on days 3 and 4, followed by tacrolimus starting on day 5 and mycophenolate mofetil starting on day 5 at 15 mg/kg three times daily not to exceed 1 g from day 5 to day 35); tacrolimus, methotrexate, and bortezomib (bortezomib 1·3 mg/m2 intravenously on days 1, 4, and 7 after HCT); or tacrolimus, methotrexate, and maraviroc (maraviroc 300 mg orally twice daily from day -3 to day 30 after HCT). Methotrexate was administered as a 15 mg/m2 intravenous bolus on day 1 and 10 mg/m2 intravenous bolus on days 3, 6, and 11 after HCT; tacrolimus was given intravenously at a dose of 0·05 mg/kg twice daily (or oral equivalent) starting on day -3 (except the post-transplantation cyclophosphamide, as indicated), with a target level of 5-15 ng/mL. Tacrolimus was continued at least until day 90 and was tapered off by day 180. Each study group was compared separately to a contemporary non-randomised prospective cohort of patients (control group) who fulfilled the same eligibility criteria as the trial, but who were treated with tacrolimus and methotrexate at centres not participating in the trial. The primary endpoint (GvHD-free, relapse-free survival [GRFS]) was defined as the time from HCT to onset of grade 3-4 acute GvHD, chronic GvHD requiring systemic immunosuppression, disease relapse, or death. The study was analysed by modified intention to treat. The study is closed to accrual and this is the planned analysis. This trial is registered with ClinicalTrials.gov, number NCT02208037. FINDINGS Between Nov 17, 2014, and May 18, 2016, 273 patients from 31 US centres were randomly assigned to the three study arms: 89 to tacrolimus, methotrexate, and bortezomib; 92 to tacrolimus, methotrexate, and maraviroc; 92 to tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; and six were excluded. Between Aug 1, 2014, and Sept 14, 2016, 224 controls received tacrolimus and methotrexate. Controls were generally well matched except for more frequent comorbidities than the intervention groups and a different distribution of types of conditioning regimens used. Compared with controls, the hazard ratio for GRFS was 0·72 (90% CI 0·54-0·94; p=0·044) for tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide, 0·98 (0·76-1·27; p=0·92) for tacrolimus, methotrexate, and bortezomib, and 1·10 (0·86-1·41; p=0·49) for tacrolimus, methotrexate, and maraviroc. 238 patients experienced grade 3 or 4 toxicities: 12 (13%) had grade 3 and 67 (73%) grade 4 events with tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; ten (11%) had grade 3 and 68 (76%) had grade 4 events with tacrolimus, methotrexate, and bortezomib; and 18 (20%) had grade 3 and 63 (68%) had grade 4 events with tacrolimus, methotrexate, and maraviroc. The most common toxicities were haematological (77 [84%] for tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide; 73 [82%] for tacrolimus, methotrexate, and bortezomib; and 78 [85%] for tacrolimus, methotrexate, and maraviroc) and cardiac (43 [47%], 44 [49%], and 43 [47%], respectively). INTERPRETATION Tacrolimus, mycophenolate mofetil, and post-transplantation cyclophosphamide was the most promising intervention, yielding the best GRFS; this regimen is thus being prospectively compared with tacrolimus and methotrexate in a phase 3 randomised trial. FUNDING US National Health, Lung, and Blood Institute; National Cancer Institute; National Institute of Allergy and Infectious Disease; and Millennium Pharmaceuticals.
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Affiliation(s)
- Javier Bolaños-Meade
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
| | - Ran Reshef
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Raphael Fraser
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mingwei Fei
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sunil Abhyankar
- Department of Internal Medicine, University of Kansas Medical Center, Westwood, KS, USA
| | - Zaid Al-Kadhimi
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Amin M Alousi
- Department of Stem Cell Transplant and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph H Antin
- Department of Medicial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sally Arai
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | | | - Yi-Bin Chen
- Department of Medicine, Massachusetts General, Hospital, Boston, MA, USA
| | - Lloyd E Damon
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yvonne A Efebera
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Nancy L Geller
- Office of Biostatistics Research, National Institutes of Health, Bethesda, MD, USA
| | - Sergio A Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Parameswaran Hari
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shernan G Holtan
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Mary M Horowitz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David A Jacobsohn
- Department of Pediatrics at George Washington University, Children's National Medical Center, Washington, DC, USA
| | - Richard J Jones
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Jane L Liesveld
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Brent R Logan
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Marco Mielcarek
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Pierre Noel
- Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Joseph Pidala
- Blood and Marrow Transplantation and Cellular Immunotherapy, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David L Porter
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Iskra Pusic
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ronald Sobecks
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Solomon
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Daniel J Weisdorf
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Juan Wu
- The Emmes Corporation, Rockville, MD, USA
| | - Marcelo C Pasquini
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Koreth
- Department of Medicial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Reshef R, Saber W, Bolaños-Meade J, Chen GL, Chen YB, Ho VT, Ponce DM, Nakamura R, Martens MJ, Hansen JA, Levine JE. Acute Gvhd Diagnosis and Adjudication in a Multicenter Trial – a Report from the BMT CTN 1202 Biorepository Study. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.132] [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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28
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McCurdy SR, Kanakry CG, Tsai HL, Gojo I, Smith BD, Gladstone DE, Bolaños-Meade J, Borrello I, Matsui WH, Swinnen LJ, Huff CA, Brodsky RA, Ambinder RF, Fuchs EJ, Rosner GL, Jones RJ, Luznik L. Development of Grade II Acute Graft-versus-Host Disease Is Associated with Improved Survival after Myeloablative HLA-Matched Bone Marrow Transplantation using Single-Agent Post-Transplant Cyclophosphamide. Biol Blood Marrow Transplant 2018; 25:1128-1135. [PMID: 30599208 DOI: 10.1016/j.bbmt.2018.12.767] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 07/16/2018] [Accepted: 12/26/2018] [Indexed: 01/01/2023]
Abstract
Post-transplant cyclophosphamide (PTCy) can be used as the sole immunosuppression after myeloablative conditioning (MAC) for HLA-matched bone marrow transplantation (BMT). However, the effects of graft-versus-host disease (GVHD) with this platform are undefined. We retrospectively analyzed 298 consecutive adult patients with hematologic malignancies who engrafted after MAC HLA-matched sibling donor (MSD; n = 187) or HLA-matched unrelated donor (MUD; n = 111) T-cell-replete BMT with PTCy 50 mg/kg on days +3 and +4. After MSD and MUD BMT, 35% and 57% of patients, respectively, developed grade II acute GVHD (aGVHD) by 100 days, 11% and 14% grade III to IV aGVHD by 100 days, and 9% and 16% chronic GVHD (cGVHD) by 1 year. In landmark analyses at 100 days after HLA-matched BMT, 4-year overall survival (OS) and progression-free survival (PFS) were 57% (95% confidence interval [CI], .49 to .67) and 40% (95% CI, .31 to .51) in patients without grades II to IV aGVHD, and 68% (95% CI, .59 to .78) and 54% (95% CI, .44 to .65) in patients with grade II aGVHD. In adjusted time-dependent multivariable analyses, grade II aGVHD was associated with improved OS (hazard ratio, .58; 95% CI, .37 to .89; P = .01) and PFS (hazard ratio, .50; 95% CI, .34 to .74; P < .001) after HLA-matched BMT with PTCy. The ability of PTCy to limit grades III to IV aGVHD and cGVHD while maintaining grade II aGVHD may contribute to its effectiveness, and further attempts to reduce aGVHD may be detrimental.
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Affiliation(s)
- Shannon R McCurdy
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher G Kanakry
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hua-Ling Tsai
- Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Ivana Gojo
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - B Douglas Smith
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Douglas E Gladstone
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Javier Bolaños-Meade
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ivan Borrello
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - William H Matsui
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Lode J Swinnen
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Carol Ann Huff
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Robert A Brodsky
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Richard F Ambinder
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland; Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Ephraim J Fuchs
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary L Rosner
- Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Richard J Jones
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Holtan SG, DeFor TE, Panoskaltsis-Mortari A, Khera N, Levine JE, Flowers MED, Lee SJ, Inamoto Y, Chen GL, Mayer S, Arora M, Palmer J, Cutler CS, Arai S, Lazaryan A, Newell LF, Jagasia MH, Pusic I, Wood WA, Renteria AS, Yanik G, Hogan WJ, Hexner E, Ayuk F, Holler E, Bunworasate U, Efebera YA, Ferrara JLM, Pidala J, Howard A, Wu J, Bolaños-Meade J, Ho V, Alousi A, Blazar BR, Weisdorf DJ, MacMillan ML. Amphiregulin modifies the Minnesota Acute Graft-versus-Host Disease Risk Score: results from BMT CTN 0302/0802. Blood Adv 2018; 2:1882-1888. [PMID: 30087106 PMCID: PMC6093743 DOI: 10.1182/bloodadvances.2018017343] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 02/12/2018] [Accepted: 06/26/2018] [Indexed: 01/07/2023] Open
Abstract
Amphiregulin (AREG) is an epidermal growth factor receptor ligand that can restore integrity to damaged intestinal mucosa in murine models of acute graft-versus-host disease (aGVHD). We previously reported that circulating AREG is elevated in late-onset aGVHD (occurring after 100 days posttransplant), but its clinical relevance in the context of aGVHD risk is unknown. We measured AREG in 251 aGVHD onset blood samples from Blood and Marrow Clinical Trials Network (BMT CTN) primary treatment trials and determined their association with GVHD severity, day 28 complete or partial response (CR/PR) to first-line therapy, overall survival (OS), and nonrelapse mortality (NRM). Every doubling of plasma AREG was associated with a 33% decrease in the odds of day 28 CR/PR (odds ratio [OR], 0.67; P < .01). An AREG threshold of 33 pg/mL or greater divided patients with Minnesota standard-risk (SR) aGVHD into a distinct group with a significantly lower likelihood of: day 28 CR/PR (72% vs 85%; P = .02); greater 2-year NRM (42% vs 15%; P < .01); and inferior OS (40% vs 66%; P < .01). High AREG ≥ 33 pg/mL also stratified patients with Minnesota high-risk (HR) aGVHD: day 28 CR/PR (54% vs 83%; P = .03) and 2-year NRM (53% vs 11%; P < .01), with a trend toward inferior 2-year OS (37% vs 60%; P = .09). High-circulating AREG (≥33 pg/mL) reclassifies patients into HR subgroups and thereby further refines the Minnesota aGVHD clinical risk score.
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Affiliation(s)
- Shernan G Holtan
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | - Todd E DeFor
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | | | | | - John E Levine
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - George L Chen
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Sebastian Mayer
- Department of Medicine, Weill Cornell Medical Center, New York, NY
| | - Mukta Arora
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | | | - Corey S Cutler
- Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sally Arai
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
| | - Aleksandr Lazaryan
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | - Laura F Newell
- Center for Hematologic Malignancies, Oregon Health and Science University, Portland, OR
| | - Madan H Jagasia
- Division of Hematology/Oncology, Stem Cell Transplantation, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Iskra Pusic
- Medical Oncology, Washington University Medical Center, St. Louis, MO
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Anne S Renteria
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gregory Yanik
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI
| | - William J Hogan
- Blood and Marrow Transplantation Program, Mayo Clinic, Rochester, MN
| | - Elizabeth Hexner
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Germany
| | - Ernst Holler
- Blood and Marrow Transplantation Program, University of Regensburg, Regensburg, Germany
| | - Udomsak Bunworasate
- Blood and Marrow Transplantation Program, Chulalongkorn University, Bangkok, Thailand
| | - Yvonne A Efebera
- Blood and Marrow Transplantation Program, The Ohio State University, Columbus, OH
| | - James L M Ferrara
- Blood and Marrow Transplantation Program, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Alan Howard
- National Marrow Donor Program, Minneapolis, MN
| | - Juan Wu
- The EMMES Corporation, Rockville, MD
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD; and
| | - Vincent Ho
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA
| | | | - Bruce R Blazar
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
| | - Daniel J Weisdorf
- Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
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30
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Carpenter PA, Logan BR, Lee SJ, Weisdorf DJ, Johnston L, Costa LJ, Kitko CL, Bolaños-Meade J, Sarantopoulos S, Alousi AM, Abhyankar S, Waller EK, Mendizabal A, Zhu J, O'Brien KA, Lazaryan A, Wu J, Nemecek ER, Pavletic SZ, Cutler CS, Horowitz MM, Arora M. A phase II/III randomized, multicenter trial of prednisone/sirolimus versus prednisone/ sirolimus/calcineurin inhibitor for the treatment of chronic graft- versus-host disease: BMT CTN 0801. Haematologica 2018; 103:1915-1924. [PMID: 29954931 PMCID: PMC6278959 DOI: 10.3324/haematol.2018.195123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 04/07/2018] [Accepted: 06/26/2018] [Indexed: 12/17/2022] Open
Abstract
Initial therapy of chronic graft-versus-host disease is prednisone ± a calcineurin-inhibitor, but most patients respond inadequately. In a randomized, adaptive, phase II/III, multicenter trial we studied whether prednisone/sirolimus or prednisone/sirolimus/photopheresis was more effective than prednisone/sirolimus/calcineurin-inhibitor for treating chronic graft-versus-host disease in treatment-naïve or early inadequate responders. Primary endpoints of this study were proportions of subjects alive without relapse or secondary therapy with 6-month complete or partial response in phase II, or with 2-year complete response in phase III. The prednisone/sirolimus/photopheresis arm closed prematurely because of slow accrual and the remaining two-drug versus three-drug study ended in phase II due to statistical futility with 138 evaluable subjects. The two-drug and three-drug arms did not differ in rates of 6-month complete or partial response (48.6% versus 50.0%, P=0.87), or 2-year complete response (14.7% versus 15.5%, P=0.90). Serum creatinine values >1.5 times baseline were less frequent in the calcineurin-inhibitor-free arm at 2 months (1.5% versus 11.7%, P=0.025) and 6 months (7.8% versus 24.0%, P=0.016). Higher adjusted Short Form-36 Physical Component Summary and Physical Functioning scores were seen in the two-drug arm at both 2 months (P=0.02 and P=0.04, respectively) and 6 months (P=0.007 and P=0.001, respectively). Failure-free survival and overall survival rates at 2 years were similar for patients in the the two-drug and three-drug arms (48.6% versus 46.2%, P=0.78; 81.5% versus 74%, P=0.28). Based on similar long-term outcomes, prednisone/sirolimus is a therapeutic alternative to prednisone/sirolimus/calcineurin-inhibitor for chronic graft-versus-host disease, being easier to administer and better tolerated. Clinicaltrials.gov identifier: NCT01106833.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amin M Alousi
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Jiaxi Zhu
- The Emmes Corporation, Rockville, MD
| | | | | | - Juan Wu
- The Emmes Corporation, Rockville, MD
| | | | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, MD
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31
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Smith SM, Godfrey J, Ahn KW, DiGilio A, Ahmed S, Agrawal V, Bachanova V, Bacher U, Bashey A, Bolaños-Meade J, Cairo M, Chen A, Chhabra S, Copelan E, Dahi PB, Aljurf M, Farooq U, Ganguly S, Hertzberg M, Holmberg L, Inwards D, Kanate AS, Karmali R, Kenkre VP, Kharfan-Dabaja MA, Klein A, Lazarus HM, Mei M, Mussetti A, Nishihori T, Geethakumari PR, Saad A, Savani BN, Schouten HC, Shah N, Urbano-Ispizua A, Vij R, Vose J, Sureda A, Hamadani M. Autologous transplantation versus allogeneic transplantation in patients with follicular lymphoma experiencing early treatment failure. Cancer 2018; 124:2541-2551. [PMID: 29645093 PMCID: PMC5990449 DOI: 10.1002/cncr.31374] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 11/01/2017] [Revised: 11/21/2017] [Accepted: 11/30/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Early treatment failure (ETF) in follicular lymphoma (FL), defined as relapse or progression within 2 years of frontline chemoimmunotherapy, is a newly recognized marker of poor survival and identifies a high-risk group of patients with an expected 5-year overall survival (OS) rate of approximately 50%. Transplantation is an established option for relapsed FL, but its efficacy in this specific ETF FL population has not been previously evaluated. METHODS This study compared autologous hematopoietic stem cell transplantation (auto-HCT) with either matched sibling donor (MSD) or matched unrelated donor (MUD) allogeneic hematopoietic cell transplantation (allo-HCT) as the first transplantation approach for patients with ETF FL (age ≥ 18 years) undergoing auto-HCT or allo-HCT between 2002 and 2014. The primary endpoint was OS. The secondary endpoints were progression-free survival, relapse, and nonrelapse mortality (NRM). RESULTS Four hundred forty FL patients had ETF (auto-HCT, 240; MSD hematopoietic stem cell transplantation [HCT], 105; and MUD HCT, 95). With a median follow-up of 69 to 73 months, the adjusted probability of 5-year OS was significantly higher after auto-HCT (70%) or MSD HCT (73%) versus MUD HCT (49%; P = .0008). The 5-year adjusted probability of NRM was significantly lower for auto-HCT (5%) versus MSD (17%) or MUD HCT (33%; P < .0001). The 5-year adjusted probability of disease relapse was lower with MSD (31%) or MUD HCT (23%) versus auto-HCT (58%; P < .0001). CONCLUSIONS Patients with high-risk FL, as defined by ETF, undergoing auto-HCT for FL have low NRM and a promising 5-year OS rate (70%). MSD HCT has lower relapse rates than auto-HCT but similar OS. Cancer 2018;124:2541-51. © 2018 American Cancer Society.
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MESH Headings
- Adult
- Aged
- Disease Progression
- Disease-Free Survival
- Female
- Follow-Up Studies
- Graft vs Host Disease/epidemiology
- Graft vs Host Disease/immunology
- Graft vs Host Disease/prevention & control
- Hematopoietic Stem Cell Transplantation/adverse effects
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Incidence
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Survival Rate
- Transplantation Conditioning/methods
- Transplantation, Autologous/adverse effects
- Transplantation, Autologous/methods
- Transplantation, Homologous/adverse effects
- Transplantation, Homologous/methods
- Treatment Failure
- Young Adult
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Affiliation(s)
- Sonali M. Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
| | | | - Kwang Woo Ahn
- 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 Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alyssa DiGilio
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Vaibhav Agrawal
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Veronika Bachanova
- Bone and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | - Mitchell Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Andy Chen
- Oregon Health and Science University, Portland, OR, USA
| | | | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Parastoo B. Dahi
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Randwick NSW, Australia
| | - Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David Inwards
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Abraham S. Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV, USA
| | | | | | - Mohamed A. Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andreas Klein
- Division of Hematology/Oncology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Hillard M. Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | | | - Alberto Mussetti
- Department of Hematology and Pediatric Onco-Hematology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bipin N. Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harry C. Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - Nairav Shah
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alvaro Urbano-Ispizua
- Department of Hematology, Hospital Clinic, University of Barcelona, IDIBAPS, and Institute of Research Josep Carreras, Barcelona, Spain
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Anna Sureda
- Hematology Department, Institut Català d’Oncologia - Hospitalet, Barcelona, Spain
| | - Mehdi Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Elmariah H, Kasamon YL, Zahurak M, Macfarlane KW, Tucker N, Rosner GL, Bolaños-Meade J, Fuchs EJ, Wagner-Johnston N, Swinnen LJ, Huff CA, Matsui WH, Gladstone DE, McCurdy SR, Borrello I, Gocke CB, Shanbhag S, Cooke KR, Ali SA, Brodsky RA, DeZern AE, Luznik L, Jones RJ, Ambinder RF. Haploidentical Bone Marrow Transplantation with Post-Transplant Cyclophosphamide Using Non-First-Degree Related Donors. Biol Blood Marrow Transplant 2018; 24:1099-1102. [PMID: 29452245 DOI: 10.1016/j.bbmt.2018.02.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 01/20/2018] [Accepted: 02/08/2018] [Indexed: 10/18/2022]
Abstract
Outcomes of nonmyeloablative (NMA) haploidentical (haplo) blood or marrow transplant (BMT) with post-transplantation cyclophosphamide (PTCy) using non-first-degree relatives are unknown. We evaluated 33 consecutive adult patients (median age, 56 years) with hematologic malignancies who underwent NMA haplo T cell-replete BMT with PTCy at Johns Hopkins using second- or third-degree related donors. Donors consisted of 10 nieces (30%), 9 nephews (27%), 7 first cousins (21%), 5 grandchildren (15%), and 2 uncles (6%). Thirty-one patients (94%) reached full donor chimerism by day 60. The estimated cumulative incidence (CuI) of grades II to IV acute graft-versus-host disease (aGVHD) at day 180 was 24% (90% confidence interval [CI], 9% to 38%). Only 1 patient experienced grades III to IV aGVHD. At 1 year the CuI of chronic GVHD was 10% (90% CI, 0% to 21%). The CuI of nonrelapse mortality at 1 year was 5% (90% CI, 0% to 14%). At 1 year the probability of relapse was 31% (90% CI, 12% to 49%), progression-free survival 64% (90% CI, 48% to 86%), and overall survival 95% (90% CI, 87% to 100%). The 1-year probability of GVHD-free, relapse-free survival was 57% (90% CI, 41% to 79%). NMA haplo BMT with PTCy from non-first-degree relatives is an acceptably safe and effective alternative donor platform, with results similar to those seen with first-degree relatives.
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Affiliation(s)
- Hany Elmariah
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yvette L Kasamon
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marianna Zahurak
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen W Macfarlane
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Noah Tucker
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary L Rosner
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nina Wagner-Johnston
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lode J Swinnen
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carol Ann Huff
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William H Matsui
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Douglas E Gladstone
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shannon R McCurdy
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ivan Borrello
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian B Gocke
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Satish Shanbhag
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kenneth R Cooke
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed Abbas Ali
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Brodsky
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy E DeZern
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard F Ambinder
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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33
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McCurdy SR, Kanakry CG, Tsai HL, Kasamon YL, Showel MM, Bolaños-Meade J, Huff CA, Borrello I, Matsui WH, Brodsky RA, Ambinder RF, Bettinotti MP, Fuchs EJ, Rosner GL, Jones RJ, Luznik L. Grade II Acute Graft-versus-Host Disease and Higher Nucleated Cell Graft Dose Improve Progression-Free Survival after HLA-Haploidentical Transplant with Post-Transplant Cyclophosphamide. Biol Blood Marrow Transplant 2018; 24:343-352. [PMID: 29055682 PMCID: PMC6464126 DOI: 10.1016/j.bbmt.2017.10.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 08/12/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022]
Abstract
Compared with standard graft-versus-host disease (GVHD) prophylaxis platforms, post-transplantation cyclophosphamide (PTCy) after T cell-replete HLA-haploidentical (haplo) bone marrow transplantation (BMT) reduces the risk of grades III to IV acute (a) and chronic (c) GVHD, but maintains similar rates of grade II aGVHD. Given that mild GVHD has been associated with reduced treatment failure in HLA-matched BMT, we evaluated the risk factors for and effects of GVHD on survival in 340 adults with hematologic malignancies who engrafted after nonmyeloablative haplo-BMT with PTCy, mycophenolate mofetil, and tacrolimus. The cumulative incidence at 100 days of grade II and grades III to IV aGVHD were 30% (95% confidence interval [CI], 25% to 35%) and 2% (95% CI, 1% to 4%), respectively. The 1-year cumulative incidence of cGVHD was 10% (95% CI, 7% to 13%). In landmark analyses at 100 days, the 4-year probabilities of overall survival (OS) and progression-free survival (PFS) were, 48% (95% CI, 41% to 56%) and 39% (95% CI, 32% to 47%) for patients without grades II to IV aGVHD, compared with 63% (95% CI, 53% to 73%) and 59% (95% CI, 50% to 71%) for patients with grade II aGVHD (P = .05 and P = .009). In multivariable modeling, when compared with patients who never experienced GVHD, the hazard ratio (HR) for OS and PFS in patients with grade II aGVHD was .78 (95% CI, .54 to 1.13; P = .19) and .69 (95% CI, .48 to .98; P = .04). Higher nucleated cell graft dose was also associated with improved OS (HR, .88; 95% CI, .78 to 1.00; P = .05) and PFS (HR, .89; 95% CI, .79 to 1.0; P = .05) and decreased risk of grades III to IV aGVHD (subdistribution HR, .66; 95% CI, .46 to .96; P = .03). PTCy reduces grades III to IV aGVHD and cGVHD, but retains similar incidence of grade II aGVHD, the development of which improves PFS. Higher nucleated cell graft dose goals may also improve survival after nonmyeloablative haplo-BMT with PTCy.
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Affiliation(s)
- Shannon R McCurdy
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Christopher G Kanakry
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hua-Ling Tsai
- Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Yvette L Kasamon
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Margaret M Showel
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carol Ann Huff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ivan Borrello
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William H Matsui
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Brodsky
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard F Ambinder
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria P Bettinotti
- Immunogenetics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary L Rosner
- Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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34
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Kasamon YL, Fuchs EJ, Zahurak M, Rosner GL, Symons HJ, Gladstone DE, Huff CA, Swinnen LJ, Brodsky RA, Matsui WH, Borrello I, Shanbhag S, Cooke KR, Ambinder RF, Luznik L, Bolaños-Meade J, Jones RJ. Shortened-Duration Tacrolimus after Nonmyeloablative, HLA-Haploidentical Bone Marrow Transplantation. Biol Blood Marrow Transplant 2018; 24:1022-1028. [PMID: 29353109 DOI: 10.1016/j.bbmt.2018.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 09/22/2017] [Accepted: 01/08/2018] [Indexed: 11/17/2022]
Abstract
With post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis, nonmyeloablative HLA-haploidentical (NMA haplo) and HLA-matched blood or marrow transplantation (BMT) have comparable outcomes. Early discontinuation of immunosuppression may reduce the risk of relapse and improve immune reconstitution, but may increase the risk of GVHD. We conducted a prospective trial of NMA haplo BMT for patients with hematologic malignancies (median age, 61 years), evaluating the safety of early discontinuation of tacrolimus. All patients received T cell-replete bone marrow followed by high-dose PTCy, mycophenolate mofetil, and tacrolimus. Tacrolimus was prespecified to stop without taper at day +90, +60, or +120, contingent on having ≥5% donor T cells, no relapse, and no grade II-IV acute or significant chronic GVHD. Safety stopping rules were based on ≥5% graft failure, ≥10% nonrelapse mortality (NRM), or a ≥20% combined incidence of severe acute and chronic GVHD from the tacrolimus stop date through day +180. Of the 47 patients in the day +90 arm, 23 (49%) stopped tacrolimus as planned. Of the 55 patients in the day +60 arm, 38 (69%) stopped as planned. Safety stopping criteria were not met. In both arms, at day +180, the probability of grade II-IV acute GVHD was <40%, that of grade III-IV acute GVHD was <8%, and that of NRM was <5%. The 1-year probabilities of chronic GVHD and NRM were <15% and <10%, respectively, in both arms. The 1-year GVHD-free relapse-free survival was higher in the day 60 arm. Thus, stopping tacrolimus as early as day +60 is feasible and carries acceptable risks after NMA haplo BMT with PTCy. This approach may facilitate post-transplantation strategies for relapse reduction.
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Affiliation(s)
- Yvette L Kasamon
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marianna Zahurak
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary L Rosner
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heather J Symons
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Douglas E Gladstone
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carol Ann Huff
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lode J Swinnen
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Brodsky
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William H Matsui
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ivan Borrello
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Satish Shanbhag
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kenneth R Cooke
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard F Ambinder
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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35
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Pasquini MC, Logan B, Jones RJ, Alousi AM, Appelbaum FR, Bolaños-Meade J, Flowers MED, Giralt S, Horowitz MM, Jacobsohn D, Koreth J, Levine JE, Luznik L, Maziarz R, Mendizabal A, Pavletic S, Perales MA, Porter D, Reshef R, Weisdorf D, Antin JH. Blood and Marrow Transplant Clinical Trials Network Report on the Development of Novel Endpoints and Selection of Promising Approaches for Graft-versus-Host Disease Prevention Trials. Biol Blood Marrow Transplant 2018; 24:1274-1280. [PMID: 29325830 DOI: 10.1016/j.bbmt.2018.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 11/02/2017] [Accepted: 01/02/2018] [Indexed: 11/26/2022]
Abstract
Graft-versus-host disease (GVHD) is a common complication after hematopoietic cell transplantation (HCT) and associated with significant morbidity and mortality. Preventing GVHD without chronic therapy or increasing relapse is a desired goal. Here we report a benchmark analysis to evaluate the performance of 6 GVHD prevention strategies tested at single institutions compared with a large multicenter outcomes database as a control. Each intervention was compared with the control for the incidence of acute and chronic GVHD and overall survival and against novel composite endpoints: acute and chronic GVHD, relapse-free survival (GRFS), and chronic GVHD, relapse-free survival (CRFS). Modeling GRFS and CRFS using the benchmark analysis further informed the design of 2 clinical trials testing GVHD prophylaxis interventions. This study demonstrates the potential benefit of using an outcomes database to select promising interventions for multicenter clinical trials and proposes novel composite endpoints for use in GVHD prevention trials.
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Affiliation(s)
- Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Brent Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins Hospital, Baltimore, Maryland
| | - Amin M Alousi
- Department of Stem Cell Transplantation, Division of Cancer Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Jacobsohn
- Division of Blood and Marrow Transplantation Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC
| | - John Koreth
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John E Levine
- Blood and Marrow Transplant Program, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leo Luznik
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins Hospital, Baltimore, Maryland
| | - Richard Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Steven Pavletic
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | | | - David Porter
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ran Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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36
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Ghosh N, Ye X, Tsai HL, Bolaños-Meade J, Fuchs EJ, Luznik L, Swinnen LJ, Gladstone DE, Ambinder RF, Varadhan R, Shanbhag S, Brodsky RA, Borrello IM, Jones RJ, Matsui W, Huff CA. Allogeneic Blood or Marrow Transplantation with Post-Transplantation Cyclophosphamide as Graft-versus-Host Disease Prophylaxis in Multiple Myeloma. Biol Blood Marrow Transplant 2017; 23:1903-1909. [PMID: 28711728 DOI: 10.1016/j.bbmt.2017.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 04/18/2017] [Accepted: 07/02/2017] [Indexed: 02/07/2023]
Abstract
Allogeneic blood or marrow transplantation (alloBMT) may lead to long-term disease control in patients with multiple myeloma (MM). However, historically, the use of alloBMT in MM has been limited by its high nonrelapse mortality (NRM) rates, primarily from graft-versus-host disease (GVHD). We previously demonstrated that post-transplantation cyclophosphamide (PTCy) decreases the toxicities of both acute and chronic GVHD after alloBMT. Here, we examine the impact of PTCy in patients with MM undergoing alloBMT at Johns Hopkins Hospital. From 2003 to 2011, 39 patients with MM underwent bone marrow or peripheral blood alloBMT from HLA-matched related/unrelated or haploidentical related donors after either myeloablative or nonmyeloablative conditioning. Post-transplantation GVHD prophylaxis consisted of cyclophosphamide (50 mg/kg) on days +3 and +4 with or without mycophenolate mofetil and tacrolimus. Engraftment was detected in 95% of patients, with neutrophil and platelet recovery at a median of 15 and 16 days, respectively. The cumulative incidences of acute grades 2 to 4 and grades 3 and 4 GVHD were .41 and .08, respectively, and no cases of grade 4 acute GVHD were observed. The cumulative incidence of chronic GVHD was .13. One patient succumbed to NRM. All cases of chronic GVHD involved extensive disease and 60% of these patients received systemic therapy with complete resolution. After alloBMT, the overall response rate was 62% with complete, very good partial, and partial response rates of 26%, 21%, and 15%, respectively. The median progression-free survival was 12 months and was associated with the depth of response but not cytogenetic risk. The estimated cumulative incidence of relapse was .46 (95% confidence interval [CI], .3 to .62) at 1 year and .56 (95% CI, .41 to .72) at 2 years. At last follow-up, 23% of patients remain without evidence of disease at a median follow-up of 10.3 years after alloBMT. The median overall survival was 4.4 years and the 5-year and 10-year overall survival probabilities were 49% (95% CI, 35% to 67%) and 43% (95% CI, 29% to 62%), respectively. The use of PTCy after alloBMT for MM is feasible and results in low NRM and GVHD rates. The safety of this approach may allow the development of novel post-transplantation maintenance strategies to improve long-term disease control.
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Affiliation(s)
- Nilanjan Ghosh
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Xiaobu Ye
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hua-Ling Tsai
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Ephraim J Fuchs
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Leo Luznik
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lode J Swinnen
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Ravi Varadhan
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Satish Shanbhag
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert A Brodsky
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ivan M Borrello
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Richard J Jones
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - William Matsui
- School of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Carol Ann Huff
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Hamadani M, Kanate AS, DiGilio A, Ahn KW, Smith SM, Lee JW, Ayala E, Chao N, Hari P, Bolaños-Meade J, Gress R, Smedegaard Anderson N, Chen YB, Farooq U, Schiller G, Yared J, Sureda A, Fenske TS, Olteanu H. Allogeneic Hematopoietic Cell Transplantation for Aggressive NK Cell Leukemia. A Center for International Blood and Marrow Transplant Research Analysis. Biol Blood Marrow Transplant 2017; 23:853-856. [PMID: 28161608 DOI: 10.1016/j.bbmt.2017.01.082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 01/10/2017] [Accepted: 01/28/2017] [Indexed: 12/20/2022]
Abstract
Aggressive NK cell leukemia (ANKL) is an exceedingly rare form of leukemia and carries a poor prognosis, with a median survival of only 2 months. Using the Center for International Blood and Marrow Transplant Research database, we evaluated outcomes of allogeneic hematopoietic cell transplantation (alloHCT) in patients with ANKL. Twenty-one patients with a centrally confirmed diagnosis of ANKL were included. Median patient age was 42 years and 15 patients (71%) were Caucasian. Fourteen patients (67%) were in complete remission (CR) at the time of alloHCT, and 5 patients had active disease. Median follow-up of survivors was 25 months (range, 12 to 116). The 2-year estimates of nonrelapse mortality, relapse/progression, progression-free (PFS), and overall survival (OS) were 21%, 59%, 20%, and 24%, respectively. The 2-year PFS of patients in CR at the time of alloHCT was significantly better than that of patients with active disease at transplantation (30% versus 0%; P = .001). The 2-year OS in similar order was 38% versus 0% (P < .001). In conclusion, this registry analysis that included majority non-Asian patient population shows that alloHCT can provide durable disease control in a subset of ANKL patients. Achieving CR before transplantation appears to be a prerequisite for successful transplantation outcomes.
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Affiliation(s)
- Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Abraham S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Alyssa DiGilio
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kwang Woo Ahn
- 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
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Jong Wook Lee
- Division of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ernesto Ayala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nelson Chao
- Division of Cell Therapy and Hematologica, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Parameswaran Hari
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Ronald Gress
- NIH-NCI Experimental Transplantation and Immunology Branch, Bethesda, Maryland
| | | | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Umar Farooq
- University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Gary Schiller
- Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jean Yared
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Anna Sureda
- Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Horatiu Olteanu
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
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38
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McCurdy SR, Kasamon YL, Kanakry CG, Bolaños-Meade J, Tsai HL, Showel MM, Kanakry JA, Symons HJ, Gojo I, Smith BD, Bettinotti MP, Matsui WH, Dezern AE, Huff CA, Borrello I, Pratz KW, Gladstone DE, Swinnen LJ, Brodsky RA, Levis MJ, Ambinder RF, Fuchs EJ, Rosner GL, Jones RJ, Luznik L. Comparable composite endpoints after HLA-matched and HLA-haploidentical transplantation with post-transplantation cyclophosphamide. Haematologica 2016; 102:391-400. [PMID: 27846611 DOI: 10.3324/haematol.2016.144139] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 10/17/2016] [Indexed: 12/16/2022] Open
Abstract
Composite endpoints that not only encompass mortality and relapse, but other critical post-transplant events such as graft-versus-host disease, are being increasingly utilized to quantify survival without significant morbidity after allogeneic blood or marrow transplantation. High-dose, post-transplantation cyclophosphamide reduces severe graft-versus-host disease with allogeneic marrow transplantation, making composite endpoints after this management particularly interesting. We retrospectively analyzed 684 adults with hematologic malignancies who received T-cell-replete bone marrow grafts and cyclophosphamide after myeloablative HLA-matched related (n=192) or unrelated (n=120), or non-myeloablative HLA-haploidentical (n=372) donor transplantation. The median follow up was 4 (range, 0.02-11.4) years. Graft-versus-host disease-free, relapse-free survival was defined as the time after transplantation without grade III-IV acute graft-versus-host disease, chronic graft-versus-host disease requiring systemic treatment, relapse, or death. Chronic graft-versus-host disease-free, relapse-free survival was defined as the time after transplantation without moderate or severe chronic graft-versus-host disease, relapse, or death. One-year graft-versus-host disease-free, relapse-free survival and chronic graft-versus-host disease-free, relapse-free survival estimates were, respectively, 47% (95% CI: 41-55%) and 53% (95% CI: 46-61%) after myeloablative HLA-matched related, 42% (95% CI: 34-52%) and 52% (95% CI: 44-62%) after myeloablative HLA-matched unrelated, and 45% (95% CI: 40-50%) and 50% (95% CI: 45-55%) after non-myeloablative HLA-haploidentical donor transplantation. In multivariable models, there were no differences in graft-versus-host disease-free, or chronic graft-versus-host disease-free, relapse-free survival after either myeloablative HLA-matched unrelated or non-myeloablative HLA-haploidentical, compared with myeloablative HLA-matched related donor transplantation. Although limited by inclusion of dissimilar cohorts, we found that post-transplantation cyclophosphamide-based platforms yield comparable composite endpoints across conditioning intensity, donor type, and HLA match.
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Affiliation(s)
- Shannon R McCurdy
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yvette L Kasamon
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher G Kanakry
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Bolaños-Meade
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hua-Ling Tsai
- Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Margaret M Showel
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer A Kanakry
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heather J Symons
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivana Gojo
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B Douglas Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria P Bettinotti
- Immunogenetics Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William H Matsui
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy E Dezern
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol Ann Huff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Borrello
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Keith W Pratz
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas E Gladstone
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lode J Swinnen
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert A Brodsky
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark J Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard F Ambinder
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary L Rosner
- Immunogenetics Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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39
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Gladstone DE, Petri M, Bolaños-Meade J, Dezern AE, Jones RJ, Fine D, Brodsky RA. Long-term systemic lupus erythematosus disease control after allogeneic bone marrow transplantation. Lupus 2016; 26:773-776. [PMID: 27687020 DOI: 10.1177/0961203316669242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/17/2022]
Abstract
Systemic lupus erythematosus (SLE), a disorder of the immune system, is potentially curable by allogeneic bone marrow transplantation (alloBMT). Until recently, alloBMT was limited by donor availability and toxicity. Reduced intensity conditioning (RIC) combined with post-transplantation cyclophosphamide (PTCy) has improved the availability and safety of alloBMT permitting its exploration in severe-refractory autoimmune illnesses. We report the six-year follow-up of a young female whose refractory SLE-associated nephrosis resolved after RIC alloBMT with PTCy.
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Affiliation(s)
- D E Gladstone
- Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - M Petri
- Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - J Bolaños-Meade
- Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - A E Dezern
- Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - R J Jones
- Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - D Fine
- Johns Hopkins Hospital and Health System, Baltimore, MD, USA
| | - R A Brodsky
- Johns Hopkins Hospital and Health System, Baltimore, MD, USA
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40
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Ghosh N, Karmali R, Rocha V, Ahn KW, DiGilio A, Hari PN, Bachanova V, Bacher U, Dahi P, de Lima M, D'Souza A, Fenske TS, Ganguly S, Kharfan-Dabaja MA, Prestidge TD, Savani BN, Smith SM, Sureda AM, Waller EK, Jaglowski S, Herrera AF, Armand P, Salit RB, Wagner-Johnston ND, Fuchs E, Bolaños-Meade J, Hamadani M. Reduced-Intensity Transplantation for Lymphomas Using Haploidentical Related Donors Versus HLA-Matched Sibling Donors: A Center for International Blood and Marrow Transplant Research Analysis. J Clin Oncol 2016; 34:3141-9. [PMID: 27269951 DOI: 10.1200/jco.2015.66.3476] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Related donor haploidentical hematopoietic cell transplantation (Haplo-HCT) using post-transplantation cyclophosphamide (PT-Cy) is increasingly used in patients lacking HLA-matched sibling donors (MSD). We compared outcomes after Haplo-HCT using PT-Cy with MSD-HCT in patients with lymphoma, using the Center for International Blood and Marrow Transplant Research registry. MATERIALS AND METHODS We evaluated 987 adult patients undergoing either Haplo-HCT (n = 180) or MSD-HCT (n = 807) following reduced-intensity conditioning regimens. The haploidentical group received graft-versus-host disease (GVHD) prophylaxis with PT-Cy with or without a calcineurin inhibitor and mycophenolate. The MSD group received calcineurin inhibitor-based GVHD prophylaxis. RESULTS Median follow-up of survivors was 3 years. The 28-day neutrophil recovery was similar in the two groups (95% v 97%; P = .31). The 28-day platelet recovery was delayed in the haploidentical group compared with the MSD group (63% v 91%; P = .001). Cumulative incidence of grade II to IV acute GVHD at day 100 was similar between the two groups (27% v 25%; P = .84). Cumulative incidence of chronic GVHD at 1 year was significantly lower after Haplo-HCT (12% v 45%; P < .001), and this benefit was confirmed on multivariate analysis (relative risk, 0.21; 95% CI, 0.14 to 0.31; P < .001). For Haplo-HCT v MSD-HCT, 3-year rates of nonrelapse mortality (15% v 13%; P = .41), relapse/progression (37% v 40%; P = .51), progression-free survival (48% v 48%; P = .96), and overall survival (61% v 62%; P = .82) were similar. Multivariate analysis showed no significant difference between Haplo-HCT and MSD-HCT in terms of nonrelapse mortality (P = .06), progression/relapse (P = .10), progression-free survival (P = .83), and overall survival (P = .34). CONCLUSION Haplo-HCT with PT-Cy provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic GVHD.
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Affiliation(s)
- Nilanjan Ghosh
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Reem Karmali
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Vanderson Rocha
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Kwang Woo Ahn
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Alyssa DiGilio
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Parameswaran N Hari
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Veronika Bachanova
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Ulrike Bacher
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Parastoo Dahi
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Marcos de Lima
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Anita D'Souza
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Timothy S Fenske
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Siddhartha Ganguly
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Mohamed A Kharfan-Dabaja
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Tim D Prestidge
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Bipin N Savani
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Sonali M Smith
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Anna M Sureda
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Edmund K Waller
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Samantha Jaglowski
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Alex F Herrera
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Philippe Armand
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Rachel B Salit
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Nina D Wagner-Johnston
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Ephraim Fuchs
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Javier Bolaños-Meade
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD
| | - Mehdi Hamadani
- Nilanjan Ghosh, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; Reem Karmali, Rush University Medical Center; Sonali M. Smith, The University of Chicago, Chicago, IL; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Kwang Woo Ahn, Alyssa DiGilio, and Mehdi Hamadani, Medical College of Wisconsin & Center for International Blood and Marrow Transplant Research; Parameswaran N. Hari and Anita D'Souza, Medical College of Wisconsin; Timothy S. Fenske, Froedtert Memorial Lutheran Hospital, Milwaukee, WI; Veronika Bachanova, University of Minnesota Medical Center, Minneapolis, MN; Ulrike Bacher, University Medicine Goettingen and University Cancer Center Hamburg, Hamburg, Germany; Parastoo Dahi, Memorial Sloan Kettering Cancer Center-Adults, New York, NY; Marcos de Lima, University Hospitals Case Medical Center, Cleveland; Samantha Jaglowski, The Ohio State University Medical Center, Columbus, OH; Siddhartha Ganguly, University of Kansas Medical Center, Kansas City, KS; Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Tim D. Prestidge, Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand; Bipin N. Savani, Vanderbilt University Medical Center, Nashville, TN; Anna M. Sureda, European Group for Blood and Marrow Transplantation and Hospital Duran I Reynals, Barcelona, Spain; Edmund K. Waller, Winship Cancer Institute, Emory University, Atlanta, GA; Alex F. Herrera, City of Hope National Medical Center, Duarte, CA; Philippe Armand, Dana-Farber Cancer Institute, Boston, MA; Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA; and Nina D. Wagner-Johnston, Ephraim Fuchs, and Javier Bolaños-Meade, Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore, MD.
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Carpenter PA, Logan BR, Lee SJ, Weisdorf DJ, Johnston L, Costa LJ, Kitko CL, Bolaños-Meade J, Alousi AM, Horowitz MM, Abhyankar S, Waller EK, Mendizabal A, Wang Y, Lazaryan A, Carter SL, Nemecek ER, Pavletic SZ, Cutler CS, Arora M. Prednisone (PDN)/Sirolimus (SRL) Compared to PDN/SRL/Calcineurin Inhibitor (CNI) as Treatment for Chronic Graft-Versus-Host-Disease (cGVHD): A Randomized Phase II Study from the Blood and Marrow Transplant Clinical Trials Network. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lombardi LR, Kanakry CG, Zahurak M, Durakovic N, Bolaños-Meade J, Kasamon YL, Gladstone DE, Matsui W, Borrello I, Huff CA, Swinnen LJ, Brodsky RA, Ambinder RF, Fuchs EJ, Rosner GL, Jones RJ, Luznik L. Therapeutic drug monitoring for either oral or intravenous busulfan when combined with pre- and post-transplantation cyclophosphamide. Leuk Lymphoma 2015; 57:666-75. [PMID: 26292764 DOI: 10.3109/10428194.2015.1071488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/13/2022]
Abstract
Busulfan (Bu)/cyclophosphamide (Cy) is a standard conditioning platform for allogeneic transplantation. We developed a strategy separating the Cy into two pre/post-transplantation doses (PTCy), providing myeloablative conditioning and single-agent graft-versus-host disease (GVHD) prophylaxis. We investigated the impact of Bu route on treatment-related toxicity for 131 consecutive adult patients. Busulfan was administered in four daily divided doses either orally (n = 72) or intravenously (n = 59) with pharmacokinetics on the first-dose and as necessary on subsequent doses to achieve a target area-under-the-concentration-curve (AUC) of 800-1400 μmol*min/L per dose. BuCy/PTCy with pharmacokinetics is well-tolerated with low treatment-related toxicity. Hepatic veno-occlusive disease incidence was 6% with two fatal events. Bu administration route in the context of BuCy/PTCy did not statistically impact hepatotoxicity, GVHD, relapse, disease-free survival, or overall survival. The BuCy/PTCy platform has a low incidence of treatment-related toxicity, including hepatotoxicity, in hematologic malignancies when using pharmacokinetics for a target AUC of 800-1400 μmol*min/L, irrespective of Bu administration route.
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Affiliation(s)
- Lindsey R Lombardi
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Christopher G Kanakry
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Marianna Zahurak
- b Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA
| | - Nadira Durakovic
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Javier Bolaños-Meade
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Yvette L Kasamon
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Douglas E Gladstone
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - William Matsui
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Ivan Borrello
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Carol Ann Huff
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Lode J Swinnen
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Robert A Brodsky
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Richard F Ambinder
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Ephraim J Fuchs
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Gary L Rosner
- b Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA
| | - Richard J Jones
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
| | - Leo Luznik
- a Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore , MD , USA and
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Kasamon YL, Bolaños-Meade J, Prince GT, Tsai HL, McCurdy SR, Kanakry JA, Rosner GL, Brodsky RA, Perica K, Smith BD, Gladstone DE, Swinnen LJ, Showel MM, Matsui WH, Huff CA, Borrello I, Pratz KW, McDevitt MA, Gojo I, Dezern AE, Shanbhag S, Levis MJ, Luznik L, Ambinder RF, Fuchs EJ, Jones RJ. Outcomes of Nonmyeloablative HLA-Haploidentical Blood or Marrow Transplantation With High-Dose Post-Transplantation Cyclophosphamide in Older Adults. J Clin Oncol 2015; 33:3152-61. [PMID: 26261255 DOI: 10.1200/jco.2014.60.4777] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Recent advances in nonmyeloablative (NMA), related HLA-haploidentical blood or marrow transplantation (haplo-BMT) have expanded the donor pool. This study evaluated the effect of age on NMA haplo-BMT outcomes in patients age 50 to 75 years. PATIENTS AND METHODS A retrospective analysis was performed of 271 consecutive patients with hematologic malignancies, age 50 to 75 years, who received NMA, T-cell-replete haplo-BMT with high-dose post-transplantation cyclophosphamide. RESULTS The median age was 61 years, with 115 patients (42%) age 50 to 59, 129 (48%) age 60 to 69, and 27 (10%) age 70 to 75 years. Overall, 84% of patients had intermediate- or high-/very high-risk disease. The 6-month probabilities of grade 3 or 4 acute graft-versus-host disease (GVHD) and nonrelapse mortality (NRM) were 3% and 8%, respectively. Patients in their 50s, 60s, and 70s had 6-month NRM probabilities of 8%, 9%, and 7%, respectively (P=.20). With a median follow-up of 4 years, corresponding 3-year progression-free survival probabilities were 39%, 35%, and 33% (P=.65), and corresponding 3-year overall survival probabilities were 48%, 45%, and 44% (P=.66). Three-year progression-free survival probabilities were 40% in acute myeloid leukemia (n=65), 39% in aggressive non-Hodgkin lymphoma (n=83), and 37% in indolent or mantle-cell lymphoma (n=65). Older patient age was associated with a significantly higher risk of grade 2 to 4 acute GVHD but not grade 3 to 4 acute or chronic GVHD. No statistically significant associations were found between older age (relative to age 50 to 59 years or as a continuous variable) and NRM, relapse, or survival. CONCLUSION NMA haplo-BMT with post-transplantation cyclophosphamide has encouraging safety and survival outcomes in patients age 50 to 75 years. In patients otherwise fit for BMT, the results support consideration of this approach despite advanced age.
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Affiliation(s)
| | | | | | - Hua-Ling Tsai
- All authors: Johns Hopkins University, Baltimore, MD
| | | | | | - Gary L Rosner
- All authors: Johns Hopkins University, Baltimore, MD
| | | | - Karlo Perica
- All authors: Johns Hopkins University, Baltimore, MD
| | | | | | | | | | | | | | - Ivan Borrello
- All authors: Johns Hopkins University, Baltimore, MD
| | - Keith W Pratz
- All authors: Johns Hopkins University, Baltimore, MD
| | | | - Ivana Gojo
- All authors: Johns Hopkins University, Baltimore, MD
| | - Amy E Dezern
- All authors: Johns Hopkins University, Baltimore, MD
| | | | - Mark J Levis
- All authors: Johns Hopkins University, Baltimore, MD
| | - Leo Luznik
- All authors: Johns Hopkins University, Baltimore, MD
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Kanakry JA, Gocke CD, Bolaños-Meade J, Gladstone DE, Swinnen LJ, Blackford AL, Fuchs EJ, Huff CA, Borrello I, Matsui WH, Brodsky RA, Rosner GL, Shanbhag S, Luznik L, Jones RJ, Ambinder RF, Kasamon YL. Phase II Study of Nonmyeloablative Allogeneic Bone Marrow Transplantation for B Cell Lymphoma with Post-Transplantation Rituximab and Donor Selection Based First on Non-HLA Factors. Biol Blood Marrow Transplant 2015; 21:2115-2122. [PMID: 26183076 DOI: 10.1016/j.bbmt.2015.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 05/07/2015] [Accepted: 07/07/2015] [Indexed: 11/12/2022]
Abstract
Outcomes of nonmyeloablative (NMA), HLA-haploidentical (haplo), related-donor allogeneic blood or marrow transplantation (allo-BMT) with high-dose post-transplantation cyclophosphamide (PTCy) appear to be similar to those using HLA-matched donors. Thus, it may be possible to prioritize donor factors other than HLA matching that could enhance antitumor activity. The Fc receptor polymorphism FCGR3A-158VV may confer greater sensitivity to rituximab than FCGR3A-158FF. In a prospective phase II study of NMA, related-donor allo-BMT with PTCy and post-transplantation rituximab for patients with B cell lymphomas, we hypothesized that donor selection that prioritized FCGR3A-158 polymorphism over HLA matching would be feasible, safe, and improve outcomes. The primary endpoint was 1-year progression-free survival (PFS). Of 83 patients transplanted (median age, 59 years), 69 (83%) received haplo grafts. Fifty-four (65%) received a graft that maintained or improved their Fc receptor polymorphism status. With 2.6-year median follow-up, the 1-year PFS and overall survival (OS) probabilities were 71% and 86%, respectively, with 1-year relapse and nonrelapse mortality (NRM) probabilities of 20% and 8%. At 1 year, the probability of acute grades II to IV graft-versus-host disease (GVHD) was 41%, with acute grades III to IV GVHD probability of 5% and chronic GVHD probability of 11%. Among haplo transplants, the 1-year probabilities of PFS, OS, relapse, and NRM were 70%, 83%, 20%, and 10%, respectively. No differences in outcomes were observed based on donor FCGR3A-158 polymorphism. Excess infection risk was not apparent with post-transplantation rituximab. Although donor selection based on FCGR3A-158 polymorphism was not shown to influence PFS, this study suggests that donor selection based on criteria other than best HLA match is feasible and safe. This study opens the way for the future investigation of donor prioritization based on promising non-HLA factors that may improve antitumor activity and decrease relapse after allo-BMT. This study was registered at www.clinicaltrials.gov as NCT00946023.
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Affiliation(s)
- Jennifer A Kanakry
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | | | - Javier Bolaños-Meade
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Douglas E Gladstone
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Lode J Swinnen
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Amanda L Blackford
- Department of Oncology Biostatistics, Johns Hopkins University, Baltimore, Maryland
| | - Ephraim J Fuchs
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Carol Ann Huff
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Ivan Borrello
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - William H Matsui
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Robert A Brodsky
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Gary L Rosner
- Department of Oncology Biostatistics, Johns Hopkins University, Baltimore, Maryland
| | - Satish Shanbhag
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Leo Luznik
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Richard J Jones
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
| | - Richard F Ambinder
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland.
| | - Yvette L Kasamon
- Department of Oncology, Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, Maryland
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Butts AR, Brown VT, McBride LD, Bolaños-Meade J, Bryk AW. Factors associated with optimized tacrolimus dosing in hematopoietic stem cell transplantation. J Oncol Pharm Pract 2015; 22:275-83. [PMID: 25802301 DOI: 10.1177/1078155215577809] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The primary objective was to analyze the initial tacrolimus concentrations achieved in allogeneic hematopoietic stem cell transplantation patients using the institutional dosing strategy of 1 mg IV daily initiated on day +5. The secondary objectives were to ascertain the tacrolimus dose, days of therapy, and dose changes necessary to achieve a therapeutic concentration, and to identify patient-specific factors that influence therapeutic dose. The relationships between the number of pre-therapeutic days and incidence of graft-versus-host disease and graft failure were delineated. METHODS A retrospective chart review included adult allogeneic hematopoietic stem cell patients who received tacrolimus for graft-versus-host disease prophylaxis in 2012. Descriptive statistics, linear and logistic regression, and graphical analyses were utilized. RESULTS Ninety-nine patients met the inclusion criteria. The first concentration was subtherapeutic (<10 ng/ml) in 97 patients (98%). The median number of days of tacrolimus needed to achieve a therapeutic trough was 10 with a median of two dose changes. The median therapeutic dose was 1.6 mg IV daily. Approximately 75% of patients became therapeutic on ≤ 2 mg IV tacrolimus daily. No relationship was found between therapeutic dose and any patient-specific factor tested, including weight. No relationship was found between the number of days of therapy required to achieve a therapeutic trough and incidence of graft-versus-host disease or graft failure. CONCLUSION An initial flat tacrolimus dose of 1 mg IV daily is a suboptimal approach to achieve therapeutic levels at this institution. A dose of 1.6 mg or 2 mg IV daily is a reasonable alternative to the current institutional practice.
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Affiliation(s)
- Allison R Butts
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, USA
| | - Victoria T Brown
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, USA
| | - Lauren D McBride
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, USA
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, USA
| | - Amy W Bryk
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, USA
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Symons HJ, Chen A, Gamper C, Cooke KR, Showel M, Bolaños-Meade J, Luznik L, Jones RJ, Fuchs EJ. Haploidentical BMT Using Fully Myeloablative Conditioning, T Cell Replete Bone Marrow Grafts, and Post-Transplant Cyclophosphamide (PT/Cy) Has Limited Toxicity and Promising Efficacy in Largest Reported Experience with High Risk Hematologic Malignancies. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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MacMillan ML, Robin M, Harris AC, DeFor TE, Martin PJ, Alousi A, Ho VT, Bolaños-Meade J, Ferrara JLM, Jones R, Arora M, Blazar BR, Holtan SG, Jacobsohn D, Pasquini M, Socie G, Antin JH, Levine JE, Weisdorf DJ. A refined risk score for acute graft-versus-host disease that predicts response to initial therapy, survival, and transplant-related mortality. Biol Blood Marrow Transplant 2015; 21:761-7. [PMID: 25585275 DOI: 10.1016/j.bbmt.2015.01.001] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/02/2015] [Indexed: 11/25/2022]
Abstract
To develop a novel acute graft-versus-host disease (GVHD) risk score, we examined the GVHD clinical stage and grade of 1723 patients at the onset of treatment with systemic steroids. Using clinical grouping, descriptive statistics and recursive partitioning, we identified poorly responsive, high-risk (HR) acute GVHD by the number of involved organs and severity of GVHD at onset. The overall response (complete response/partial response) rate 28 days after initiation of steroid therapy for acute GVHD was lower in the 269 patients with HR-GVHD than in the 1454 patients with standard risk (SR)-GVHD (44% [95% confidence interval (CI) 38% to 50%] versus 68% [95% CI, 66% to 70%], P < .001). Patients with HR-GVHD were less likely to respond at day 28 (odds ratio [OR], .3; 95% CI, .2 to .4; P < .001) and had higher risks of mortality (relative risk, 2.1; 95% CI, 1.7 to 2.6; P < .001) and transplant-related mortality (relative risk, 2.5; 95% CI, 2.0% to 3.2%, P < .001) than patients with SR-GVHD. This refined definition of acute GVHD risk is a better predictor of response, survival, and transplant-related mortality than other published acute GVHD risk scores. Patients with HR-GVHD are candidates for studies investigating new treatment approaches. Likewise, patients with SR-GVHD are candidates for studies investigating less toxic therapy.
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Affiliation(s)
- Margaret L MacMillan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | | | - Andrew C Harris
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan
| | - Todd E DeFor
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Department of Biostatistics and Informatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Paul J Martin
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Amin Alousi
- MD Anderson Cancer Center, Houston, Texas; Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin
| | - Vincent T Ho
- Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin; Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Javier Bolaños-Meade
- Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin; Johns Hopkins University, Baltimore, Maryland
| | - James L M Ferrara
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan; Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin
| | - Richard Jones
- Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin; Johns Hopkins University, Baltimore, Maryland
| | - Mukta Arora
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Bruce R Blazar
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Shernan G Holtan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - David Jacobsohn
- Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin; Children's National Medical Center, Washington, District of Columbia
| | - Marcelo Pasquini
- Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Joseph H Antin
- Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin; Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John E Levine
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan; Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin
| | - Daniel J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Blood and Marrow Transplant Clinical Trials Network GVHD Study Committee, Milwaukee, Wisconsin; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Levine JE, Braun TM, Harris AC, Holler E, Taylor A, Miller H, Magenau J, Weisdorf DJ, Ho VT, Bolaños-Meade J, Alousi AM, Ferrara JLM. A prognostic score for acute graft-versus-host disease based on biomarkers: a multicentre study. Lancet Haematol 2014; 2:e21-9. [PMID: 26687425 DOI: 10.1016/s2352-3026(14)00035-0] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/24/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Graft-versus-host disease (GVHD) is the major cause of non-relapse mortality after allogeneic haemopoietic stem-cell transplantation (SCT). The severity of symptoms at the onset of GVHD does not accurately define risk, and thus most patients are treated alike with high dose systemic corticosteroids. We aimed to define clinically meaningful risk strata for patients with newly diagnosed acute GVHD using plasma biomarkers. METHODS Between April 13, 2000, and May 7, 2013, we prospectively collected plasma from 492 SCT patients with newly diagnosed acute GVHD and randomly assigned (2:1) using a random number generator, conditional on the final two datasets having the same median day of onset, into training (n=328) and test (n=164) sets. We used the concentrations of three recently validated biomarkers (TNFR1, ST2, and Reg3α) to create an algorithm that computed the probability of non-relapse mortality 6 months after GVHD onset for individual patients in the training set alone. We rank ordered the probabilities and identified thresholds that created three distinct non-relapse mortality scores. We evaluated the algorithm in the test set, and again in an independent validation set of an additional 300 patients who underwent stem cell transplant and were enrolled on multicentre clinical trials of primary therapy for acute GVHD. FINDINGS In all three datasets (training, test, and validation), the cumulative incidence of 6-month non-relapse mortality significantly increased as the Ann Arbor GVHD score increased. In the multicentre validation set, scores were 8% (95% CI 3-16) for score 1, 27% (20-34) for score 2, and 46% (33-58) for score 3 (p<0·0001). Conversely, the response to primary GVHD treatment within 28 days decreased as the GVHD score increased 86% for score 1, 67% for score 2, and 46% for score 3 in the multicentre validation set, p<0·0001). INTERPRETATION Biomarker-based scores can be used to guide risk-adapted therapy at the onset of acute GVHD. High risk patients with a score of 3 are candidates for intensive primary therapy, while low risk patients with a score of 1 are candidates for rapid tapers of systemic steroid therapy. FUNDING The National Cancer Institute, the National Heart, Lung, and Blood Institute, the National Institute of Allergy and Infectious Diseases, the Doris Duke Charitable Fund, the American Cancer Society, and the Judith Devries Fund.
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Affiliation(s)
- John E Levine
- Blood & Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA
| | - Thomas M Braun
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Andrew C Harris
- Blood & Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA
| | - Ernst Holler
- Department of Hematology and Oncology, University of Regensburg, Regensburg, Germany
| | - Austin Taylor
- Blood & Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA; The Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Holly Miller
- Blood & Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA
| | - John Magenau
- Blood & Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Weisdorf
- Blood & Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - Vincent T Ho
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Amin M Alousi
- Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, TX, USA
| | - James L M Ferrara
- Blood & Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA; The Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
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Kanakry CG, Ganguly S, Zahurak M, Bolaños-Meade J, Thoburn C, Perkins B, Fuchs EJ, Jones RJ, Hess AD, Luznik L. Aldehyde dehydrogenase expression drives human regulatory T cell resistance to posttransplantation cyclophosphamide. Sci Transl Med 2014; 5:211ra157. [PMID: 24225944 DOI: 10.1126/scitranslmed.3006960] [Citation(s) in RCA: 253] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
High-dose, posttransplantation cyclophosphamide (PTCy) is an effective strategy for preventing graft-versus-host disease (GVHD) after allogeneic blood or marrow transplantation (alloBMT). However, the mechanisms by which PTCy modulates alloimmune responses are not well understood. We studied early T cell reconstitution in patients undergoing alloBMT with PTCy and the effects of mafosfamide, a cyclophosphamide (Cy) analog, on CD4(+) T cells in allogeneic mixed lymphocyte reactions (MLRs) in vitro. Patients exhibited reductions in naïve, potentially alloreactive conventional CD4(+) T cells with relative preservation of memory CD4(+)Foxp3(+) T cells. In particular, CD4(+)CD45RA(-)Foxp3(+hi) effector regulatory T cells (Tregs) recovered rapidly after alloBMT and, unexpectedly, were present at higher levels in patients with GVHD. CD4(+)Foxp3(+) T cells from patients and from allogeneic MLRs expressed relatively high levels of aldehyde dehydrogenase (ALDH), the major in vivo mechanism of Cy resistance. Treatment of MLR cultures with the ALDH inhibitor diethylaminobenzaldehyde reduced the activation and proliferation of CD4(+) T cells and sensitized Tregs to mafosfamide. Finally, removing Tregs from peripheral blood lymphocyte grafts obviated PTCy's GVHD-protective effect in a xenogeneic transplant model. Together, these findings suggest that Treg resistance to Cy through expression of ALDH may contribute to the clinical activity of PTCy in preventing GVHD.
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Affiliation(s)
- Christopher G Kanakry
- The Sidney Kimmel Comprehensive Cancer Center and Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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50
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Mauskopf J, Chirila C, Graham J, Gersten ID, Leather H, Maziarz RT, Baden LR, Bolaños-Meade J, Brown JMY, Walsh TJ, Horowitz MH, Kurtzberg J, Marr KA, Wingard JR. Comparative cost-effectiveness analysis of voriconazole and fluconazole for prevention of invasive fungal infection in patients receiving allogeneic hematopoietic cell transplants. Am J Health Syst Pharm 2014; 70:1518-27. [PMID: 23943184 DOI: 10.2146/ajhp120599] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The cost-effectiveness of voriconazole versus fluconazole prophylaxis against fungal infections in hematopoietic cell transplant (HCT) recipients is investigated. METHODS A decision-analytic model was developed to estimate the drug costs associated with planned or supplemental prophylaxis and empirical therapy and the costs of treating suspected or documented invasive fungal infections (IFIs) in HCT recipients. Published clinical trial data on 599 patients who received 100-180 days of prophylactic therapy with voriconazole or fluconazole were used to model specified IFI-prevention and mortality outcomes; 6-month, 12-month, and lifetime incremental cost-effectiveness ratios (ICERs) were estimated, with a bootstrap analysis performed to reffect the uncertainty of the clinical trial data. RESULTS Estimated mean total prophylaxis and IFI-related costs associated with voriconazole versus fluconazole prophylaxis over 12 months were higher in the entire study population and among patients receiving HCT for diagnoses other than acute myeloid leukemia (AML) but were not significantly different for patients with AML. The cost per IFI avoided ($66,919) and the cost per life-year gained ($5,453) were lower among patients with AML who received voriconazole relative to the full study population. ICERs were more favorable for voriconazole over a 6-month time frame and when modeling was conducted using generic price data. Assuming a threshold value of $50,000 for one year of life gained, the calculated probability of voriconazole being cost-effective was 33% for the full study population and 85% for the AML subgroup. CONCLUSION The decision model indicated that voriconazole prophylaxis was cost-effective for patients undergoing allogeneic HCT for AML.
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Affiliation(s)
- Josephine Mauskopf
- Health Economics, RTI Health Solutions, Research Triangle Park, NC 12194, USA.
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