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Gogineni E, Schaefer D, Ewing A, Andraos T, DiCostanzo D, Weldon M, Christ D, Baliga S, Jhawar S, Mitchell D, Grecula J, Konieczkowski DJ, Palmer J, Jahraus T, Dibs K, Chakravarti A, Martin D, Gamez ME, Blakaj D. Systematic Implementation of Effective Quality Assurance Processes for the Assessment of Radiation Target Volumes in Head and Neck Cancer. Pract Radiat Oncol 2024; 14:e205-e213. [PMID: 38237893 DOI: 10.1016/j.prro.2023.12.012] [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: 07/31/2023] [Revised: 10/17/2023] [Accepted: 12/01/2023] [Indexed: 02/26/2024]
Abstract
PURPOSE Significant heterogeneity exists in clinical quality assurance (QA) practices within radiation oncology departments, with most chart rounds lacking prospective peer-reviewed contour evaluation. This has the potential to significantly affect patient outcomes, particularly for head and neck cancers (HNC) given the large variance in target volume delineation. With this understanding, we incorporated a prospective systematic peer contour-review process into our workflow for all patients with HNC. This study aims to assess the effectiveness of implementing prospective peer review into practice for our National Cancer Institute Designated Cancer Center and to report factors associated with contour modifications. METHODS AND MATERIALS Starting in November 2020, our department adopted a systematic QA process with real-time metrics, in which contours for all patients with HNC treated with radiation therapy were prospectively peer reviewed and graded. Contours were graded with green (unnecessary), yellow (minor), or red (major) colors based on the degree of peer-recommended modifications. Contours from November 2020 through September 2021 were included for analysis. RESULTS Three hundred sixty contours were included. Contour grades were made up of 89.7% green, 8.9% yellow, and 1.4% red grades. Physicians with >12 months of clinical experience were less likely to have contour changes requested than those with <12 months (8.3% vs 40.9%; P < .001). Contour grades were significantly associated with physician case load, with physicians presenting more than the median number of 50 cases having significantly less modifications requested than those presenting <50 (6.7% vs 13.3%; P = .013). Physicians working with a resident or fellow were less likely to have contour changes requested than those without a trainee (5.2% vs 12.6%; P = .039). Frequency of major modification requests significantly decreased over time after adoption of prospective peer contour review, with no red grades occurring >6 months after adoption. CONCLUSIONS This study highlights the importance of prospective peer contour-review implementation into systematic clinical QA processes for HNC. Physician experience proved to be the highest predictor of approved contours. A growth curve was demonstrated, with major modifications declining after prospective contour review implementation. Even within a high-volume academic practice with subspecialist attendings, >10% of patients had contour changes made as a direct result of prospective peer review.
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Affiliation(s)
- E Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Schaefer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - A Ewing
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - T Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D DiCostanzo
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - M Weldon
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Christ
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - S Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - S Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - J Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D J Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - J Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - T Jahraus
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - K Dibs
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - A Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Martin
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - M E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - D Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Hudgens S, Verstovsek S, Floden L, Harrison CN, Palmer J, Gupta V, McLornan D, McMullin MF, Kiladjian JJ, Foltz L, Platzbecker U, Fox ML, Mead AJ, Ross DM, Oh ST, Perkins AA, Leahy MF, Deheshi S, Donahue R, Klencke BJ, Mesa RA. Meaningful Symptomatic Change in Patients With Myelofibrosis From the SIMPLIFY Studies. Value Health 2024; 27:607-613. [PMID: 38311180 DOI: 10.1016/j.jval.2024.01.014] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Patients with myelofibrosis develop symptoms due to bone marrow fibrosis, systemic inflammation, and/or organomegaly. Alleviating symptoms improves overall quality of life. Clinical trials have historically defined symptom response as a reduction of at least 50% in Total Symptom Score at week 24 compared with baseline. Whether 50% constitutes a meaningful benefit has not been established. This study determined the meaningful change threshold (MCT) for 2 momelotinib phase III trials, SIMPLIFY-1 and SIMPLIFY-2. METHODS The absolute and percentage MCT was determined using anchor-based methods applied to the modified Myeloproliferative Neoplasm Symptom Assessment Form v2.0 and Patient Global Impression of Change. MCTs were applied retrospectively to determine responder rates. Generalized estimating equations estimated the treatment-related difference in likelihood of improvement. RESULTS In SIMPLIFY-1, a Janus kinase inhibitor-naive population, the MCT was 8 points. In SIMPLIFY-2, a previously Janus kinase inhibitor-treated population, the MCT was 6 points. A 32% MCT was determined in both studies, showing that the historic 50% reduction threshold may be a conservative choice. In SIMPLIFY-1, a similar proportion of patients achieved responder status with 24 weeks of momelotinib or ruxolitinib therapy based on the absolute MCT (39% vs 41%, respectively). In SIMPLIFY-2, a significantly greater proportion of patients treated with momelotinib achieved responder states compared with best available therapy based on absolute and percent change MCTs. CONCLUSIONS This study demonstrates that momelotinib provided clinically meaningful symptom benefit for patients with myelofibrosis and provides insight into the appropriateness of the symptom change threshold used in historical studies.
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Affiliation(s)
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Claire N Harrison
- Department of Haematology, Guy's and St. Thomas' National Health Service Foundation Trust, London, England, UK
| | - Jeanne Palmer
- Department of Hematology, Mayo Clinic, Phoenix, AZ, USA
| | - Vikas Gupta
- Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Donal McLornan
- Department of Haematology, Guy's and St. Thomas' National Health Service Foundation Trust, London, England, UK
| | - Mary Frances McMullin
- School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast City Hospital Trust, Belfast, Northern Ireland, UK
| | - Jean-Jacques Kiladjian
- Université de Paris, AP-HP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, INSERM, Paris, France
| | - Lynda Foltz
- Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Uwe Platzbecker
- Department of Hematology, Hemostaseology, Cellular Therapy and Infectiology, Leipzig University Hospital, Leipzig, Germany
| | - Maria Laura Fox
- Department of Haematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Adam J Mead
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, Oxford, England, UK
| | - David M Ross
- College of Medicine and Public Health, Flinders Medical Centre and University, Adelaide, SA, Australia
| | - Stephen T Oh
- Division of Hematology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew A Perkins
- Department of Haematology, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Michael F Leahy
- Department of Haematology, University of Western Australia, Perth, WA, Australia
| | | | - Rafe Donahue
- Sierra Oncology, a GSK company, San Mateo, CA, USA
| | | | - Ruben A Mesa
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Yacoub A, Borate U, Rampal RK, Ali H, Wang ES, Gerds AT, Hobbs G, Kremyanskaya M, Winton E, O'Connell C, Goel S, Oh ST, Schiller G, McCloskey J, Palmer J, Holmes H, Hager S, Assad A, Erickson-Viitanen S, Zhou F, Daver N. Phase 2 study of add-on parsaclisib for patients with myelofibrosis and suboptimal response to ruxolitinib: final results. Blood Adv 2024; 8:1515-1528. [PMID: 38290135 DOI: 10.1182/bloodadvances.2023011620] [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: 09/07/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024] Open
Abstract
ABSTRACT Ruxolitinib reduces spleen volume, improves symptoms, and increases survival in patients with intermediate- or high-risk myelofibrosis. However, suboptimal response may occur, potentially because of signaling via the phosphoinositide 3-kinase (PI3K)/protein kinase B pathway. This phase 2 study evaluated dosing, efficacy, and safety of add-on PI3Kδ inhibitor parsaclisib for patients with primary or secondary myelofibrosis with suboptimal response to ruxolitinib. Eligible patients remained on a stable ruxolitinib dose and received add-on parsaclisib 10 or 20 mg, once daily for 8 weeks, and once weekly thereafter (daily-to-weekly dosing; n = 32); or parsaclisib 5 or 20 mg, once daily for 8 weeks, then 5 mg once daily thereafter (all-daily dosing; n = 42). Proportion of patients achieving a ≥10% decrease in spleen volume at 12 weeks was 28% for daily-to-weekly dosing and 59.5% for all-daily dosing. Proportions of patients achieving ≥50% decrease at week 12 in Myelofibrosis Symptom Assessment Form and Myeloproliferative Neoplasms Symptom Assessment Form symptom scores were 14% and 18% for daily-to-weekly dosing, and 28% and 32% for all-daily dosing, respectively. Most common nonhematologic treatment-emergent adverse events were nausea (23%), diarrhea (22%), abdominal pain and fatigue (each 19%), and cough and dyspnea (each 18%). New-onset grade 3 and 4 thrombocytopenia were observed in 19% of patients, each dosed daily-to-weekly, and in 26% and 7% of patients dosed all-daily, respectively, managed with dose interruptions. Hemoglobin levels remained steady. The addition of parsaclisib to stable-dose ruxolitinib can reduce splenomegaly and improve symptoms, with manageable toxicity in patients with myelofibrosis with suboptimal response to ruxolitinib. This trial was registered at www.clinicaltrials.gov as #NCT02718300.
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Affiliation(s)
- Abdulraheem Yacoub
- Department of Internal Medicine, University of Kansas Cancer Center, Westwood, KS
| | - Uma Borate
- Department of Medicine, Oregon Health & Science University, Portland, OR
| | - Raajit K Rampal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Eunice S Wang
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Aaron T Gerds
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Gabriela Hobbs
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Marina Kremyanskaya
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, Manhattan, NY
| | - Elliott Winton
- Department of Hematology Oncology, Emory University, Atlanta, GA
| | - Casey O'Connell
- Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Swati Goel
- Department of Medical Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Stephen T Oh
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Gary Schiller
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - James McCloskey
- Department of Leukemia, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - Jeanne Palmer
- Division of Hematology/Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | - Houston Holmes
- Hematology and Medical Oncology, Texas Oncology/Baylor-Sammons Cancer Center, Dallas, TX
| | - Steven Hager
- C CARE, California Cancer Associates for Research & Excellence, Inc, Fresno, CA
| | - Albert Assad
- Oncology Drug Development, Incyte Corporation, Wilmington, DE
| | | | - Feng Zhou
- Biostatistics, Incyte Corporation, Wilmington, DE
| | - Naval Daver
- Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX
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Kremyanskaya M, Kuykendall AT, Pemmaraju N, Ritchie EK, Gotlib J, Gerds A, Palmer J, Pettit K, Nath UK, Yacoub A, Molina A, Saks SR, Modi NB, Valone FH, Khanna S, Gupta S, Verstovsek S, Ginzburg YZ, Hoffman R. Rusfertide, a Hepcidin Mimetic, for Control of Erythrocytosis in Polycythemia Vera. N Engl J Med 2024; 390:723-735. [PMID: 38381675 DOI: 10.1056/nejmoa2308809] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Polycythemia vera is a chronic myeloproliferative neoplasm characterized by erythrocytosis. Rusfertide, an injectable peptide mimetic of the master iron regulatory hormone hepcidin, restricts the availability of iron for erythropoiesis. The safety and efficacy of rusfertide in patients with phlebotomy-dependent polycythemia vera are unknown. METHODS In part 1 of the international, phase 2 REVIVE trial, we enrolled patients in a 28-week dose-finding assessment of rusfertide. Part 2 was a double-blind, randomized withdrawal period in which we assigned patients, in a 1:1 ratio, to receive rusfertide or placebo for 12 weeks. The primary efficacy end point was a response, defined by hematocrit control, absence of phlebotomy, and completion of the trial regimen during part 2. Patient-reported outcomes were assessed by means of the modified Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) patient diary (scores range from 0 to 10, with higher scores indicating greater severity of symptoms). RESULTS Seventy patients were enrolled in part 1 of the trial, and 59 were assigned to receive rusfertide (30 patients) or placebo (29 patients) in part 2. The estimated mean (±SD) number of phlebotomies per year was 8.7±2.9 during the 28 weeks before the first dose of rusfertide and 0.6±1.0 during part 1 (estimated difference, 8.1 phlebotomies per year). The mean maximum hematocrit was 44.5±2.2% during part 1 as compared with 50.0±5.8% during the 28 weeks before the first dose of rusfertide. During part 2, a response was observed in 60% of the patients who received rusfertide as compared with 17% of those who received placebo (P = 0.002). Between baseline and the end of part 1, rusfertide treatment was associated with a decrease in individual symptom scores on the MPN-SAF in patients with moderate or severe symptoms at baseline. During parts 1 and 2, grade 3 adverse events occurred in 13% of the patients, and none of the patients had a grade 4 or 5 event. Injection-site reactions of grade 1 or 2 in severity were common. CONCLUSIONS In patients with polycythemia vera, rusfertide treatment was associated with a mean hematocrit of less than 45% during the 28-week dose-finding period, and the percentage of patients with a response during the 12-week randomized withdrawal period was greater with rusfertide than with placebo. (Funded by Protagonist Therapeutics; REVIVE ClinicalTrials.gov number, NCT04057040.).
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Affiliation(s)
- Marina Kremyanskaya
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Andrew T Kuykendall
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Naveen Pemmaraju
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Ellen K Ritchie
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Jason Gotlib
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Aaron Gerds
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Jeanne Palmer
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Kristen Pettit
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Uttam K Nath
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Abdulraheem Yacoub
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Arturo Molina
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Samuel R Saks
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Nishit B Modi
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Frank H Valone
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Sarita Khanna
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Suneel Gupta
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Srdan Verstovsek
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Yelena Z Ginzburg
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
| | - Ronald Hoffman
- From the Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (M.K., Y.Z.G., R.H.), and the Division of Hematology and Medical Oncology, Weill Cornell Medical College (E.K.R.) - both in New York; the Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL (A.T.K.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (N.P., S.V.); the Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford (J.G.), and Clinical Research and Development, Protagonist Therapeutics, Newark (A.M., S.R.S, N.B.M., F.H.V., S.K., S.G.) - both in California; the Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland (A.G.); the Mayo Clinic, Phoenix, AZ (J.P.); the Rogel Cancer Center, University of Michigan Health, Ann Arbor (K.P.); All India Institute of Medical Sciences, Rishikesh, India (U.K.N.); and the University of Kansas Cancer Center, Westwood (A.Y.)
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5
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Baranwal A, Basmaci R, He R, Viswanatha D, Greipp P, Murthy HS, Foran J, Palmer J, Hogan WJ, Litzow MR, Hefazi M, Mangaonkar A, Shah MV, Al-Kali A, Alkhateeb HB. Genetic features and outcomes of allogeneic transplantation in patients with WT1-mutated myeloid neoplasms. Blood Adv 2024; 8:562-570. [PMID: 38011614 PMCID: PMC10837491 DOI: 10.1182/bloodadvances.2023010960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/05/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
| | - Rami Basmaci
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - David Viswanatha
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Patricia Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
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6
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Gangat N, Karrar O, Iftikhar M, McCullough K, Johnson IM, Abdelmagid M, Abdallah M, Al-Kali A, Alkhateeb HB, Begna KH, Mangaonkar A, Saliba AN, Hefazi Torghabeh M, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Badar T, Murthy H, Foran J, Palmer J, Sproat L, Khera N, Arana Yi C, Tefferi A. Venetoclax and hypomethylating agent combination therapy in newly diagnosed acute myeloid leukemia: Genotype signatures for response and survival among 301 consecutive patients. Am J Hematol 2024; 99:193-202. [PMID: 38071734 DOI: 10.1002/ajh.27138] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 01/21/2024]
Abstract
Venetoclax + hypomethylating agent (Ven-HMA) is currently the standard frontline therapy for older/unfit patients with newly diagnosed acute myeloid leukemia (ND-AML). Our objective in the current retrospective study of 301 adult patients (median age 73 years; 62% de novo) with ND-AML was to identify molecular predictors of treatment response to Ven-HMA and survival; European LeukemiaNet (ELN) genetic risk assignment was favorable 15%, intermediate 16%, and adverse 69%. Complete remission, with (CR) or without (CRi), count recovery, was documented in 182 (60%) patients. In multivariable analysis, inclusive of mutations only, "favorable" predictors of CR/CRi were NPM1 (86% vs. 56%), IDH2 (80% vs. 58%), and DDX41 (100% vs. 58%) and "unfavorable" TP53 (40% vs. 67%), FLT3-ITD (36% vs. 63%), and RUNX1 (44% vs. 64%) mutations; significance was sustained for each mutation after adjustment for age, karyotype, and therapy-related qualification. CR/CRi rates ranged from 36%, in the presence of unfavorable and absence of favorable mutation, to 91%, in the presence of favorable and absence of unfavorable mutation. At median follow-up of 8.5 months, 174 deaths and 41 allogeneic stem cell transplants (ASCT) were recorded. In multivariable analysis, risk factors for inferior survival included failure to achieve CR/CRi (HR 3.4, 95% CI 2.5-4.8), adverse karyotype (1.6, 1.1-2.6), TP53 mutation (1.6, 1.0-2.4), and absence of IDH2 mutation (2.2, 1.0-4.7); these risk factors were subsequently applied to construct an HR-weighted risk model that performed better than the ELN genetic risk model (AIC 1661 vs. 1750): low (n = 130; median survival 28.9 months), intermediate (n = 105; median 9.6 months), and high (n = 66; median 3.1 months; p < .001); survival in each risk category was significantly upgraded by ASCT. The current study identifies genotype signatures for predicting response and proposes a 3-tiered, CR/CRi-based, and genetics-enhanced survival model for AML patients receiving upfront therapy with Ven-HMA.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Omer Karrar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Moazah Iftikhar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Isla M Johnson
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kebede H Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Hemant Murthy
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nandita Khera
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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7
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Baranwal A, Gurney M, Basmaci R, Katamesh B, He R, Viswanatha DS, Greipp P, Foran J, Badar T, Murthy H, Yi CA, Palmer J, Mangaonkar AA, Patnaik MM, Litzow MR, Hogan WJ, Begna K, Gangat N, Tefferi A, Al-Kali A, Shah MV, Alkhateeb HB. Genetic landscape and clinical outcomes of patients with BCOR mutated myeloid neoplasms. Haematologica 2024. [PMID: 38299584 DOI: 10.3324/haematol.2023.284185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 02/02/2024] Open
Abstract
The BCL6-corepressor (BCOR) is a tumor-suppressor gene located on the short arm of chromosome X. Data is limited regarding factors predicting survival in BCOR-mutated (mBCOR) acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We evaluated 138 patients with mBCOR myeloid disorders, of which 36 (26.1%) had AML and 63 (45.6%) had MDS. Sixty-six (47.8%) patients had a normal karyotype while 18 (13%) patients had complex karyotype. BCOR-mutated MDS/AML were highly associated with RUNX1 and U2AF1 comutations. In contrast, TP53 mutation was infrequently seen with mBCOR MDS. Patients with an isolated BCOR mutation had similar survival compared to those with high-risk co-mutations by ELN 2022 criteria (median OS 1.16 vs. 1.27 years, P = 0.46). Complex karyotype adversely impacted survival among mBCOR AML/MDS (HR 4.12, P < 0.001), while allogeneic stem cell transplant (alloSCT) improved survival (HR 0.38, P = 0.04). However, RUNX1 co-mutation was associated with an increased risk of post-alloSCT relapse (HR 88.0, P = 0.02), whereas melphalan-based conditioning was associated with a decreased relapse-risk (HR 0.02, P = 0.01). We conclude that mBCOR is a high-risk feature across MDS/AML and that alloSCT improves survival in this population.
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Affiliation(s)
- Anmol Baranwal
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Cancer Centers of Southwest Oklahoma, Lawton, OK
| | - Mark Gurney
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rami Basmaci
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Bahga Katamesh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rong He
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - David S Viswanatha
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Patricia Greipp
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James Foran
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Talha Badar
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Hemant Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Department of Medicine, Mayo Clinic, Jacksonville, FL
| | - Cecilia Arana Yi
- Division of Hematology, Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - Jeanne Palmer
- Division of Hematology, Department of Medicine, Mayo Clinic, Phoenix, AZ
| | | | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - William J Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Kebede Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Naseema Gangat
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Aref Al-Kali
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mithun V Shah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Hassan B Alkhateeb
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.
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8
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Karrar O, Abdelmagid M, Rana M, Iftikhar M, McCullough K, Al-Kali A, Alkhateeb HB, Begna KH, Elliott MA, Mangaonkar A, Saliba A, Hefazi Torghabeh M, Litzow MR, Hogan W, Shah M, Patnaik MM, Pardanani A, Badar T, Murthy H, Foran J, Palmer J, Sproat L, Khera N, Arana Yi C, Tefferi A, Gangat N. Venetoclax duration (14 vs. 21 vs. 28 days) in combination with hypomethylating agent in newly diagnosed acute myeloid leukemia: Comparative analysis of response, toxicity, and survival. Am J Hematol 2024; 99:E63-E66. [PMID: 38100217 DOI: 10.1002/ajh.27180] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
Overall survival and response rates of 270 patients with newly diagnosed acute myeloid leukemia receiving venetoclax (Ven) plus hypomethylating agent, stratified by Ven dosing schedule (Cycle 1 Ven 14 vs. 21 vs. 28 days).
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Affiliation(s)
- Omer Karrar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maymona Abdelmagid
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Masooma Rana
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Moazah Iftikhar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristen McCullough
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan B Alkhateeb
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede H Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle A Elliott
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek Mangaonkar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Antoine Saliba
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mithun Shah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Animesh Pardanani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Hemant Murthy
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nandita Khera
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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9
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Gangat N, McCullough K, Abdelmagid M, Karrar O, Powell M, Al-Kali A, Alkhateeb H, Begna K, Mangaonkar A, Saliba A, Torghabeh MH, Litzow M, Hogan W, Shah M, Patnaik M, Pardanani A, Badar T, Foran J, Palmer J, Sproat L, Yi CA, Tefferi A. Molecular predictors of response and survival following IDH1/2 inhibitor monotherapy in acute myeloid leukemia. Haematologica 2024; 109:187-292. [PMID: 37534525 PMCID: PMC10772527 DOI: 10.3324/haematol.2023.283732] [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: 06/11/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023] Open
Abstract
Not available.
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Affiliation(s)
| | | | | | - Omer Karrar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - Lisa Sproat
- Division of Hematology, Mayo Clinic, Scottsdale, AZ
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10
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Palmer J. Are transplant indications changing for myelofibrosis? Hematology Am Soc Hematol Educ Program 2023; 2023:676-681. [PMID: 38066916 PMCID: PMC10727025 DOI: 10.1182/hematology.2023000453] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Myelofibrosis is a devastating myeloid malignancy characterized by dysregulation of the JAK-STAT pathway, resulting in splenomegaly, constitutional symptoms, anemia, thrombocytopenia, leukocytosis, and an increased likelihood of progression to acute leukemia. The only curative option is allogeneic stem cell transplantation. The numbers of transplants have been increasing every year, and although there have been improvements in survival, there remain many unanswered questions. In this review, we will evaluate patient selection and appropriate timing for transplantation. We will cover the current prognostic scoring systems, which can aid in the decision of when to move forward with transplant. We will also review the different donor options, as well as the conditioning regimens. The peritransplant management of splenomegaly will be reviewed. We will discuss management of posttransplant complications such as loss of donor chimerism or disease relapse. Finally, we will review what is known about the outlook of patients who have undergone allogeneic stem cell transplant with regards to quality of life and long-term survival.
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Affiliation(s)
- Jeanne Palmer
- Division of Hematology/Medical Oncology, Mayo Clinic, Phoenix, AZ
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11
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Gaulin C, Craig F, Fortin Ensign S, Robetorye R, Gibson S, Kelemen K, Khera N, Leis J, Tsang M, Rosenthal A, Munoz J, Palmer J, Hilal T. Allogeneic hematopoietic stem cell transplantation in adults with dendritic/histiocytic neoplasms. Leuk Lymphoma 2023; 64:2347-2350. [PMID: 37680001 DOI: 10.1080/10428194.2023.2255707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Charles Gaulin
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Fiona Craig
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Phoenix, AZ, USA
| | - Shannon Fortin Ensign
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ryan Robetorye
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Phoenix, AZ, USA
| | - Sarah Gibson
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Phoenix, AZ, USA
| | - Katalin Kelemen
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Phoenix, AZ, USA
| | - Nandita Khera
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jose Leis
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Mazie Tsang
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Allison Rosenthal
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Javier Munoz
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jeanne Palmer
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Talal Hilal
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
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12
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Huff D, Fortin Ensign S, Ryan MS, Palmer J, Munoz J. Histiocytic Sarcoma Treated with Pembrolizumab: A Case Report and Literature Review. J Immunother Precis Oncol 2023; 6:198-202. [PMID: 38143950 PMCID: PMC10734394 DOI: 10.36401/jipo-23-11] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/25/2023] [Accepted: 07/24/2023] [Indexed: 12/26/2023]
Abstract
Histiocytic sarcoma (HS) is a rare hematologic malignancy that has historically been treated with lymphoma-based regimens with a median survival of 6 months. We describe a case of a 51-year-old woman who presented with acute back pain and cord compression. She was diagnosed with HS with diffuse skeletal lesions and high expression of programmed death ligand 1 (PD-L1). She was subsequently treated with chemotherapy plus off-label use of pembrolizumab followed by allogeneic stem cell transplantation. Ultimately, the patient died in the setting of progression of disease 17 months after her stem cell transplantation and 26 months after her diagnosis. This article also presents a literature review of cases of HS treated with programmed death ligand inhibition.
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Affiliation(s)
- Daniel Huff
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - Jeanne Palmer
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Javier Munoz
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
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13
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Gangat N, Ajufo H, Abdelmagid M, Karrar O, McCullough K, Badar T, Foran J, Palmer J, Alkhateeb H, Mangaonkar A, Kuykendall A, Rampal RK, Tefferi A. IDH1/2 inhibitor monotherapy in blast-phase myeloproliferative neoplasms: A multicentre experience. Br J Haematol 2023; 203:e87-e92. [PMID: 37537750 DOI: 10.1111/bjh.19027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Helen Ajufo
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering, New York, New York, USA
| | | | - Omer Karrar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | | | - Raajit K Rampal
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering, New York, New York, USA
| | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Ladbury CJ, Sanchez JF, Chowdhury A, Palmer J, Liu A, Stein A, Htut M, Farol L, Cai JL, Somlo G, Rosenzweig M, Wong JYC, Sahebi F. Phase I Study of Bortezomib, Fludarabine, and Melphalan, with or without Total Marrow Irradiation as Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation in Patients with High-Risk or Relapsed/Refractory Multiple Myeloma. Int J Radiat Oncol Biol Phys 2023; 117:S107-S108. [PMID: 37784283 DOI: 10.1016/j.ijrobp.2023.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Though outcomes of patients with multiple myeloma (MM) have improved, cure remains elusive. Allogeneic hematopoietic stem cell transplantation (allo-sCT) is associated with a lower relapse rate, but its role is hindered due to toxicities. We hypothesized that targeted total body irradiation in the form of total marrow irradiation (TMI) could safely facilitate allo-SCT via an improved toxicity profile. Therefore, we conducted a phase I study to investigate the safety and feasibility of a bortezomib (BTZ), fludarabine (FLU), and melphalan (MEL), with or without TMI, prior to allo-SCT for patients with high-risk (HR) or relapsed/refractory (R/R) MM. MATERIALS/METHODS Between 2012 and 2018 this study enrolled patients with HR or R/R MM on one of two strata, each comprising BTZ dose-escalation cohorts. Patients aged 18-60 with no prior radiation (RT) received TMI at 900 cGy (in 6 fractions delivered twice-daily), FLU, and MEL conditioning, with BTZ added in the second cohort (stratum I). Patients aged 18-70 with prior RT received FLU, MEL, and BTZ, without TMI (stratum II). The primary endpoint was feasibility of escalating doses of BTZ, with or without TMI, defined using a 3+3 design. Dose-limiting toxicity (DLT) was defined as any Grade 3+ Bearman toxicity or prolonged CTCAE v4.0 Grade 4+ neutropenia. Secondary endpoints included treatment response, time to neutrophil and platelet engraftment, incidence of acute (a) and chronic (c) graft-versus-host disease (GVHD), progression-free-survival (PFS), and overall survival (OS). RESULTS Eight patients were enrolled on stratum I. One of three patients in the first cohort of stratum I experienced DLT, which led to expansion to three more patients with no DLT. Cohort 2 enrolled only 2 patients due to low accrual, with BTZ added at 0.5 mg/m2; neither experienced DLT. Nine patients were enrolled on stratum II. Three patients were enrolled on cohort 1 (BTZ 0.5 mg/m2) and none experienced DLT. Three were enrolled on cohort 2 (bortezomib 0.7 mg/m2), and one experienced DLT. Therefore, the cohort expanded to three more patients. One more patient experienced DLT and 0.5 mg/m2 was considered the maximum tolerated dose. There were no primary or secondary graft failures. Complete response was achieved in 7 and 4 patients in strata I and II, respectively. Median follow-up for all patients was 30.7 months (mos) and was 99.8 mos for surviving patients. Median overall survival (OS) on strata I and II were 44.5 mos and 21.6 mos, respectively. Median PFS on strata I and II were 18.1 mos and 8.9 mos, respectively. In strata I, 5 patients developed Grade 2+ aGVHD and 8 developed extensive cGVHD. In strata II, 4 patients developed Grade 2+ aGVHD and 6 developed extensive cGVHD. CONCLUSION The TMI 900 cGy, FLU, and MEL conditioning regimen is considered safe as conditioning for allo-SCT and may warrant further investigation due to favorable response rates and survival; the conditioning regimen of FLU, MEL, and BTZ (0.7 mg/m2) is associated with unacceptable toxicities.
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Affiliation(s)
- C J Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - J F Sanchez
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - A Chowdhury
- Division of Biostatistics, City of Hope National Medical Center, Duarte, CA
| | - J Palmer
- Division of Biostatistics, City of Hope National Medical Center, Duarte, CA
| | - A Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - A Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - M Htut
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - L Farol
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - J L Cai
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - G Somlo
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - M Rosenzweig
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - J Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - F Sahebi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
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15
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Mascarenhas J, Migliaccio AR, Kosiorek H, Bhave R, Palmer J, Kuykendall A, Mesa R, Rampal RK, Gerds AT, Yacoub A, Pettit K, Talpaz M, Komrokji R, Kremyanskaya M, Gonzalez A, Fabris F, Johnson K, Dougherty M, McGovern E, Arango Ossa J, Domenico D, Farnoud N, Weinberg RS, Kong A, Najfeld V, Vannucchi AM, Arciprete F, Zingariello M, Falchi M, Salama ME, Mead-Harvey C, Dueck A, Varricchio L, Hoffman R. A Phase Ib Trial of AVID200, a TGFβ 1/3 Trap, in Patients with Myelofibrosis. Clin Cancer Res 2023; 29:3622-3632. [PMID: 37439808 PMCID: PMC10502472 DOI: 10.1158/1078-0432.ccr-23-0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/09/2023] [Accepted: 07/11/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Myelofibrosis (MF) is a clonal myeloproliferative neoplasm characterized by systemic symptoms, cytopenias, organomegaly, and bone marrow fibrosis. JAK2 inhibitors afford symptom and spleen burden reduction but do not alter the disease course and frequently lead to thrombocytopenia. TGFβ, a pleiotropic cytokine elaborated by the MF clone, negatively regulates normal hematopoiesis, downregulates antitumor immunity, and promotes bone marrow fibrosis. Our group previously showed that AVID200, a potent and selective TGFβ 1/3 trap, reduced TGFβ1-induced proliferation of human mesenchymal stromal cells, phosphorylation of SMAD2, and collagen expression. Moreover, treatment of MF mononuclear cells with AVID200 led to increased numbers of progenitor cells (PC) with wild-type JAK2 rather than JAK2V617F. PATIENTS AND METHODS We conducted an investigator-initiated, multicenter, phase Ib trial of AVID200 monotherapy in 21 patients with advanced MF. RESULTS No dose-limiting toxicity was identified at the three dose levels tested, and grade 3/4 anemia and thrombocytopenia occurred in 28.6% and 19.0% of treated patients, respectively. After six cycles of therapy, two patients attained a clinical benefit by IWG-MRT criteria. Spleen and symptom benefits were observed across treatment cycles. Unlike other MF-directed therapies, increases in platelet counts were noted in 81% of treated patients with three patients achieving normalization. Treatment with AVID200 resulted in potent suppression of plasma TGFβ1 levels and pSMAD2 in MF cells. CONCLUSIONS AVID200 is a well-tolerated, rational, therapeutic agent for the treatment of patients with MF and should be evaluated further in patients with thrombocytopenic MF in combination with agents that target aberrant MF intracellular signaling pathways.
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Affiliation(s)
- John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Heidi Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | - Rupali Bhave
- Comprehensive Cancer Center of Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | | | - Andrew Kuykendall
- Department of Hematologic Malignancy, Moffitt Cancer Center, Tampa, Florida
| | - Ruben Mesa
- Comprehensive Cancer Center of Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Raajit K. Rampal
- Leukemia Service, Department of Medicine, Center for Hematologic Malignancies, Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Aaron T. Gerds
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | | | - Kristen Pettit
- University of Michigan, Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Moshe Talpaz
- University of Michigan, Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Rami Komrokji
- Department of Hematologic Malignancy, Moffitt Cancer Center, Tampa, Florida
| | - Marina Kremyanskaya
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Agapito Gonzalez
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Frank Fabris
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kathryn Johnson
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mikaela Dougherty
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin McGovern
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juan Arango Ossa
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dylan Domenico
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Noushin Farnoud
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Amy Kong
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vesna Najfeld
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Francesca Arciprete
- Unit of Microscopic and Ultrastructural Anatomy, University Campus Bio-Medico, Rome, Italy
| | - Maria Zingariello
- Unit of Microscopic and Ultrastructural Anatomy, University Campus Bio-Medico, Rome, Italy
| | - Mario Falchi
- National HIV/AIDS Research Center, Istituto Superiore di Sanità, Viale Regina Elena Rome Italy
| | | | - Carolyn Mead-Harvey
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | - Amylou Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | - Lilian Varricchio
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronald Hoffman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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16
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Tamari R, McLornan DP, Ahn KW, Estrada-Merly N, Hernández-Boluda JC, Giralt S, Palmer J, Gale RP, DeFilipp Z, Marks DI, van der Poel M, Verdonck LF, Battiwalla M, Diaz MA, Gupta V, Ali H, Litzow MR, Lazarus HM, Gergis U, Bashey A, Liesveld J, Hashmi S, Pu JJ, Beitinjaneh A, Bredeson C, Rizzieri D, Savani BN, Abid MB, Ganguly S, Agrawal V, Ulrike Bacher V, Wirk B, Jain T, Cutler C, Aljurf M, Kindwall-Keller T, Kharfan-Dabaja MA, Hildebrandt GC, Pawarode A, Solh MM, Yared JA, Grunwald MR, Nathan S, Nishihori T, Seo S, Scott BL, Nakamura R, Oran B, Czerw T, Yakoub-Agha I, Saber W. A simple prognostic system in patients with myelofibrosis undergoing allogeneic stem cell transplantation: a CIBMTR/EBMT analysis. Blood Adv 2023; 7:3993-4002. [PMID: 37134306 PMCID: PMC10410129 DOI: 10.1182/bloodadvances.2023009886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
To develop a prognostic model for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) for myelofibrosis (MF), we examined the data of 623 patients undergoing allo-HCT between 2000 and 2016 in the United States (the Center for International Blood and Marrow Transplant Research [CIBMTR] cohort). A Cox multivariable model was used to identify factors prognostic of mortality. A weighted score using these factors was assigned to patients who received transplantation in Europe (the European Bone Marrow Transplant [EBMT] cohort; n = 623). Patient age >50 years (hazard ratio [HR], 1.39; 95% confidence interval [CI], 0.98-1.96), and HLA-matched unrelated donor (HR, 1.29; 95% CI, 0.98-1.7) were associated with an increased hazard of death and were assigned 1 point. Hemoglobin levels <100 g/L at time of transplantation (HR, 1.63; 95% CI, 1.2-2.19) and a mismatched unrelated donor (HR, 1.78; 95% CI, 1.25-2.52) were assigned 2 points. The 3-year overall survival (OS) in patients with a low (1-2 points), intermediate (3-4 points), and high score (5 points) were 69% (95% CI, 61-76), 51% (95% CI, 46-56.4), and 34% (95% CI, 21-49), respectively (P < .001). Increasing score was predictive of increased transplant-related mortality (TRM; P = .0017) but not of relapse (P = .12). The derived score was predictive of OS (P < .001) and TRM (P = .002) but not of relapse (P = .17) in the EBMT cohort as well. The proposed system was prognostic of survival in 2 large cohorts, CIBMTR and EBMT, and can easily be applied by clinicians consulting patients with MF about the transplantation outcomes.
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Affiliation(s)
- Roni Tamari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Donal P. McLornan
- Department of Medicine, University College Hospital, London, United Kingdom
| | - Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sergio Giralt
- Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeanne Palmer
- Department of Medicine, Mayo Clinic Arizona and Phoenix Children’s Hospital, Phoenix, AZ
| | - Robert Peter Gale
- Department of Immunology and Inflammation, Haematology Centre, Imperial College London, London, United Kingdom
| | - Zachariah DeFilipp
- Department of Medicine, Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - David I. Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Marjolein van der Poel
- Division of Hematology, Department of Internal Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leo F. Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Minoo Battiwalla
- Outcomes Research, Sarah Cannon Blood Cancer Network, Nashville, TN
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Vikas Gupta
- Department of Internal Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Haris Ali
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Mark Robert Litzow
- Division of Hematology and Transplant Center, Mayo Clinic, Rochester, MN
| | - Hillard M. Lazarus
- Department of Hematology and Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Usama Gergis
- Division of Hematological Malignancies, Department of Medicine Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Asad Bashey
- Department of Medicine, Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | - Jane Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Jeffrey J. Pu
- Department of Medicine, Banner University Medical Center Tucson, Syracuse, NY
| | - Amer Beitinjaneh
- Divison of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Christopher Bredeson
- Department of Medicine, The Ottawa Hospital Transplant & Cellular Therapy Program, Ottawa, ON, Canada
| | | | - Bipin N. Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Muhammad Bilal Abid
- Divisions of Hematology/Oncology & Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Siddhartha Ganguly
- Department of Medicine, Houston Methodist Hospital and Cancer Center, Houston, TX
| | - Vaibhav Agrawal
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Baldeep Wirk
- Department of Medicine, Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | - Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Corey Cutler
- Stem Cell Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | - Mohamed A. Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | | | - Attaphol Pawarode
- Division of Hematology/Oncology, Department of Internal Medicine, Blood and Marrow Transplantation Program, University of Michigan Medical School, Ann Arbor, MI
| | - Melhem M. Solh
- The Blood and Marrow Transplant Program, Northside Hospital Cancer Institute, Atlanta, GA
| | - Jean A. Yared
- Division of Hematology/Oncology, Department of Medicine, Transplantation & Cellular Therapy Program, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD
| | - Michael R. Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Sunita Nathan
- Department of Internal Medicine, Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Bart L. Scott
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Betul Oran
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tomasz Czerw
- Department of Haematology and BMT, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | | | - Wael Saber
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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Aalbers J, Akerib DS, Akerlof CW, Al Musalhi AK, Alder F, Alqahtani A, Alsum SK, Amarasinghe CS, Ames A, Anderson TJ, Angelides N, Araújo HM, Armstrong JE, Arthurs M, Azadi S, Bailey AJ, Baker A, Balajthy J, Balashov S, Bang J, Bargemann JW, Barry MJ, Barthel J, Bauer D, Baxter A, Beattie K, Belle J, Beltrame P, Bensinger J, Benson T, Bernard EP, Bhatti A, Biekert A, Biesiadzinski TP, Birch HJ, Birrittella B, Blockinger GM, Boast KE, Boxer B, Bramante R, Brew CAJ, Brás P, Buckley JH, Bugaev VV, Burdin S, Busenitz JK, Buuck M, Cabrita R, Carels C, Carlsmith DL, Carlson B, Carmona-Benitez MC, Cascella M, Chan C, Chawla A, Chen H, Cherwinka JJ, Chott NI, Cole A, Coleman J, Converse MV, Cottle A, Cox G, Craddock WW, Creaner O, Curran D, Currie A, Cutter JE, Dahl CE, David A, Davis J, Davison TJR, Delgaudio J, Dey S, de Viveiros L, Dobi A, Dobson JEY, Druszkiewicz E, Dushkin A, Edberg TK, Edwards WR, Elnimr MM, Emmet WT, Eriksen SR, Faham CH, Fan A, Fayer S, Fearon NM, Fiorucci S, Flaecher H, Ford P, Francis VB, Fraser ED, Fruth T, Gaitskell RJ, Gantos NJ, Garcia D, Geffre A, Gehman VM, Genovesi J, Ghag C, Gibbons R, Gibson E, Gilchriese MGD, Gokhale S, Gomber B, Green J, Greenall A, Greenwood S, van der Grinten MGD, Gwilliam CB, Hall CR, Hans S, Hanzel K, Harrison A, Hartigan-O'Connor E, Haselschwardt SJ, Hernandez MA, Hertel SA, Heuermann G, Hjemfelt C, Hoff MD, Holtom E, Hor JYK, Horn M, Huang DQ, Hunt D, Ignarra CM, Jacobsen RG, Jahangir O, James RS, Jeffery SN, Ji W, Johnson J, Kaboth AC, Kamaha AC, Kamdin K, Kasey V, Kazkaz K, Keefner J, Khaitan D, Khaleeq M, Khazov A, Khurana I, Kim YD, Kocher CD, Kodroff D, Korley L, Korolkova EV, Kras J, Kraus H, Kravitz S, Krebs HJ, Kreczko L, Krikler B, Kudryavtsev VA, Kyre S, Landerud B, Leason EA, Lee C, Lee J, Leonard DS, Leonard R, Lesko KT, Levy C, Li J, Liao FT, Liao J, Lin J, Lindote A, Linehan R, Lippincott WH, Liu R, Liu X, Liu Y, Loniewski C, Lopes MI, Lopez Asamar E, López Paredes B, Lorenzon W, Lucero D, Luitz S, Lyle JM, Majewski PA, Makkinje J, Malling DC, Manalaysay A, Manenti L, Mannino RL, Marangou N, Marzioni MF, Maupin C, McCarthy ME, McConnell CT, McKinsey DN, McLaughlin J, Meng Y, Migneault J, Miller EH, Mizrachi E, Mock JA, Monte A, Monzani ME, Morad JA, Morales Mendoza JD, Morrison E, Mount BJ, Murdy M, Murphy ASJ, Naim D, Naylor A, Nedlik C, Nehrkorn C, Neves F, Nguyen A, Nikoleyczik JA, Nilima A, O'Dell J, O'Neill FG, O'Sullivan K, Olcina I, Olevitch MA, Oliver-Mallory KC, Orpwood J, Pagenkopf D, Pal S, Palladino KJ, Palmer J, Pangilinan M, Parveen N, Patton SJ, Pease EK, Penning B, Pereira C, Pereira G, Perry E, Pershing T, Peterson IB, Piepke A, Podczerwinski J, Porzio D, Powell S, Preece RM, Pushkin K, Qie Y, Ratcliff BN, Reichenbacher J, Reichhart L, Rhyne CA, Richards A, Riffard Q, Rischbieter GRC, Rodrigues JP, Rodriguez A, Rose HJ, Rosero R, Rossiter P, Rushton T, Rutherford G, Rynders D, Saba JS, Santone D, Sazzad ABMR, Schnee RW, Scovell PR, Seymour D, Shaw S, Shutt T, Silk JJ, Silva C, Sinev G, Skarpaas K, Skulski W, Smith R, Solmaz M, Solovov VN, Sorensen P, Soria J, Stancu I, Stark MR, Stevens A, Stiegler TM, Stifter K, Studley R, Suerfu B, Sumner TJ, Sutcliffe P, Swanson N, Szydagis M, Tan M, Taylor DJ, Taylor R, Taylor WC, Temples DJ, Tennyson BP, Terman PA, Thomas KJ, Tiedt DR, Timalsina M, To WH, Tomás A, Tong Z, Tovey DR, Tranter J, Trask M, Tripathi M, Tronstad DR, Tull CE, Turner W, Tvrznikova L, Utku U, Va'vra J, Vacheret A, Vaitkus AC, Verbus JR, Voirin E, Waldron WL, Wang A, Wang B, Wang JJ, Wang W, Wang Y, Watson JR, Webb RC, White A, White DT, White JT, White RG, Whitis TJ, Williams M, Wisniewski WJ, Witherell MS, Wolfs FLH, Wolfs JD, Woodford S, Woodward D, Worm SD, Wright CJ, Xia Q, Xiang X, Xiao Q, Xu J, Yeh M, Yin J, Young I, Zarzhitsky P, Zuckerman A, Zweig EA. First Dark Matter Search Results from the LUX-ZEPLIN (LZ) Experiment. Phys Rev Lett 2023; 131:041002. [PMID: 37566836 DOI: 10.1103/physrevlett.131.041002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/06/2023] [Accepted: 06/07/2023] [Indexed: 08/13/2023]
Abstract
The LUX-ZEPLIN experiment is a dark matter detector centered on a dual-phase xenon time projection chamber operating at the Sanford Underground Research Facility in Lead, South Dakota, USA. This Letter reports results from LUX-ZEPLIN's first search for weakly interacting massive particles (WIMPs) with an exposure of 60 live days using a fiducial mass of 5.5 t. A profile-likelihood ratio analysis shows the data to be consistent with a background-only hypothesis, setting new limits on spin-independent WIMP-nucleon, spin-dependent WIMP-neutron, and spin-dependent WIMP-proton cross sections for WIMP masses above 9 GeV/c^{2}. The most stringent limit is set for spin-independent scattering at 36 GeV/c^{2}, rejecting cross sections above 9.2×10^{-48} cm at the 90% confidence level.
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Affiliation(s)
- J Aalbers
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - D S Akerib
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - C W Akerlof
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
| | - A K Al Musalhi
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - F Alder
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - A Alqahtani
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - S K Alsum
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - C S Amarasinghe
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
| | - A Ames
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - T J Anderson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - N Angelides
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - H M Araújo
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - J E Armstrong
- University of Maryland, Department of Physics, College Park, Maryland 20742-4111, USA
| | - M Arthurs
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
| | - S Azadi
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - A J Bailey
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - A Baker
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - J Balajthy
- University of California, Davis, Department of Physics, Davis, California 95616-5270, USA
| | - S Balashov
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - J Bang
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - J W Bargemann
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - M J Barry
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - J Barthel
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - D Bauer
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - A Baxter
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - K Beattie
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - J Belle
- Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510-5011, USA
| | - P Beltrame
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
- University of Edinburgh, SUPA, School of Physics and Astronomy, Edinburgh EH9 3FD, United Kingdom
| | - J Bensinger
- Brandeis University, Department of Physics, Waltham, Massachusetts 02453, USA
| | - T Benson
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - E P Bernard
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - A Bhatti
- University of Maryland, Department of Physics, College Park, Maryland 20742-4111, USA
| | - A Biekert
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - T P Biesiadzinski
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - H J Birch
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - B Birrittella
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - G M Blockinger
- University at Albany (SUNY), Department of Physics, Albany, New York 12222-0100, USA
| | - K E Boast
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - B Boxer
- University of California, Davis, Department of Physics, Davis, California 95616-5270, USA
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - R Bramante
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - C A J Brew
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - P Brás
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - J H Buckley
- Washington University in St. Louis, Department of Physics, St. Louis, Missouri 63130-4862, USA
| | - V V Bugaev
- Washington University in St. Louis, Department of Physics, St. Louis, Missouri 63130-4862, USA
| | - S Burdin
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - J K Busenitz
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - M Buuck
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - R Cabrita
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - C Carels
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - D L Carlsmith
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - B Carlson
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - M C Carmona-Benitez
- Pennsylvania State University, Department of Physics, University Park, Pennsylvania 16802-6300, USA
| | - M Cascella
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - C Chan
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - A Chawla
- Royal Holloway, University of London, Department of Physics, Egham, TW20 0EX, United Kingdom
| | - H Chen
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - J J Cherwinka
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - N I Chott
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - A Cole
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - J Coleman
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - M V Converse
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - A Cottle
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
- Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510-5011, USA
| | - G Cox
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
- Pennsylvania State University, Department of Physics, University Park, Pennsylvania 16802-6300, USA
| | - W W Craddock
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
| | - O Creaner
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - D Curran
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - A Currie
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - J E Cutter
- University of California, Davis, Department of Physics, Davis, California 95616-5270, USA
| | - C E Dahl
- Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510-5011, USA
- Northwestern University, Department of Physics & Astronomy, Evanston, Illinois 60208-3112, USA
| | - A David
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - J Davis
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - T J R Davison
- University of Edinburgh, SUPA, School of Physics and Astronomy, Edinburgh EH9 3FD, United Kingdom
| | - J Delgaudio
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - S Dey
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - L de Viveiros
- Pennsylvania State University, Department of Physics, University Park, Pennsylvania 16802-6300, USA
| | - A Dobi
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - J E Y Dobson
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - E Druszkiewicz
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - A Dushkin
- Brandeis University, Department of Physics, Waltham, Massachusetts 02453, USA
| | - T K Edberg
- University of Maryland, Department of Physics, College Park, Maryland 20742-4111, USA
| | - W R Edwards
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - M M Elnimr
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - W T Emmet
- Yale University, Department of Physics, New Haven, Connecticut 06511-8499, USA
| | - S R Eriksen
- University of Bristol, H.H. Wills Physics Laboratory, Bristol, BS8 1TL, United Kingdom
| | - C H Faham
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - A Fan
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - S Fayer
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - N M Fearon
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - S Fiorucci
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - H Flaecher
- University of Bristol, H.H. Wills Physics Laboratory, Bristol, BS8 1TL, United Kingdom
| | - P Ford
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - V B Francis
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - E D Fraser
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - T Fruth
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - R J Gaitskell
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - N J Gantos
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - D Garcia
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - A Geffre
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - V M Gehman
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - J Genovesi
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - C Ghag
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - R Gibbons
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - E Gibson
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - M G D Gilchriese
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - S Gokhale
- Brookhaven National Laboratory (BNL), Upton, New York 11973-5000, USA
| | - B Gomber
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - J Green
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - A Greenall
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - S Greenwood
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | | | - C B Gwilliam
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - C R Hall
- University of Maryland, Department of Physics, College Park, Maryland 20742-4111, USA
| | - S Hans
- Brookhaven National Laboratory (BNL), Upton, New York 11973-5000, USA
| | - K Hanzel
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - A Harrison
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - E Hartigan-O'Connor
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - S J Haselschwardt
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - M A Hernandez
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
| | - S A Hertel
- University of Massachusetts, Department of Physics, Amherst, Massachusetts 01003-9337, USA
| | - G Heuermann
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
| | - C Hjemfelt
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - M D Hoff
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - E Holtom
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - J Y-K Hor
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - M Horn
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - D Q Huang
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - D Hunt
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - C M Ignarra
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - R G Jacobsen
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - O Jahangir
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - R S James
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - S N Jeffery
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - W Ji
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - J Johnson
- University of California, Davis, Department of Physics, Davis, California 95616-5270, USA
| | - A C Kaboth
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
- Royal Holloway, University of London, Department of Physics, Egham, TW20 0EX, United Kingdom
| | - A C Kamaha
- University at Albany (SUNY), Department of Physics, Albany, New York 12222-0100, USA
- University of Califonia, Los Angeles, Department of Physics and Astronomy, Los Angeles, California 90095-1547
| | - K Kamdin
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - V Kasey
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - K Kazkaz
- Lawrence Livermore National Laboratory (LLNL), Livermore, California 94550-9698, USA
| | - J Keefner
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - D Khaitan
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - M Khaleeq
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - A Khazov
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - I Khurana
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - Y D Kim
- IBS Center for Underground Physics (CUP), Yuseong-gu, Daejeon, Korea
| | - C D Kocher
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - D Kodroff
- Pennsylvania State University, Department of Physics, University Park, Pennsylvania 16802-6300, USA
| | - L Korley
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
- Brandeis University, Department of Physics, Waltham, Massachusetts 02453, USA
| | - E V Korolkova
- University of Sheffield, Department of Physics and Astronomy, Sheffield S3 7RH, United Kingdom
| | - J Kras
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - H Kraus
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - S Kravitz
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - H J Krebs
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
| | - L Kreczko
- Brookhaven National Laboratory (BNL), Upton, New York 11973-5000, USA
| | - B Krikler
- Brookhaven National Laboratory (BNL), Upton, New York 11973-5000, USA
| | - V A Kudryavtsev
- University of Sheffield, Department of Physics and Astronomy, Sheffield S3 7RH, United Kingdom
| | - S Kyre
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - B Landerud
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - E A Leason
- University of Edinburgh, SUPA, School of Physics and Astronomy, Edinburgh EH9 3FD, United Kingdom
| | - C Lee
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - J Lee
- IBS Center for Underground Physics (CUP), Yuseong-gu, Daejeon, Korea
| | - D S Leonard
- IBS Center for Underground Physics (CUP), Yuseong-gu, Daejeon, Korea
| | - R Leonard
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - K T Lesko
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - C Levy
- University at Albany (SUNY), Department of Physics, Albany, New York 12222-0100, USA
| | - J Li
- IBS Center for Underground Physics (CUP), Yuseong-gu, Daejeon, Korea
| | - F-T Liao
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - J Liao
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - J Lin
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - A Lindote
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - R Linehan
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - W H Lippincott
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
- Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510-5011, USA
| | - R Liu
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - X Liu
- University of Edinburgh, SUPA, School of Physics and Astronomy, Edinburgh EH9 3FD, United Kingdom
| | - Y Liu
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - C Loniewski
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - M I Lopes
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - E Lopez Asamar
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - B López Paredes
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - W Lorenzon
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
| | - D Lucero
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - S Luitz
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
| | - J M Lyle
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - P A Majewski
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - J Makkinje
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - D C Malling
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - A Manalaysay
- University of California, Davis, Department of Physics, Davis, California 95616-5270, USA
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - L Manenti
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - R L Mannino
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - N Marangou
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - M F Marzioni
- University of Edinburgh, SUPA, School of Physics and Astronomy, Edinburgh EH9 3FD, United Kingdom
| | - C Maupin
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - M E McCarthy
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - C T McConnell
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - D N McKinsey
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - J McLaughlin
- Northwestern University, Department of Physics & Astronomy, Evanston, Illinois 60208-3112, USA
| | - Y Meng
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - J Migneault
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - E H Miller
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - E Mizrachi
- University of Maryland, Department of Physics, College Park, Maryland 20742-4111, USA
- Lawrence Livermore National Laboratory (LLNL), Livermore, California 94550-9698, USA
| | - J A Mock
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University at Albany (SUNY), Department of Physics, Albany, New York 12222-0100, USA
| | - A Monte
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
- Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510-5011, USA
| | - M E Monzani
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
- Vatican Observatory, Castel Gandolfo, V-00120, Vatican City State
| | - J A Morad
- University of California, Davis, Department of Physics, Davis, California 95616-5270, USA
| | - J D Morales Mendoza
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - E Morrison
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - B J Mount
- Black Hills State University, School of Natural Sciences, Spearfish, South Dakota 57799-0002, USA
| | - M Murdy
- University of Massachusetts, Department of Physics, Amherst, Massachusetts 01003-9337, USA
| | - A St J Murphy
- University of Edinburgh, SUPA, School of Physics and Astronomy, Edinburgh EH9 3FD, United Kingdom
| | - D Naim
- University of California, Davis, Department of Physics, Davis, California 95616-5270, USA
| | - A Naylor
- University of Sheffield, Department of Physics and Astronomy, Sheffield S3 7RH, United Kingdom
| | - C Nedlik
- University of Massachusetts, Department of Physics, Amherst, Massachusetts 01003-9337, USA
| | - C Nehrkorn
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - F Neves
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - A Nguyen
- University of Edinburgh, SUPA, School of Physics and Astronomy, Edinburgh EH9 3FD, United Kingdom
| | - J A Nikoleyczik
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - A Nilima
- University of Edinburgh, SUPA, School of Physics and Astronomy, Edinburgh EH9 3FD, United Kingdom
| | - J O'Dell
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - F G O'Neill
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
| | - K O'Sullivan
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - I Olcina
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - M A Olevitch
- Washington University in St. Louis, Department of Physics, St. Louis, Missouri 63130-4862, USA
| | - K C Oliver-Mallory
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - J Orpwood
- University of Sheffield, Department of Physics and Astronomy, Sheffield S3 7RH, United Kingdom
| | - D Pagenkopf
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - S Pal
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - K J Palladino
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - J Palmer
- Royal Holloway, University of London, Department of Physics, Egham, TW20 0EX, United Kingdom
| | - M Pangilinan
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - N Parveen
- University at Albany (SUNY), Department of Physics, Albany, New York 12222-0100, USA
| | - S J Patton
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - E K Pease
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - B Penning
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
- Brandeis University, Department of Physics, Waltham, Massachusetts 02453, USA
| | - C Pereira
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - G Pereira
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - E Perry
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - T Pershing
- Lawrence Livermore National Laboratory (LLNL), Livermore, California 94550-9698, USA
| | - I B Peterson
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - A Piepke
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - J Podczerwinski
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - D Porzio
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - S Powell
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - R M Preece
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - K Pushkin
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
| | - Y Qie
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - B N Ratcliff
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
| | - J Reichenbacher
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - L Reichhart
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - C A Rhyne
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - A Richards
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - Q Riffard
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - G R C Rischbieter
- University at Albany (SUNY), Department of Physics, Albany, New York 12222-0100, USA
| | - J P Rodrigues
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - A Rodriguez
- Black Hills State University, School of Natural Sciences, Spearfish, South Dakota 57799-0002, USA
| | - H J Rose
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - R Rosero
- Brookhaven National Laboratory (BNL), Upton, New York 11973-5000, USA
| | - P Rossiter
- University of Sheffield, Department of Physics and Astronomy, Sheffield S3 7RH, United Kingdom
| | - T Rushton
- University of Sheffield, Department of Physics and Astronomy, Sheffield S3 7RH, United Kingdom
| | - G Rutherford
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - D Rynders
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - J S Saba
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - D Santone
- Royal Holloway, University of London, Department of Physics, Egham, TW20 0EX, United Kingdom
| | - A B M R Sazzad
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - R W Schnee
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - P R Scovell
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - D Seymour
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - S Shaw
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - T Shutt
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - J J Silk
- University of Maryland, Department of Physics, College Park, Maryland 20742-4111, USA
| | - C Silva
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - G Sinev
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - K Skarpaas
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
| | - W Skulski
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - R Smith
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - M Solmaz
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - V N Solovov
- Laboratório de Instrumentação e Física Experimental de Partículas (LIP), University of Coimbra, P-3004 516 Coimbra, Portugal
| | - P Sorensen
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - J Soria
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - I Stancu
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - M R Stark
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - A Stevens
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - T M Stiegler
- Texas A&M University, Department of Physics and Astronomy, College Station, Texas 77843-4242, USA
| | - K Stifter
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
- Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510-5011, USA
| | - R Studley
- Brandeis University, Department of Physics, Waltham, Massachusetts 02453, USA
| | - B Suerfu
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - T J Sumner
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - P Sutcliffe
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - N Swanson
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - M Szydagis
- University at Albany (SUNY), Department of Physics, Albany, New York 12222-0100, USA
| | - M Tan
- University of Oxford, Department of Physics, Oxford OX1 3RH, United Kingdom
| | - D J Taylor
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
| | - R Taylor
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - W C Taylor
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - D J Temples
- Northwestern University, Department of Physics & Astronomy, Evanston, Illinois 60208-3112, USA
| | - B P Tennyson
- Yale University, Department of Physics, New Haven, Connecticut 06511-8499, USA
| | - P A Terman
- Texas A&M University, Department of Physics and Astronomy, College Station, Texas 77843-4242, USA
| | - K J Thomas
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - D R Tiedt
- University of Maryland, Department of Physics, College Park, Maryland 20742-4111, USA
- South Dakota Science and Technology Authority (SDSTA), Sanford Underground Research Facility, Lead, South Dakota 57754-1700, USA
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - M Timalsina
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - W H To
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - A Tomás
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - Z Tong
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - D R Tovey
- University of Sheffield, Department of Physics and Astronomy, Sheffield S3 7RH, United Kingdom
| | - J Tranter
- University of Sheffield, Department of Physics and Astronomy, Sheffield S3 7RH, United Kingdom
| | - M Trask
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - M Tripathi
- University of California, Davis, Department of Physics, Davis, California 95616-5270, USA
| | - D R Tronstad
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701-3901, USA
| | - C E Tull
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - W Turner
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - L Tvrznikova
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
- Yale University, Department of Physics, New Haven, Connecticut 06511-8499, USA
- Lawrence Livermore National Laboratory (LLNL), Livermore, California 94550-9698, USA
| | - U Utku
- University College London (UCL), Department of Physics and Astronomy, London WC1E 6BT, United Kingdom
| | - J Va'vra
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
| | - A Vacheret
- Imperial College London, Physics Department, Blackett Laboratory, London SW7 2AZ, United Kingdom
| | - A C Vaitkus
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - J R Verbus
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - E Voirin
- Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510-5011, USA
| | - W L Waldron
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - A Wang
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - B Wang
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - J J Wang
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - W Wang
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
- University of Massachusetts, Department of Physics, Amherst, Massachusetts 01003-9337, USA
| | - Y Wang
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - J R Watson
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - R C Webb
- Texas A&M University, Department of Physics and Astronomy, College Station, Texas 77843-4242, USA
| | - A White
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - D T White
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - J T White
- Texas A&M University, Department of Physics and Astronomy, College Station, Texas 77843-4242, USA
| | - R G White
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, Stanford, California 94305-4085 USA
| | - T J Whitis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
- University of California, Santa Barbara, Department of Physics, Santa Barbara, California 93106-9530, USA
| | - M Williams
- University of Michigan, Randall Laboratory of Physics, Ann Arbor, Michigan 48109-1040, USA
- Brandeis University, Department of Physics, Waltham, Massachusetts 02453, USA
| | - W J Wisniewski
- SLAC National Accelerator Laboratory, Menlo Park, California 94025-7015, USA
| | - M S Witherell
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
- University of California, Berkeley, Department of Physics, Berkeley, California 94720-7300, USA
| | - F L H Wolfs
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - J D Wolfs
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - S Woodford
- University of Liverpool, Department of Physics, Liverpool L69 7ZE, United Kingdom
| | - D Woodward
- Pennsylvania State University, Department of Physics, University Park, Pennsylvania 16802-6300, USA
| | - S D Worm
- STFC Rutherford Appleton Laboratory (RAL), Didcot, OX11 0QX, United Kingdom
| | - C J Wright
- Brookhaven National Laboratory (BNL), Upton, New York 11973-5000, USA
| | - Q Xia
- Lawrence Berkeley National Laboratory (LBNL), Berkeley, California 94720-8099, USA
| | - X Xiang
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
- Brookhaven National Laboratory (BNL), Upton, New York 11973-5000, USA
| | - Q Xiao
- University of Wisconsin-Madison, Department of Physics, Madison, Wisconsin 53706-1390, USA
| | - J Xu
- Lawrence Livermore National Laboratory (LLNL), Livermore, California 94550-9698, USA
| | - M Yeh
- Brookhaven National Laboratory (BNL), Upton, New York 11973-5000, USA
| | - J Yin
- University of Rochester, Department of Physics and Astronomy, Rochester, New York 14627-0171, USA
| | - I Young
- Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510-5011, USA
| | - P Zarzhitsky
- University of Alabama, Department of Physics and Astronomy, Tuscaloosa, Alabama 34587-0324, USA
| | - A Zuckerman
- Brown University, Department of Physics, Providence, Rhode Island 02912-9037, USA
| | - E A Zweig
- University of Califonia, Los Angeles, Department of Physics and Astronomy, Los Angeles, California 90095-1547
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Mesa RA, Hudgens S, Floden L, Harrison CN, Palmer J, Gupta V, McLornan DP, McMullin MF, Kiladjian J, Foltz L, Platzbecker U, Fox ML, Mead AJ, Ross DM, Oh ST, Perkins A, Leahy MF, Deheshi S, Donahue R, Klencke BJ, Verstovsek S. Symptomatic benefit of momelotinib in patients with myelofibrosis: Results from the SIMPLIFY phase III studies. Cancer Med 2023; 12:10612-10624. [PMID: 37021939 PMCID: PMC10225216 DOI: 10.1002/cam4.5799] [Citation(s) in RCA: 5] [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: 11/18/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Myelofibrosis (MF)-associated constitutional symptoms can severely impact health-related quality of life. Clinical trials in MF traditionally measure symptom response to treatment as a landmark endpoint of total symptom score (TSS) reduction ≥50% from baseline. However, this dichotomous assessment provides a limited view of clinically relevant symptomatic changes. Herein we evaluated longitudinal change from baseline in TSS over the continuous 24-week period and individual symptom scores to obtain a more comprehensive understanding of symptom benefits experienced by patients with MF receiving therapy. METHODS Longitudinal symptom change was evaluated using mixed-effect model repeated measure (MMRM) methodology with individual item-level analyses to complement the interpretation of the landmark symptom results in the completed phase III SIMPLIFY studies of momelotinib in MF. MMRM compared mean change in TSS from baseline with Week 24 using data from all patient visits. Generalized estimating equations were used to estimate item-level odds ratios using multiple predictive imputations for missing data. RESULTS Momelotinib and ruxolitinib groups reported similar overall symptom improvements, with a TSS difference of <1.5 points between groups for each post-baseline visit in SIMPLIFY-1. In SIMPLIFY-2, the improvement in TSS observed in momelotinib-treated patients was consistent with that observed in SIMPLIFY-1, whereas progressive TSS deterioration was observed with control. Item-level scores were heterogeneous in both studies. A similar and greater proportion of momelotinib-treated patients were categorized as "improved" or "stable" compared with control in SIMPLIFY-1 and SIMPLIFY-2, respectively. Odds ratios for between-group comparison ranged from 0.75 to 1.21 in SIMPLIFY-1, demonstrating similarity in likelihood of symptom improvement. In SIMPLIFY-2, the likelihood of symptom improvement in each item was higher in the momelotinib arm. CONCLUSIONS These findings suggest that momelotinib provides clinically relevant symptom benefits in the JAK inhibitor-naïve and JAK inhibitor-exposed settings.
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Affiliation(s)
- Ruben A. Mesa
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of MedicineWinston SalemNorth CarolinaUSA
| | | | | | | | | | - Vikas Gupta
- University Health Network, University of TorontoTorontoOntarioCanada
| | | | | | | | - Lynda Foltz
- St Paul's Hospital, University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - M. Laura Fox
- Hematology DepartmentHospital Universitario Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Adam J. Mead
- MRC Weatherall Institute of Molecular MedicineOxfordUK
| | - David M. Ross
- Flinders Medical Centre and UniversityAdelaideSouth AustraliaAustralia
| | - Stephen T. Oh
- Washington University School of MedicineSt. LouisMissouriUSA
| | - Andrew Perkins
- Alfred Hospital, Monash UniversityMelbourneVictoriaAustralia
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Tibes R, Kosiorek HE, Dueck AC, Palmer J, Sproat L, Bogenberger J, Hashmi S, Mesa R, Hogan W, Litzow MR, Al-Kali A. Phase 1/1b study of azacitidine and hedgehog pathway inhibitor sonidegib in patients with myeloid neoplasms. Cancer 2023. [PMID: 37042080 DOI: 10.1002/cncr.34800] [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] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Myeloid neoplasms (myelodysplastic syndrome [MDS], myelofibrosis, and chronic myelomonocytic [CMML]) are aggressive hematological malignancies for which, despite recent approvals, novel therapies are needed to improve clinical outcomes. The hedgehog (HH) pathway is one of the main pathways for cancer stem cells survival and several HH inhibitors (HHi) are approved in clinical practice. METHODS Sonidegib (SON), an oral HHi, was tested in this phase 1/1b trial in combination with azacitidine (AZA, 75 mg/m2 days ×7) in patients with newly diagnosed and relapsed/refractory (r/r) chronic MN or acute myeloid leukemia (AML). RESULTS Sixty-two patients (28 [45%] newly diagnosed) were treated in this study, including 10 patients in the dose-finding component and 52 patients in phase 1b. SON 200 mg oral daily on days 1-28 each cycle was deemed the recommended dose for phase 1b. Out of 21 rrAML patients, two achieved response (one complete response/one morphologic leukemia-free state) with no responses seen in seven r/r MDS/CMML patients. In newly diagnosed AML/MDS, response was seen in six (three had complete remission, two had morphological leukemia-free status) of 27 patients. Median overall survival was 26.4 and 4.7 months for newly diagnosed MDS and AML, respectively. Safety was satisfactory with common (>20%) side effects including fatigue, constipation, nausea, cough, insomnia, and diarrhea. Only 7% of patients died in the study, and none of the deaths were deemed related to treatment. CONCLUSIONS Our study shows that AZA + SON are a safe combination in a patient with MN. Similar to other hedgehog inhibitors, this combination yielded limited response rate in patients with myeloid neoplasms.
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Affiliation(s)
- Raoul Tibes
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
- AstraZeneca, Cambridge, UK
| | - Heidi E Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Amylou C Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeanne Palmer
- Department of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa Sproat
- Department of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - James Bogenberger
- Department of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Shahrukh Hashmi
- Department of Hematology and Oncology, Sheikh Shakhbout Medical Center, Abu Dhabi, United Arab Emirates
| | - Ruben Mesa
- Department of Hematology and Medical Oncology, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - William Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark R Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aref Al-Kali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Al-Kali A, Tibes R, Atherton P, Palmer J, Alkhateeb HB, Patnaik M, Begna K, Gangat N, Hashmi S, He R, Litzow M. A phase II study of combination daunorubicin, cytarabine (Ara-c), and nilotinib (TAsigna) (DATA) in patients newly diagnosed with acute myeloid leukemia with KIT expression. Am J Hematol 2023; 98:472-480. [PMID: 36625066 DOI: 10.1002/ajh.26831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
Acute myeloid leukemia (AML) is a challenging cancer in terms of achieving and maintaining long-duration remissions. Many novel therapies have been added to the standard regimen (combining cytarabine and anthracycline "7 + 3") to achieve such goals. Nilotinib is an oral multikinase inhibitor that is active against KIT tyrosine kinase, an important stem cell target. In this trial, we combined nilotinib with 7 + 3 induction (daunorubicin 60 mg/m2), high-dose cytarabine consolidation, and subsequently, if the patient was a candidate, for 2 years' maintenance therapy in patients with AML and KIT (CD117) expression. Patients were allowed to proceed to allogeneic hematopoietic cell transplantation (HCT) if deemed necessary. Our primary goal was increased complete remission rate with this combination. Thirty-four patients (with a median age 58.5 years) were enrolled on a single-arm phase II bi-institutional study; 21 (62%) patients achieved remission. The complete remission rate was 78% in evaluable patients. Thirteen of 34 (38%) patients had allogeneic HCT, all thirteen of which are still alive (100%). Common (>20%) grade 3 non-hematological toxicities included febrile neutropenia, hypophosphatemia, elevated liver enzymes, and hypertension. Only one patient (3%) died in induction due to liver failure, which was thought secondary to daunorubicin. Our current study reveals good outcomes in patients who received HCT and may warrant a larger study to confirm our findings in that specific population.
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Affiliation(s)
- Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Raoul Tibes
- AstraZeneca, Cambridge, UK.,Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Pamela Atherton
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeanne Palmer
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahrukh Hashmi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rong He
- Division of hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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21
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Currie C, Palmer J, Stone S, Brocklehurst P, Aggarwal V, Dorman P, Pearce M, Durham J. Persistent Orofacial Pain Attendances at General Medical Practitioners. J Dent Res 2023; 102:164-169. [PMID: 36314491 PMCID: PMC9896262 DOI: 10.1177/00220345221128226] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Patients with persistent orofacial pain (POFP) can go through complex care pathways to receive a diagnosis and management, which can negatively affect their pain. This study aimed to describe 44-y trends in attendances at Welsh medical practices for POFP and establish the number of attendances per patient and referrals associated with orofacial pain and factors that may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Data were extracted using diagnostic codes ("Read codes"). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 468,827 POFP and migraine diagnostic codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1,000 patient-years (95% confidence interval [CI], 4.21-4.23). The attendance rate increased over the study period. Almost one-third of patients (n = 92,192, 30.54%) attended more than once over the study period, and 15.83% attended more than once within a 12-mo period. There were 20,103 referral codes that were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (odds ratio [OR], 1.23; 95% CI, 1.17-1.29), in those living in rural locations (OR, 1.17; 95% CI, 1.12-1.22), and in the least deprived quintile (OR, 1.39; 95% CI, 1.29-1.48). Odds also increased with increasing age (OR, 1.03; 95% CI, 1.03-1.03). The increasing attendance may be explained by the increasing incidence of POFP within the population. These patients can attend on a repeated basis, and very few are referred, but when they are, this may occur multiple times; therefore, current care pathways could be improved.
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Affiliation(s)
- C.C. Currie
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK,C.C. Currie, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK.
| | - J. Palmer
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S.J. Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - P.J. Dorman
- Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M.S. Pearce
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - J. Durham
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK,Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
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Gaulin C, Ulrickson ML, Husnain M, Iqbal M, Vergidis P, Rosenthal A, Murthy H, Mead-Harvey C, Wang Y, Castro JE, Palmer J, Leis JF, Johnston PB, Blair J, Kharfan-Dabaja MA, Lin Y, Muñoz J. Low Incidence of Fungal Infections after Chimeric Antigen Receptor T-Cell Therapy for Non-Hodgkin Lymphoma in an Endemic Region for Coccidioidomycosis. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00501-8] [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: 02/07/2023]
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23
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Baranwal A, Langer KJ, Ali K, Kharfan-Dabaja MA, Ayala E, Foran J, Murthy H, Badar T, Iqbal M, Palmer J, Sproat LZ, Durani U, Mangaonkar A, Shah MV, Litzow MR, Hogan WJ, Alkhateeb HB. Surrogates of Endothelial Injury Predict Non-Relapse Mortality Among Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation with Post-Transplant Cyclophosphamide-Based Gvhd Prophylaxis. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00080-5] [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: 02/07/2023]
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Gangat N, Chetram D, McCullough K, Al-Kali A, Begna K, Hogan W, Litzow M, Foran J, Badar T, Palmer J, Patnaik M, Pardanani A, Tefferi A. Limited activity of luspatercept in myelofibrosis and myeloid neoplasms other than myelodysplastic syndromes with ring sideroblasts. Am J Hematol 2022; 97:E474-E477. [PMID: 36197043 DOI: 10.1002/ajh.26749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Deandra Chetram
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kebede Begna
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - James Foran
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeanne Palmer
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ayalew Tefferi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Granroth G, Rosenthal A, McCallen M, Coughlin C, Benson H, Palmer J, Castro JE, Munoz J. Supportive Care for Patients with Lymphoma Undergoing CAR-T-cell Therapy: the Advanced Practice Provider's Perspective. Curr Oncol Rep 2022; 24:1863-1872. [PMID: 36336769 PMCID: PMC9638184 DOI: 10.1007/s11912-022-01330-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW The purpose of our paper is to describe the all-encompassing supportive care for patients with relapsed or refractory lymphoma undergoing cellular therapy, with a focus on the advanced practice provider's (APPs) perspective. RECENT FINDINGS Chimeric antigen receptor-T (CAR-T) cell therapy has become more available for treating relapsed or refractory B-cell hematologic malignancies, requiring proficient and adequate treatment of side effects, complications, and infections that may occur during therapy. APPs often meet these patients during the initial referral and help to support them through the CAR-T cell therapy process. As APPs acquire a complete understanding and comprehensive knowledge of how to treat, support, and guide patients with B-cell malignancies through CAR-T cell therapy, they play a pivotal role in these patients throughout their treatment. Standardization of supportive care is paramount.
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Affiliation(s)
- Ginna Granroth
- Bone and Marrow Transplant, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, USA.
| | | | | | | | - Hollie Benson
- Bone and Marrow Transplant, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, USA
| | | | | | - Javier Munoz
- Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
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Palmer J. EXABS-163-MPN Myelofibrosis with Cytopenia. Clin Lymphoma Myeloma Leuk 2022; 22 Suppl 2:S70-S71. [PMID: 36164237 DOI: 10.1016/s2152-2650(22)00667-x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Pemmaraju N, Kuykendall A, Kremyanskaya M, Ginzburg Y, Ritchie E, Gotlib J, Gerds A, Palmer J, Valone F, O'Connor P, Modi N, Gupta S, Hoffman R, Verstovsek S. MPN-469 Rusfertide (PTG-300) Treatment Interruption Reverses Hematological Gains and Upon Reinitiation, Restoration of Clinical Benefit Observed in Patients With Polycythemia Vera. Clin Lymphoma Myeloma Leuk 2022; 22 Suppl 2:S338-S339. [PMID: 36164011 DOI: 10.1016/s2152-2650(22)01462-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
CONTEXT Polycythemia vera (PV) patients are routinely treated with periodic therapeutic phlebotomy (TP) alone or combined with cytoreductive therapy to maintain hematocrit (HCT) <45% and reduce the incidence of thrombosis. TP may not adequately control HCT and results in iron deficiency. Rusfertide, a hepcidin mimetic, eliminates phlebotomy requirements and improves iron deficiency. We examined the impact of rusfertide dosing interruption on TP requirements, HCT, and iron homeostasis in 2 studies during FDA-mandated clinical hold in response to pre-clinical and clinical safety findings. DESIGN AND PATIENTS The REVIVE study (NCT04057040), in phlebotomy-dependent PV patients consisted of 3 parts: (1) 28-week dose-finding; (2) 12-week blinded randomized withdrawal (1:1) rusfertide vs placebo; and (3) 52-week open-label extension. The PACIFIC study (NCT04767802) in PV patients with high HCT (>48%), consisted of 2 parts, (1) Induction with 40mg SQ twice weekly until HCT<45%, and (2) Continuation, typically with weekly dosing. INTERVENTIONS Subcutaneous rusfertide 10-120 mg weekly added to the existing regimen and adjusted to maintain HCT <45%. During treatment interruption, patients received their baseline cytoreductive regimens with TP to maintain HCT <45%. MAIN OUTCOME MEASURES Iron homeostasis, HCT control, and TP requirements. RESULTS In the REVIVE study, all participants were essentially phlebotomy free, HCTs maintained at <45%, and ferritin normalized, when rusfertide was added to their treatment. In the PACIFIC study, participants with an average baseline HCT of 51% had their HCT reduced to and maintained at <45% within ~6 weeks of treatment initiation. When a clinical hold necessitated rusfertide dosing interruption, participants had significant (p<0.01) increases in TPs, HCT, and RBC count, and a decrease in serum ferritin. Reinitiating rusfertide normalized hematologic parameters, eliminated TP, and restored ferritin demonstrating the potential effectiveness of rusfertide. Most adverse events (AEs) were grade 1-2. The most frequent AEs were transient injection site reactions reported in 59% of participants. CONCLUSIONS Rusfertide maintains HCT at <45%, essentially eliminates TP requirements, and reverses iron deficiency in PV patients with/without cytoreductive agents. Reversal of hematological parameters during dosing interruption further confirms the effect of rusfertide on erythrocytosis and iron homeostasis. A global Phase 3 trial, VERIFY (NCT05210790), has been initiated.
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Affiliation(s)
| | | | | | - Yelena Ginzburg
- Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - Ellen Ritchie
- New York Presbyterian Hospital - Weill Cornell Medical Center, New York, USA
| | | | - Aaron Gerds
- Cleveland Clinic Taussig Cancer Center, Cleveland, USA
| | | | | | | | | | | | - Ronald Hoffman
- Icahn School of Medicine at Mount Sinai Hospital, New York, USA
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Mesa R, Oh ST, Gerds AT, Gupta V, Catalano J, Cervantes F, Devos T, Hus M, Kiladjian JJ, Lech-Maranda E, McLornan D, Palmer J, Platzbecker U, Treliński J, Shimoda K, Donahue R, D'Hollander K, Kowalski M, Verstovsek S. Momelotinib reduces transfusion requirements in patients with myelofibrosis. Leuk Lymphoma 2022; 63:1718-1722. [PMID: 35255234 DOI: 10.1080/10428194.2022.2043304] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Ruben Mesa
- Mays Cancer Center, UT Health San Antonio Cancer Center, San Antonio, TX, USA
| | - Stephen T Oh
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Aaron T Gerds
- Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Vikas Gupta
- Department of Medicine, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - John Catalano
- Haematology Department, Monash University & Frankston Hospital, Frankston, Australia
| | - Francisco Cervantes
- Hematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Timothy Devos
- Department of Hematology, University Hospitals Leuven and Department of Microbiology and Immunology, Laboratory of Molecular Immunology (Rega Institute), KU Leuven, Leuven, Belgium
| | - Marek Hus
- Hematooncology Department, Medical University of Lublin, Lublin, Poland
| | - Jean-Jacques Kiladjian
- Université de Paris, AP-HP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, INSERM, Paris, France
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Donal McLornan
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeanne Palmer
- Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Uwe Platzbecker
- Department of Hematology, Cellular Therapy and Hemostaseology, Leipzig University Hospital, Leipzig, Germany
| | - Jacek Treliński
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Kazuya Shimoda
- Department of Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Rafe Donahue
- Biometrics, Sierra Oncology Inc, San Mateo, CA, USA
| | - Koenraad D'Hollander
- Biostatistics, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Mark Kowalski
- Research and Early Development, Sierra Oncology Inc, San Mateo, CA, USA
| | - Srdan Verstovsek
- Leukemia Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Langlais B, Mazza GL, Scherber RM, Geyer H, Gowin KL, Palmer J, Kosiorek HE, Mead-Harvey C, Butterfield R, Mesa RA, Dueck AC. Impact of imbalanced gender participation in online myeloproliferative neoplasm symptom surveys. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19078 Background: Patients with myeloproliferative neoplasms (MPN), including polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF), experience chronic disease-related symptoms. Surveying these patients while incorporating the MPN-Symptom Assessment Form (SAF) gains valuable insight. Independent surveys evaluating symptoms among MPN patients have seen disproportionate participation among females compared to males (upwards of 4:1). Though the general MPN patient population is roughly gender balanced, epidemiological studies show the occurrence of MPN types differ between men and women (MPN [%male]: PV [65%], ET [33%], MF [50%]. Mehta, et al. Leuk & Lymph 2014). In-clinic evaluations and international MPN surveys of disease-related symptoms suggest women report higher symptom burden on average compared to men, despite MPN type [Emanuel, et al. JCO 2012. Geyer, et al. Haematol 2017]. Further, a recent study across cancer trials showed women had a 34% increased risk of reporting severe symptoms [Unger, et al. JCO 2022]. This study aimed to evaluate gender imbalance in survey participation among MPN patient surveys and investigate its potential to overestimate symptom burden if gender is ignored. Methods: Five anonymous web-based surveys were used to assess the impact of disproportionate gender participation. The MPN-10 assessing the 10 most clinically meaningful SAF items was present in these surveys and generated the Total Symptom Score (TSS). Survey responses with no self-reported gender or ≥5 missing MPN-10 symptoms were excluded. Raking weights based on expected MPN population were applied at the survey- and MPN type-level. Relative bias of mean TSS was calculated to evaluate over- and underestimation due to this participation imbalance. Relative bias <5% is commonly acceptable. Results: There were 4962 survey participants total and 74% were female (Table). Epidemiologically expected gender frequency by MPN type was not seen (MPN [%male]: PV [31%], ET [15%], MF [37%]). The gender participation imbalance accounted for a 3.1% overestimation of overall TSS. This also resulted in a 6.8% underestimation of the mean difference in TSS between genders, across MPNs. Conclusions: Overall bias due to gender participation imbalance was relatively low. However, analyses considering gender differences were more impacted. Anonymous surveys should seek to reduce participation bias during the survey design phase. More research is needed to evaluate gender and other participation biases in surveys across cancer domains.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Amylou C. Dueck
- Alliance Statistics and Data Center and Mayo Clinic, Phoenix, AZ
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Mohty R, Thoendel M, Swei S, Bansal R, Palmer J, Hogan WJ, Vergidis P, Munoz J, Iqbal M, Yassine F, Bennani NN, Hathcock M, Murthy HS, Castro JE, Lin Y, Razonable RR, Kharfan-Dabaja M. Treatment with anti-spike monoclonal antibodies in allogeneic HCT and CAR T-cell recipients with mild to moderate COVID-19: The Mayo Clinic experience. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19049 Background: Prognosis of COVID-19 is poor in the setting of immunosuppression. Casirivimab/imdevimab (REGEN-COV), bamlanivimab, and sotrovimab are investigational monoclonal antibodies (MoAbs) authorized for treatment of mild/moderate COVID-19 for patients (pts) 12 years or older and who are at high-risk for progression to severe COVID-19. These neutralizing antibodies, against SARS-CoV-2 spike proteins, have been shown to decrease risk of progression to severe disease. Recipients of allogeneic stem cell transplants (allo-SCT) or chimeric antigen T cell therapy (CAR T cell) represent a high risk population. However, treatment outcomes with these MoAbs in these pts are not well described. Methods: This retrospective study included 33 consecutive adult pts who developed mild/moderate COVID-19 and received anti-spike SARS-CoV-2 MoAbs between December 2020 and November 2021. Allo-SCT (N=27) or CAR T cell (N=6) recipients were included, and outcomes were analyzed separately. Pts received REGEN-COV (N=19), bamlanivimab (N=11), or sotrovimab (N=1), missing (N=2). Results: In the allo-SCT cohort (N=27), median age at time of COVID-19 was 55 (23-76) years. Median time from allo-SCT to COVID-19 was 31 (22-64) months. Two pts received CAR T-cell therapy prior to allo-SCT. Diagnoses included leukemia or myeloid diseases (82%), lymphoma (11%), or myeloma (7%). Transplant characteristics are summarized (Table). Thirteen pts were vaccinated against SARS-CoV-2 prior to breakthrough COVID-19. Events considered included hospitalization due to COVID-19, disease progression, or death from any cause. The 6-month event-free and overall survivals were 81% and 91%, respectively. In the CAR T cell recipients cohort (N=6), 4 pts received axicabtagene ciloleucel for diffuse large B-cell or follicular lymphoma and 2 received brexucabtagene autoleucel for mantle cell lymphoma. The median follow-up was 8 (1-11) months. Two pts received autologous SCT prior to COVID-19. Median time from CAR T cell therapy to COVID-19 was 10 (3-24) months. Three pts were vaccinated prior to COVID-19. Only 1 pt was hospitalized due to severe COVID-19 requiring mechanical ventilation leading to death. Conclusions: These results show a potential benefit of MoAbs in high-risk pts, namely allo-SCT or CAR T cell recipients. Future studies should evaluate the role of prophylactic use MoAbs in these populations. A comparative analysis with a matched control cohort (who did not receive MoAbs) will be provided at the meeting. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - Javier Munoz
- Division of Hematology, Mayo Clinic, Gilbert, AZ
| | - Madiha Iqbal
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
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Baliga S, Klamer B, Palmer J, Wells-Di Gregirio S, Kale S, Bonomi M, Old M, Rocco J, Blakaj D. OC-0591 Defining the psychiatric burden of mental and substance use disorders in cancer patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02613-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mesa R, Palmer J, Bose P, Oh S, Rampal R, Buckley S, Roman-Torres K, Verstovsek S, Mascarenhas J. CLO22-067: Symptom Burden in Patients With Myelofibrosis who Have Moderate or Severe Thrombocytopenia: A Retrospective Analysis of Patients Enrolled in the PERSIST-2 Study. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ruben Mesa
- 1 UT Health San Antonio Cancer Center, San Antonio, TX
| | | | | | - Stephen Oh
- 4 Washington University School of Medicine, Saint Louis, MO
| | - Raajit Rampal
- 5 Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - John Mascarenhas
- 7 Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Zeidan AM, DeAngelo DJ, Palmer J, Seet CS, Tallman MS, Wei X, Raymon H, Sriraman P, Kopytek S, Bewersdorf JP, Burgess MR, Hege K, Stock W. Phase 1 study of anti-CD47 monoclonal antibody CC-90002 in patients with relapsed/refractory acute myeloid leukemia and high-risk myelodysplastic syndromes. Ann Hematol 2022; 101:557-569. [PMID: 34981142 PMCID: PMC9414073 DOI: 10.1007/s00277-021-04734-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [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: 09/16/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023]
Abstract
CC-90002 is an anti-CD47 antibody that inhibits CD47-SIRPα interaction and enables macrophage-mediated killing of tumor cells in hematological cancer cell lines. In this first clinical, phase 1, dose-escalation and -expansion study (CC-90002-AML-001; NCT02641002), we evaluated CC-90002 in patients with relapsed/refractory acute myeloid leukemia (AML) or high-risk myelodysplastic syndromes (MDS). CC-90002 was administered in escalating doses of 0.1-4.0 mg/kg, using a modified 3 + 3 design. Primary endpoints included dose-limiting toxicities (DLTs), non-tolerated dose (NTD), maximum tolerated dose (MTD), and recommended phase 2 dose. Secondary endpoints included preliminary efficacy, pharmacokinetics, and presence/frequency of anti-drug antibodies (ADAs). Between March 2016 and July 2018, 28 patients were enrolled (24 with AML and 4 with MDS) at 6 sites across the USA. As of July 18, 2018, all patients had discontinued, mainly due to death or progressive disease. The most common treatment-emergent adverse events were diarrhea (46.4%), thrombocytopenia (39.3%), febrile neutropenia (35.7%), and aspartate aminotransferase increase (35.7%). Four patients experienced DLTs (1 patient had grade 4 disseminated intravascular coagulation and grade 5 cerebral hemorrhage, 1 had grade 3 purpura, 1 had grade 4 congestive cardiac failure and grade 5 acute respiratory failure, and another had grade 5 sepsis). The NTD and MTD were not reached. No objective responses occurred. CC-90002 serum exposure was dose-dependent. ADAs were present across all doses, and the proportion of ADA-positive patients in cycle 1 increased over time. Despite no unexpected safety findings, the CC-90002-AML-001 study was discontinued in dose escalation for lack of monotherapy activity and evidence of ADAs. However, as other anti-CD47 agents in clinical trials are showing promising early results for AML and MDS, understanding preclinical and clinical differences between individual agents in this class will be of high importance.
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Affiliation(s)
- Amer M Zeidan
- Department of Internal Medicine, Yale University and Yale Cancer Center, New Haven, CT, USA.
- Yale School of Medicine, Smilow Cancer Hospital Care Center at Yale New Haven, 35 Park Street, Ste NP-7, New Haven, CT, 06511, USA.
| | | | - Jeanne Palmer
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Christopher S Seet
- Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Martin S Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xin Wei
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | | | - Jan Philipp Bewersdorf
- Department of Internal Medicine, Yale University and Yale Cancer Center, New Haven, CT, USA
| | | | | | - Wendy Stock
- University of Chicago Medicine, Chicago, IL, USA
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Wiedmeier-Nutor JE, Iqbal M, Muñoz J, Bezerra ED, Garcia Robledo JE, Bansal R, Johnston PB, Hathcock M, Larsen JT, Bergsagel PL, Wang Y, Reeder C, Leis JF, Fonseca R, Palmer J, Warsame R, Kourelis T, Hayman SR, Dingli D, Kapoor P, Villasboas JC, Paludo J, Bennani NN, Ansell S, Castro JE, Kharfan-Dabaja MA, Lin Y, Vergidis P, Murthy H, Rosenthal A. Response to COVID-19 Vaccination Post-CAR T Therapy in Patients with Non-Hodgkin Lymphoma and Multiple Myeloma. Transplant Cell Ther 2022. [PMCID: PMC8930047 DOI: 10.1016/s2666-6367(22)00400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- John Fasolino
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahmi Oklu
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Jeanne Palmer
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Musab S Hommos
- Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ, USA.
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Eckert R, Huberty J, Kurka J, Laird B, Mesa R, Palmer J. A Randomized Pilot Study of Online Hatha Yoga for Physical and Psychological Symptoms Among Survivors of Allogenic Bone Marrow Transplant. Int J Yoga Therap 2022; 32:Article 12. [PMID: 36305845 DOI: 10.17761/2022-d-21-00047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 06/16/2023]
Abstract
Bone marrow transplant (BMT) is a curative procedure for patients with hematological malignancies, hemoglobinopathies, and errors of inborn metabolism. Survivors are not without symptom burden. The purpose of this study was to assess the feasibility of a 12-week online yoga intervention compared to an educational control group in survivors of allogenic BMT. Participants were recruited nationally. Consenting participants were assigned to online yoga or a podcast control. Yoga and control group participants were instructed to complete 12 weeks of 60 minutes/week of online yoga and podcasts, respectively. Study participants were asked to complete online questionnaires at baseline (wk 0), midpoint (wk 6), postintervention (wk 12), and follow-up (wk 20). Feasibility benchmarks included > 70% satisfied with intervention and > 70% intending to continue participating in online yoga (acceptability); > 70% of participants achieving > 42 minutes/week of online yoga (demand); > 70% completing all four questionnaires (practicality); and at least small effect sizes of the intervention on Lee Symptom Score, physical function, fatigue, anxiety, sleep disturbance, social functioning, pain interference, depression, and quality of life as compared to control group (limited efficacy). Seventy-two participants consented and enrolled in the study (yoga group n = 33; podcast group n = 39). Of the yoga group participants, 54.5% (n = 19) completed the postintervention questionnaire, with 73.7% (n = 14) indicating they were satisfied/very satisfied and 15.8% (n = 3) likely/very likely to continue online yoga. Yoga participation averaged 31.98 minutes/week across 12 weeks. Both groups experienced a significant improvement in the Lee Symptom Score (6.2%-8.7% improvement from baseline) and depressive symptoms (5.3%-6.6% improvement from baseline). The yoga group experienced a significant reduction in pain (6.1% from baseline), and the podcast group experienced a significant reduction in fatigue (6.4% improvement from baseline). Online yoga was not found to be feasible to deliver to this population of survivors of BMT. However, there was satisfaction with online yoga among the majority of survivors of BMT, and beneficial effects were experienced in the yoga group on Lee Symptom Score, depressive symptoms, and pain. Future research is needed to enhance our understanding of barriers to online yoga participation for survivors of BMT and to determine its efficacy.
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Affiliation(s)
- Ryan Eckert
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, Texas
| | - Jennifer Huberty
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, Texas
| | - Jonathan Kurka
- College of Health Solutions, Arizona State University, Phoenix
| | - Breanne Laird
- College of Health Solutions, Arizona State University, Phoenix
| | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, Texas
| | - Jeanne Palmer
- Department of Hematology, Mayo Clinic Arizona, Phoenix
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Stein A, Al Malki M, Yang D, Liu A, Han C, Palmer J, Dandapani S, Farol L, Hui S, Marcucci G, Nakamura R, Pullarkat V, Rosenthal J, Salhotra A, Spielberger R, Forman S, Wong J. Total Marrow and Lymphoid Irradiation to 20 Gy Combined With Post-Transplant Cyclophosphamide Graft vs. Host Disease (GvHD) Prophylaxis is Associated With Low Non-Relapse Mortality Rates and Favorable GvHD-Free/Relapse-Free Survival in AML. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hitchman L, Palmer J, Sethi S, Chetter I. 1023 An Audit of The Prevalence of Frailty and The Impact on Surgical Management and Resource Use, For Vascular Inpatients Using the National Vascular Registry (NVR) Frailty Classifications. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To determine if the NVR frailty score was being routinely collected on all relevant vascular patients on admission, identify the prevalence of frailty in vascular inpatients and determine if frailty was associated with a higher mortality and morbidity.
Method
A prospective audit of consecutive patients admitted onto the vascular ward who were eligible for inclusion on the NVR. Data was collected from electronic patient records and paper case notes between November 2019 and February 2020. The primary outcome was completeness of frailty assessment. Secondary outcomes were prevalence of frailty and mortality and morbidity associated with frailty score.
Results
Frailty status was documented in 65% of patients. 43% (28/65) were assessed to be frail. The 30-day mortality rate was 1.53% (1/65). 26.15% (17/65) had one or more complication. The commonest complications were graft occlusions, acute kidney injury, hospital acquired pneumonia and groin infections. 93.84% (61/65) were discharged home. There was no correlation between frailty and number of post-operative complications (p = 0.394), length of stay (p = 0.171) or mortality (p = 0.371).
Conclusions
This audit found frailty assessment is poorly assessed and the current NVR frailty classification did not correlate to increase mortality or morbidity in this patient cohort.
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Affiliation(s)
- L Hitchman
- Academic Vascular Surgery Unit, Hull, United Kingdom
| | - J Palmer
- Academic Vascular Surgery Unit, Hull, United Kingdom
| | - S Sethi
- Academic Vascular Surgery Unit, Hull, United Kingdom
| | - I Chetter
- Academic Vascular Surgery Unit, Hull, United Kingdom
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Cave B, Najafali D, Gilliam W, Barr J, Cain C, Yum C, Palmer J, Tanveer S, Esposito E, Tran Q. 387 Outcome Predictors of Interhospital Transferred Patients to Emergency General Surgery Service: Does Transfer Location Matter? Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.402] [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: 10/20/2022]
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Adibhatla S, Lurie T, Andavarapu S, Palmer J, Raffman A, White A, Tran Q, Gingold D. 341 All Over the Road: A Systematic Review of Mobile Integrated Health, Community Paramedicine Programs. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.355] [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: 10/20/2022]
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Langlais BT, Mazza GL, Kosiorek HE, Palmer J, Mesa R, Dueck AC. Validation of a Modified Version of the Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score. J Hematol 2021; 10:207-211. [PMID: 34804309 PMCID: PMC8577588 DOI: 10.14740/jh914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with myeloproliferative neoplasms (MPNs) suffer from chronic and progressive symptom burden. MPN trials capturing patient-reported symptoms routinely administer the MPN Symptom Assessment Form (SAF). The MPN-10 assesses 10 of the most clinically relevant symptoms, including fatigue and generates a Total Symptom Score (TSS). The original MPN-10 included a fatigue item from the Brief Fatigue Inventory (BFI). The myelofibrosis-specific symptom assessment tool called the MFSAF v4 utilizes a fatigue item developed to be consistent with other items within the SAF. This study sought to validate a modified version of the MPN-10 TSS using the SAF fatigue item for harmonization with MFSAF v4. METHODS Survey data from two cohorts of patients with essential thrombocythemia, polycythemia vera, or myelofibrosis assessing MPN characteristics and symptom burden were used. RESULTS AND CONCLUSION BFI and SAF fatigue items were highly correlated in raw score (Pearson r = 0.88), comparable in their severity categorizations (89% agreement for severe versus non-severe) and respective contributions to the TSS (both Cronbach's alpha = 0.89). Reliability of SAF fatigue was acceptable and independently associated with known disease-related characteristics (splenomegaly, low quality-of-life, and distress). Fatigue in patients with MPNs is measured with high similarity using the SAF fatigue item within the MPN-10 in harmonization with the MFSAF v4.
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Affiliation(s)
- Blake T. Langlais
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Gina L. Mazza
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Heidi E. Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Jeanne Palmer
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Amylou C. Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA,Corresponding Author: Amylou C. Dueck, Department of Quantitative Health Sciences, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA.
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Vancov T, Palmer J, Keen B. Pilot scale demonstration of a two-stage pretreatment and bioethanol fermentation process for cotton gin trash. Bioresour Technol 2021; 335:125224. [PMID: 33984554 DOI: 10.1016/j.biortech.2021.125224] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
A two-stage dilute acid and steam explosion (SE) pretreatment process was developed and evaluated at pilot scale for ethanol production from cotton gin trash (CGT). Optimal conditions for CGT processing were defined as 1:6 solids to liquids ratio with 9% H2SO4 wt. on solids at 180 °C for 15 min. during stage 1 with ensuing pressed fibres successively exposed to SE at 200 °C for 5 min during stage 2. SE fibres were highly acquiescent to enzyme hydrolysis (76%) in the presence of PEG 6000, yielding 381 g glucose kg-1 fibre. Simultaneous saccharification and fermentation (SSF) trials validated the selected process option and additional fed-batch SSFs confirmed titres above the minimum 4% ww-1 benchmark for economically viable distillation. The practicality of converting CGT to ethanol was demonstrated at pilot scale with titres above 4% ww-1 and a conversion efficiency of 60% t-1 dry GCT.
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Affiliation(s)
- T Vancov
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, NSW, Australia.
| | - J Palmer
- NSW Department of Primary Industries, Wollongbar Primary Industries Institute, NSW, Australia
| | - B Keen
- NSW Department of Primary Industries, Wollongbar Primary Industries Institute, NSW, Australia
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Abedin S, Rashid N, Schroeder M, Romee R, Nauffal M, Alhaj Moustafa M, Kharfan-Dabaja MA, Palmer J, Hogan W, Hefazi M, Larson S, Holtan S, DeFilipp Z, Jayani R, Dholaria B, Pidala J, Khimani F, Grunwald MR, Butler C, Hamadani M. Ruxolitinib resistance or intolerance in steroid-refractory acute graft-versus-host disease - a real-world outcomes analysis. Br J Haematol 2021; 195:429-432. [PMID: 34254289 DOI: 10.1111/bjh.17700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 01/15/2023]
Abstract
Ruxolitinib for steroid-refractory acute graft-versus-host disease (SR-aGVHD) results in resistance or intolerance in 1/5 of patients. Outcomes of such patients are undefined. We identified these patients in a multicentre review and reported outcomes. Ruxolitinib-resistant aGVHD was identified in 48/307 patients. Among patients receiving additional therapy, the overall response rate to next therapy was 36%. Median survival was 21 days. Ruxolitinib intolerance led to treatment discontinuation in 16/307 patients. Ten intolerant patients received additional therapy with 50% experiencing continued improvement of aGVHD. Median survival was 50 days in these patients. These data serve as a baseline for future SR-aGVHD studies.
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Affiliation(s)
- Sameem Abedin
- Blood & Marrow Transplantation and Cellular Therapy Program, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nahid Rashid
- Division of Hematology, University of Washington, Seattle, WA, USA
| | - Mark Schroeder
- Division of Oncology, Washington University, St Louis, MO, USA
| | - Rizwan Romee
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Mary Nauffal
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Muhamad Alhaj Moustafa
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Jeanne Palmer
- Division of Hematology/Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - William Hogan
- Division of Hematology, Department of Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mehrdad Hefazi
- Division of Hematology, Department of Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Samantha Larson
- Hematology/Oncology Pharmacy Program, M Health Fairview, Maple Grove, MN, USA
| | - Shernan Holtan
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cell Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Reena Jayani
- Division of Hematology and Oncology, Vanderbilt University, Nashville, TN, USA
| | | | - Joseph Pidala
- Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Farhad Khimani
- Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Candace Butler
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Mehdi Hamadani
- Blood & Marrow Transplantation and Cellular Therapy Program, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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Querfeld CS, Tsai N, Palmer J, Martinez X, Abdulla F, Wu X, Rosen ST, Zain J. PHASE 1 RESULTS OF ANTI‐PD‐LIGAND 1 (DURVALUMAB) & LENALIDOMIDE IN PATIENTS WITH CUTANEOUS T CELL LYMPHOMA AND CORRELATION WITH GENE EXPRESSION PROFILE. Hematol Oncol 2021. [DOI: 10.1002/hon.125_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- C. S. Querfeld
- City of Hope Beckman Research Institute and Dept. of Pathology Duarte California USA
| | - N.‐C. Tsai
- City of Hope Division of Biostatistics Duarte California USA
| | - J. Palmer
- City of Hope Division of Biostatistics Duarte California USA
| | - X. Martinez
- City of Hope Division of Dermatology Duarte California USA
| | - F. Abdulla
- City of Hope Division of Dermatology Duarte California USA
| | - X. Wu
- City of Hope Integrative Genomics Core Duarte California USA
| | - S. T. Rosen
- City of Hope Hematology and Hematopoietic Cell Transplantation Duarte California USA
| | - J. Zain
- City of Hope Hematology and Hematopoietic Cell Transplantation Duarte California USA
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Imam T, Konstant-Hambling R, Fluck R, Hall N, Palmer J, Conroy S. 548 FRAILTY ANALYSIS ACROSS POPULATIONS: THE USE OF THE HOSPITAL FRAILTY RISK SCORE IN SPECIALISED SERVICES USING NHS NATIONAL DATA. Age Ageing 2021. [DOI: 10.1093/ageing/afab117.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Frailty is increasingly used to risk stratify older people, but across specialised services there is no standardised approach. The aim of this study was to answer the question posed by NHS England to assess frailty could be measured and related to outcomes across Specialsed Services. The Hospital Frailty Risk Score (HFRS) was used and the data published in Age and Ageing in 2020.
Method
A retrospective cohort study was performed using the Secondary Uses Service (SUS) electronic database for people aged 75 or older admitted between April 2017 and March 2018. Based on HFRS, the populations were risk stratified into mild, moderate and severe frailty risk. The relationships with length of stay, readmission rate, mortality and some selected condition specific treatment complications were quantified using descriptive statistics.
Results
Frailty was differentially distributed across the specialties; around one-third had mild frailty; another third had moderate frailty and one-quarter severe frailty. Increasing frailty risk was associated with increased length of stay for the index admission, more days in hospital in the year following intervention and increased risk of dying in hospital. Severe frailty was a powerful discriminator of the risk of death; between 25 and 40% of those with severe frailty risk died at 30 months across all specialties.
Conclusions
This study demonstrates the first application of the HFRS to a national dataset to describe service outcomes and mortality for older people undergoing a range of specialised interventions. This information was used to identify those that might benefit from holistic assessment, aid prognostication, commissioning and service planning. It informed the promotion of quality improvement work in this area via the Specialised Clinical Frailty Network. By implementing the HFRS, changes in outcomes can be plotted across years to assess improvements, performance and benchmarking.
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Affiliation(s)
- T Imam
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - R Konstant-Hambling
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - R Fluck
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - N Hall
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - J Palmer
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - S Conroy
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
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Mountjoy L, McNally H, Buras M, McCallen M, Rogers J, Sproat LO, Slack JL, Palmer J, Leis JF, Khera N. Association of acute graft versus host disease clinical outcomes and the Ann Arbor Biomarker Risk Probability Using the Commercial Assay. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19023 Background: Acute GVHD (aGVHD) is a major cause of mortality and morbidity following stem cell transplantation (HCT). In effort to prognostic patients with aGVHD, the Mount Sinai Acute GVHD International Consortium (MAGIC) combined two biomarkers, ST2 and REG3α to generate an algorithm known as the Ann Arbor (AA) biomarker risk. This is now available as a commercial test to help predict risk for severe acute GVHD and non-relapse mortality when done at the onset of symptomatic aGVHD. Our institution began utilizing these lab values and here we report our “real world” experience. The primary aim was to correlate AA risk probabilities with recently defined endpoints including day 28 overall response rate (ORR) and 6 month freedom from treatment failure (6mFFTF) and overall survival (OS). Methods: 58 HCT patients who underwent HCT between October 2018 and November 2019 and had the biomarker assay at the onset of aGVHD were identified from the institutional database and clinical information about disease, transplant and outcomes was obtained from the medical records. Clinical staging of aGVHD was documented per standardized published guidelines. Day 28 ORR was defined as complete response by day 28. 6mFFTF was defined as a patient being alive, without relapse of underlying disease or addition of new systemic therapy for aGVHD, and prior to the development of cGVHD. Results: When comparing low (n = 39), intermediate (n = 11), and high (n = 8) AA risk, there was no difference in age ( p =0.254), primary disease ( p =0.10), DRI ( p =0.994), donor source ( p =0.193), conditioning regimen intent ( p =0.537), GVHD prophylaxis ( p =0.351) ATG use ( p =0.06). Low AA risk was associated with lower grades of aGVHD at onset (grade I = 15%, grade II = 80%, grade III = 5%, grade IV = 0%), whereas high AA risk was associated with higher grades of aGVHD at onset (grade I = 0%, grade II = 50%, grade III = 25%, grade IV = 25%) ( p =0.009). For low, intermediate, and high AA risk the day 28 ORR was 69%, 45% and 29% ( p = 0.083); the 6mFFTF was 82%, 82%, and 25% ( p = 0.0001); 6 month OS was 92%, 100%, and 50% ( p = 0.0006) respectively. Conclusions: Our study shows a high correlation between AA risk and outcomes. High risk AA risk was associated with inferior outcomes This study was limited by the retrospective single institutional experience with relatively small numbers. However, our findings using the commercial assay mirror that seen with the MAGIC studies. Our “real world data” can serve as a foundation and continued validation for institutional implementation of AA risk stratification for aGVHD.
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Affiliation(s)
| | | | - Matthew Buras
- Mayo Clinic Arizona Department of Statistics, Scottsdale, AZ
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Mesa RA, Oh ST, Gerds AT, Gupta V, Catalano JV, Cervantes F, Devos T, Hus M, Kiladjian JJ, Lech-Maranda E, Mclornan DP, Palmer J, Platzbecker U, Treliński J, Shimoda K, Donahue R, Strouse B, Kowalski MM, Verstovsek S. Association of transfusion independence with improved overall survival in myelofibrosis patients receiving momelotinib. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
7046 Background: Momelotinib (MMB) is a potent JAK1, JAK2 and ACVR1 inhibitor with clinical activity against the hallmark features of myelofibrosis (MF), namely anemia, constitutional symptoms and splenomegaly, across the continuum of JAKi naïve or previously JAKi treated intermediate/high risk MF patients as demonstrated in the previously conducted Phase 3 SIMPLIFY-1 & -2 clinical trials (S1, S2). S1 enrolled JAKi-naïve patients with MF (n = 432) double-blind randomized 1:1 to MMB or ruxolitinib (RUX). S2 enrolled patients with MF with hematological toxicity during prior RUX therapy (n = 156) randomized 2:1 to open-label MMB or best available therapy (BAT; consisting of RUX in 88% of patients). In both trials, following the 24-week randomized treatment (RT) period, patients could continue MMB (MMB→MMB) and those randomized to RUX/BAT could cross-over to MMB (RUX/BAT→MMB) for extended treatment (ET). Previously published data from the SIMPLIFY studies demonstrate robust overall survival (OS) for MMB-treated patients in S1 and S2 (median not reached and 34.3 months, respectively) with a maximum follow up of approximately 5 years and median of 2.9 years in S1 and 2.3 years in S2. Methods: OS data for patients receiving MMB in S1 and S2 are reported here for subgroups defined by Week 24 (W24) transfusion independence (TI) responders vs non-responders, and also other efficacy endpoints. Survival was estimated using KM analysis with descriptive log-rank tests for comparison applied (all p-values are descriptive). Results: As previously reported, W24 TI rates were higher in the MMB arms of S1 (67% vs 49%) and S2 (43% vs 21%). In S1, W24 TI responders in the MMB group show an OS advantage, with median OS not reached and 3-year survival of 80% (HR = 0.30; p = 0.0001) compared to MMB TI non-responders. Similarly in S2, W24 TI responders in the MMB group show a trend toward better OS compared to TI non-responders (HR = 0.57; p = 0.0652). The HRs in S1 for MMB responders vs non-responders for W24 SRR and TSS were 0.59 (p = 0.0904) and 0.65 (p = 0.1657), respectively. Alternative analyses using OS defined from W24 demonstrated consistent results. Conclusions: These new analyses suggest JAKi naïve patients receiving MMB who maintain or achieve TI at W24 have favorable OS compared to MMB TI non-responders, with a similar trend observed in S2. These findings are consistent with anemia and transfusion dependency being key predictors of shortened OS in MF and suggest that TI response at W24 may become a surrogate for clinical benefit, supporting the clinical relevance of MMB’s differentiated pro-erythropoietic ACVR1 inhibition. Clinical trial information: NCT01969838.
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Affiliation(s)
| | - Stephen T. Oh
- Washington University School of Medicine, St. Louis, MO
| | - Aaron Thomas Gerds
- Cleveland Clinic Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland, OH
| | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - John V. Catalano
- Frankston Hospital and Department of Clinical Haematology, Frankston, Australia
| | | | - Timothy Devos
- Universitaire Ziekenhuizen Leuven (UZ Leuven), Leuven, Belgium
| | - Marek Hus
- Medical University in Lublin, Lublin, Poland
| | | | - Ewa Lech-Maranda
- Institute of Hematology and Transfusion Medicine, Department of Hematology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Donal P. Mclornan
- Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom
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Mesa RA, Hudgens S, Floden L, Palmer J, Gupta V, Mclornan DP, McMullin MF, Kiladjian JJ, Foltz LM, Platzbecker U, Fox ML, Mead AJ, Ross DM, Oh ST, Perkins A, Leahy MF, Deheshi S, Donahue R, Klencke BJ, Verstovsek S. Longitudinal and individual symptom analyses of momelotinib and ruxolitinib treated myelofibrosis patients from SIMPLIFY-1. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19040 Background: Clinical trials investigating JAK1/JAK2 inhibitors for myelofibrosis (MF) subjects have measured symptom improvement as a minimum 50% reduction in total symptom score (TSS) at the end of a 24-week treatment period. This landmark analysis is based on post-baseline score changes from Weeks 21 (W21) to 24 and requires vastly different absolute TSS improvements for patients with very high or low baseline (BL) TSS to reach responder status. A phase 3 clinical study, SIMPLIFY-1, randomized 432 intermediate and high risk JAK inhibitor (JAKi) naive MF patients 1:1 to momelotinib (MMB) or ruxolitinib (RUX). Non-inferiority on the MPN-SAF TSS response rate endpoint at W24 was not met (MMB: 28% vs RUX: 42%); however, improvement in each of the 7 TSS items was similar for MMB vs RUX. To understand the discrepancy, we applied item analysis and mixed effect models for repeated measures (MMRM) to SIMPLIFY-1. Methods: Analyses were conducted in the intention-to-treat (ITT) population and in a symptomatic subset (selected as subjects with BL TSS ≥ 10). The distributions of TSS items were examined at BL and shift in scores at W24 (health state shifts) were assessed. GEE models were used to estimate item-level odds ratios using multiple predictive imputations for missing data. MMRM compared mean change in TSS from BL to W24 using data from all visits. The meaningful change threshold (MCT) was determined using Patient Global Impression of Change. Results: BL scores across items were heterogenous in the MMB and RUX groups; the proportion of subjects with no or mild symptoms (0–3 on a 0-10 point scale) ranged from 44% (tiredness) to 81% (itching). Distributions of BL scores were different across arms with 6 out of 7 items in the MMB arm reporting more severe or very severe symptoms (scores of 7-10) at BL. Despite the imbalance in BL scores, item-level health state shifts showed similar improvements for MMB and RUX. Categorical responder analysis showed no significant differences on any items. Odds ratios for each between-group comparison ranged from 0.74 to 1.20. MMRM mean TSS change at W24 was 6.35 (MMB) vs 7.87 (RUX) in the ITT and 8.80 (MMB) vs 10.46 (RUX) in the symptomatic subset. Mean TSS were near the within-subject MCT of 8 points in the ITT and exceeded the MCT in the symptomatic subset. The between-group difference was 1.52 (95% CI: (0.196, 2.847)) in the ITT and 1.67 (95% CI: -0.134, 3.468) in the symptomatic subset. Conclusions: Comparable item health state shifts at W24 and similar improvements in mean TSS as shown by MMRM, with a minimal between-group difference of 1.52 on the 70 point scale in context of an 8-point MCT suggest MMB provides clinically relevant and comparable symptom improvements to RUX; these analyses require further validation in independent data sets. Imbalance in BL symptom scores in MMB subjects may have contributed to the inability to demonstrate non-inferiority in TSS response rate at W24. Clinical trial information: NCT01969838.
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Affiliation(s)
| | | | | | | | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Donal P. Mclornan
- Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Lynda M. Foltz
- St Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Maria Laura Fox
- Hematology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | | | - Stephen T. Oh
- Washington University School of Medicine, St. Louis, MO
| | - Andrew Perkins
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
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Affiliation(s)
- J Palmer
- School of Dental Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - J Durham
- School of Dental Sciences, Newcastle University, Newcastle-upon-Tyne, UK
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Haque F, Khan H, Bozas G, Avery G, Palmer J, Maraveyas A. PO-66 Patient-reported outcome (PRO) assessment of symptom severity and impairment of daily activities in a group of ambulant cancer patients with IPE: correlation with the Hull score. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00239-5] [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: 10/21/2022]
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