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Wareing N, Wang X, Keyes-Elstein L, Goldmuntz EA, Lyons MA, McSweeney P, Furst DE, Nash RA, Crofford LJ, Welch B, Pinckney A, Mayes MD, Sullivan KM, Assassi S. Myeloablation followed by hematopoietic stem cell transplantation leads to long-term normalization of systemic sclerosis molecular signatures. Arthritis Rheumatol 2024. [PMID: 38497141 DOI: 10.1002/art.42847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/16/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE In the randomized Scleroderma: Cyclophosphamide Or Transplantation (SCOT trial), myeloablation, followed by hematopoietic stem cell transplantation (HSCT), led to normalization of systemic sclerosis (SSc) peripheral blood gene cell (PBC) expression signature at the 26-month visit. Herein, we examined long-term molecular changes ensuing 54 months after randomization for individuals receiving an HSCT or 12 months of intravenous cyclophosphamide (CYC). METHOD Global PBC transcript studies were performed at pretreatment baseline, 38 months, and 54 months post-randomization, as well as in healthy controls using Illumina HT-12 arrays. RESULTS Thirty (HSCT=19 and CYC=11) participants had 38-month and 26 (HSCT=16 and CYC=11) had 54-month samples available. In the paired comparison to baseline, a significant down-regulation of interferon modules and an up-regulation of cytotoxic/NK module were observed at 38-month and 54-month visits in the HSCT arm indicating a long-term normalization of baseline SSc gene expression signature. No differentially expressed modules were detected in the CYC arm. In the comparison to healthy controls, 38-month visit samples in the HSCT arm showed an upregulation of B cell and plasmablast modules and a downregulation of myeloid and inflammation modules. Importantly, 54-month HSCT samples did not show any differentially expressed modules compared to healthy controls suggesting completion of immune reconstitution. Participants in the CYC arm continued to show an SSc transcript signature in comparison to controls at both time points. CONCLUSION Paralleling the observed clinical benefit, HSCT leads to durable long-term normalization of the molecular signature in SSc with completion of immune resetting to 54 months post-HSCT.
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Affiliation(s)
- Nancy Wareing
- UTHealth Houston McGovern Medical School, Houston, Texas, USA
| | - Xuan Wang
- Baylor Institute for Immunology Research, Dallas, Texas, USA
| | | | | | - Marka A Lyons
- UTHealth Houston McGovern Medical School, Houston, Texas, USA
| | | | - Daniel E Furst
- University of California Los Angeles, Los Angeles, California, USA
- University of Washington, Seattle, Washington, USA
| | | | | | | | | | - Maureen D Mayes
- UTHealth Houston McGovern Medical School, Houston, Texas, USA
| | | | - Shervin Assassi
- UTHealth Houston McGovern Medical School, Houston, Texas, USA
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Daniel SK, Sullivan KM, Dickerson LK, van den Bijgaart RJE, Utria AF, Labadie KP, Kenerson HL, Jiang X, Smythe KS, Campbell JS, Pierce RH, Kim TS, Riehle KJ, Yeung RS, Carter JA, Barry KC, Pillarisetty VG. Reversing immunosuppression in the tumor microenvironment of fibrolamellar carcinoma via PD-1 and IL-10 blockade. Sci Rep 2024; 14:5109. [PMID: 38429349 PMCID: PMC10907637 DOI: 10.1038/s41598-024-55593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
Fibrolamellar carcinoma (FLC) is a rare liver tumor driven by the DNAJ-PKAc fusion protein that affects healthy young patients. Little is known about the immune response to FLC, limiting rational design of immunotherapy. Multiplex immunohistochemistry and gene expression profiling were performed to characterize the FLC tumor immune microenvironment and adjacent non-tumor liver (NTL). Flow cytometry and T cell receptor (TCR) sequencing were performed to determine the phenotype of tumor-infiltrating immune cells and the extent of T cell clonal expansion. Fresh human FLC tumor slice cultures (TSCs) were treated with antibodies blocking programmed cell death protein-1 (PD-1) and interleukin-10 (IL-10), with results measured by cleaved caspase-3 immunohistochemistry. Immune cells were concentrated in fibrous stromal bands, rather than in the carcinoma cell compartment. In FLC, T cells demonstrated decreased activation and regulatory T cells in FLC had more frequent expression of PD-1 and CTLA-4 than in NTL. Furthermore, T cells had relatively low levels of clonal expansion despite high TCR conservation across individuals. Combination PD-1 and IL-10 blockade signficantly increased cell death in human FLC TSCs. Immunosuppresion in the FLC tumor microenvironment is characterized by T cell exclusion and exhaustion, which may be reversible with combination immunotherapy.
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Affiliation(s)
- S K Daniel
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - K M Sullivan
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - L K Dickerson
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - R J E van den Bijgaart
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - A F Utria
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - K P Labadie
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - H L Kenerson
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - X Jiang
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - K S Smythe
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J S Campbell
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - R H Pierce
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - T S Kim
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - K J Riehle
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - R S Yeung
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - J A Carter
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA
| | - K C Barry
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - V G Pillarisetty
- Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA.
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Sullivan KM, Forman SJ, Korngold R, Porter DL. Reflections: A New Monthly Feature in Transplantation and Cellular Therapy. Transplant Cell Ther 2023; 29:403. [PMID: 37400188 DOI: 10.1016/j.jtct.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
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Khanna D, Krieger N, Sullivan KM. Improving outcomes in scleroderma: recent progress of cell-based therapies. Rheumatology (Oxford) 2023; 62:2060-2069. [PMID: 36355455 PMCID: PMC10234204 DOI: 10.1093/rheumatology/keac628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/23/2022] [Indexed: 08/27/2023] Open
Abstract
Scleroderma is a rare, potentially fatal, clinically heterogeneous, systemic autoimmune connective tissue disorder that is characterized by progressive fibrosis of the skin and visceral organs, vasculopathy and immune dysregulation. The more severe form of the disease, diffuse cutaneous scleroderma (dcSSc), has no cure and limited treatment options. Haematopoietic stem cell transplantation has emerged as a potentially disease-modifying treatment but faces challenges such as toxicity associated with fully myeloablative conditioning and recurrence of autoimmunity. Novel cell therapies-such as mesenchymal stem cells, chimeric antigen receptor-based therapy, tolerogenic dendritic cells and facilitating cells-that may restore self-tolerance with more favourable safety and tolerability profiles are being explored for the treatment of dcSSc and other autoimmune diseases. This narrative review examines these evolving cell therapies.
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Affiliation(s)
- Dinesh Khanna
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nancy Krieger
- Talaris Therapeutics, Boston, MA and Louisville, KY, USA
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Kim JH, Johnson R, Kovac M, Cunningham AL, Amakrane M, Sullivan KM, Dagnew AF, Curran D, Schuind A. Adjuvanted recombinant zoster vaccine decreases herpes zoster-associated pain and the use of pain medication across 3 randomized, placebo-controlled trials. Pain 2023; 164:741-748. [PMID: 36066965 PMCID: PMC10026829 DOI: 10.1097/j.pain.0000000000002760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Herpes zoster (HZ) and HZ-associated pain greatly affect patients' quality of life, particularly in older and immunocompromised adults, for whom comorbidities and polypharmacy are often reported. Three phase III, randomized, placebo-controlled clinical trials have reported the adjuvanted recombinant zoster vaccine (RZV) as highly efficacious in preventing HZ and reducing pain severity in healthy adults ≥50 years old (Zoster Efficacy Study [ZOE]-50 study, NCT01165177) and ≥70 years old (ZOE-70; NCT01165229) and in immunocompromised adults ≥18 years old undergoing autologous hematopoietic stem cell transplantation (ZOE-HSCT; NCT01610414). Here, we investigated efficacy of RZV in reducing (i) the duration of clinically significant pain (Zoster Brief Pain Inventory pain score ≥3) and (ii) HZ-associated pain medication use and duration of use in participants with confirmed HZ ("breakthrough cases") from the 3 studies. Recombinant zoster vaccine effectively reduced the duration of clinically significant HZ-associated pain during HZ episodes by 38.5% ( P -value: 0.010) in the ZOE-HSCT study. Although a similar trend was observed in the ZOE-50 and ZOE-70 studies, the results were not statistically significant because of the high vaccine efficacy (VE) against HZ resulting in rare breakthrough cases. VE in reducing pain medication use (39.6%; P -value: 0.008) and duration of medication use (49.3%, P -value: 0.040) was reported in the ZOE-70 study; corresponding positive VE estimates were observed in the ZOE-50 and ZOE-HSCT studies but were not statistically significant. Data reported here demonstrate efficacy of RZV in reducing HZ-associated pain duration and pain medication use in breakthrough cases, thereby improving quality of life of those with HZ.
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Affiliation(s)
- Joon Hyung Kim
- GSK, Rockville, MD, United States, Martina Kovac is now with the PPD, Bethesda, MD, United States. Alemnew F. Dagnew is now with the Bill & Melinda Gates Medical Research Institute, Cambridge, MA, United States. Anne Schuind is now with the PATH, Washington, DC, United States
| | - Robert Johnson
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Martina Kovac
- GSK, Rockville, MD, United States, Martina Kovac is now with the PPD, Bethesda, MD, United States. Alemnew F. Dagnew is now with the Bill & Melinda Gates Medical Research Institute, Cambridge, MA, United States. Anne Schuind is now with the PATH, Washington, DC, United States
| | - Anthony L. Cunningham
- The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Alemnew F. Dagnew
- GSK, Rockville, MD, United States, Martina Kovac is now with the PPD, Bethesda, MD, United States. Alemnew F. Dagnew is now with the Bill & Melinda Gates Medical Research Institute, Cambridge, MA, United States. Anne Schuind is now with the PATH, Washington, DC, United States
| | | | - Anne Schuind
- GSK, Rockville, MD, United States, Martina Kovac is now with the PPD, Bethesda, MD, United States. Alemnew F. Dagnew is now with the Bill & Melinda Gates Medical Research Institute, Cambridge, MA, United States. Anne Schuind is now with the PATH, Washington, DC, United States
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Krishnamurti L, Neuberg D, Sullivan KM, Smith S, Eapen M, Walters MC. Enrollment Lessons from a Biological Assignment Study of Marrow Transplantation versus Standard Care for Adolescents and Young Adults with Sickle Cell Disease: Considerations for Future Gene and Cellular Therapy Trials. Transplant Cell Ther 2023; 29:217-221. [PMID: 36270432 PMCID: PMC10539686 DOI: 10.1016/j.jtct.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/12/2022]
Abstract
We previously conducted a single-arm feasibility study (STRIDE1) of myeloablative bone marrow transplantation (BMT) in adolescents and young adults with sickle cell disease (SCD). The trial identified donors before entry, enrolled well, and found no unexpected regimen-related toxicity. Although many single-arm studies have been published, there are no controlled trials of either BMT or gene therapy in SCD. Therefore, we designed a comparative trial by biological assignment (available donor versus no donor). This multicenter National Institutes of Health-funded study (Blood and Marrow Transplant Clinical Trials Network 1503; STRIDE2) enrolled patients between 2016 and 2021 at 35 sites. Lagging recruitment led to study closure, and here we report the impediments to accrual. The BMT regimen and entry criteria were from STRIDE1, and 2-year survival was the primary endpoint. To minimize selection bias from prior HLA typing, STRIDE2 excluded individuals with previously identified donors. Accrual was stopped at 69% of target (138 enrolled; assigned 28 with donor, 96 with no donor). Barriers to enrollment included lower than expected frequency of HLA-matched related and unrelated donors; loss of enrollees owing to previously identified donors; conventional care arm dissuading some seeking BMT; challenging short-term endpoints in SCD, including incomplete documentation of sickle pain episodes; state Medicaid (primary insurers of SCD) denial of BMT coverage for adult SCD despite the study having secured Coverage with Evidence Development from the Center for Medicare & Medicaid Services; slowed accrual in 2019 to 2021 during the Coronavirus disease 2019 pandemic; and restriction of BMT resourcing for nonmalignant diseases by academic medical (cancer) centers. Social obstacles and access to BMT centers also limited entry, as did practitioner and participant concerns over suitability, cost, and toxicity. Planning for future controlled trials of curative therapy in SCD and other nonmalignant diseases likely will meet these enrollment challenges. Lessons from this trial may aid the development of future comparative studies.
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Affiliation(s)
- Lakshmanan Krishnamurti
- Section of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
| | | | | | - Shannon Smith
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Mary Eapen
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mark C Walters
- Department of Pediatrics, UCSF Benioff Children's Hospital, Oakland, California
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Adamska JZ, Zia A, Bloom MS, Crofford LJ, Furst DE, Goldmuntz E, Keyes-Elstein L, Mayes MD, McSweeney P, Nash RA, Pinckney A, Welch B, Love ZZ, Sullivan KM, Robinson W. Myeloablative autologous haematopoietic stem cell transplantation resets the B cell repertoire to a more naïve state in patients with systemic sclerosis. Ann Rheum Dis 2023; 82:357-364. [PMID: 36241361 PMCID: PMC9918657 DOI: 10.1136/ard-2021-221925] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/16/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Myeloablative autologous haematopoietic stem cell transplant (HSCT) was recently demonstrated to provide significant benefit over cyclophosphamide (CYC) in the treatment of diffuse cutaneous systemic sclerosis (dcSSc) in the Scleroderma: Cyclophosphamide or Transplantation (SCOT) trial. As dysregulation of the B cell compartment has previously been described in dcSSc, we sought to gain insight into the effects of myeloablative autologous HSCT as compared with CYC. METHODS We sequenced the peripheral blood immunoglobulin heavy chain (IGH) repertoires in patients with dcSSc enrolled in the SCOT trial. RESULTS Myeloablative autologous HSCT was associated with a sustained increase in IgM isotype antibodies bearing a low mutation rate. Clonal expression was reduced in IGH repertoires following myeloablative autologous HSCT. Additionally, we identified a underusage of immunoglobulin heavy chain V gene 5-51 in patients with dcSSc, and usage normalised following myeloablative autologous HSCT but not CYC treatment. CONCLUSIONS Together, these findings suggest that myeloablative autologous HSCT resets the IGH repertoire to a more naïve state characterised by IgM-expressing B cells, providing a possible mechanism for the elimination of pathogenic B cells that may contribute to the benefit of HSCT over CYC in the treatment of dcSSc.
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Affiliation(s)
- Julia Z Adamska
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California, USA,VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Amin Zia
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California, USA,VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Michelle S Bloom
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California, USA,VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Daniel E Furst
- Rheumatology, Univ of Cal at Los Angeles, Los Angeles, California, USA
| | - Ellen Goldmuntz
- Division of Allergy, Immunology, and Transplantation, NIH/NIAID, Bethesda, Maryland, USA
| | | | - Maureen D Mayes
- Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center Houston Medical School, Houston, Texas, USA
| | - Peter McSweeney
- Rocky Mountain Blood and Marrow Transplant Program, Colorado Blood Cancer Institute, Denver, Colorado, USA
| | - Richard A Nash
- Rocky Mountain Blood and Marrow Transplant Program, Colorado Blood Cancer Institute, Denver, Colorado, USA
| | | | - Beverly Welch
- Division of Allergy, Immunology, and Transplantation, NIH/NIAID, Bethesda, Maryland, USA
| | - Zelda Z Love
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Keith M Sullivan
- Department of Medicine, Duke University Health System, Durham, North Carolina, USA
| | - William Robinson
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California, USA .,VA Palo Alto Health Care System, Palo Alto, California, USA
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Keyes-Elstein L, Pinckney A, Goldmuntz E, Welch B, Franks JM, Martyanov V, Wood TA, Crofford L, Mayes M, McSweeney P, Nash R, Georges G, Csuka M, Simms R, Furst D, Khanna D, St Clair EW, Whitfield ML, Sullivan KM. Clinical and Molecular Findings After Autologous Stem Cell Transplantation or Cyclophosphamide for Scleroderma: Handling Missing Longitudinal Data. Arthritis Care Res (Hoboken) 2023; 75:307-316. [PMID: 34533286 PMCID: PMC8926930 DOI: 10.1002/acr.24785] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/23/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Among individuals with systemic sclerosis (SSc) randomized to cyclophosphamide (CYC) (n = 34) or hematopoietic stem cell transplantation (HSCT) (n = 33), we examined longitudinal trends of clinical, pulmonary function, and quality of life measures while accounting for the influence of early failures on treatment comparisons. METHODS Assuming that data were missing at random, mixed-effects regression models were used to estimate longitudinal trends for clinical measures when comparing treatment groups. Results were compared to observed means and to longitudinal trends estimated from shared parameter models, assuming that data were missing not at random. Longitudinal trends for SSc intrinsic molecular subsets defined by baseline gene expression signatures (normal-like, inflammatory, and fibroproliferative signatures) were also studied. RESULTS Available observed means for pulmonary function tests appeared to improve over time in both arms. However, after accounting for participant loss, forced vital capacity in HSCT recipients increased by 0.77 percentage points/year but worsened by -3.70/year for CYC (P = 0.004). Similar results were found for diffusing capacity for carbon monoxide and quality of life indicators. Results for both analytic models were consistent. HSCT recipients in the inflammatory (n = 20) and fibroproliferative (n = 20) subsets had superior long-term trends compared to CYC for pulmonary and quality of life measures. HSCT was also superior for modified Rodnan skin thickness scores in the fibroproliferative subset. For the normal-like subset (n = 22), superiority of HSCT was less apparent. CONCLUSION Longitudinal trends estimated from 2 statistical models affirm the efficacy of HSCT over CYC in severe SSc. Failure to account for early loss of participants may distort estimated clinical trends over the long term.
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Affiliation(s)
| | | | - Ellen Goldmuntz
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Beverly Welch
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | | | | | | | - Leslie Crofford
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Maureen Mayes
- University of Texas McGovern Medical School, Houston, TX
| | | | | | | | - M.E. Csuka
- Medical College of Wisconsin, Milwaukee, WI
| | - Robert Simms
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Daniel Furst
- University of California Los Angeles, Los Angeles, CA; University of Washington, Seattle, WA; University of Florence, Florence, Italy
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Ayoglu B, Donato M, Furst DE, Crofford LJ, Goldmuntz E, Keyes-Elstein L, James J, Macwana S, Mayes MD, McSweeney P, Nash RA, Sullivan KM, Welch B, Pinckney A, Mao R, Chung L, Khatri P, Utz PJ. Characterising the autoantibody repertoire in systemic sclerosis following myeloablative haematopoietic stem cell transplantation. Ann Rheum Dis 2023; 82:670-680. [PMID: 36653124 PMCID: PMC10176357 DOI: 10.1136/ard-2021-221926] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/30/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Results from the SCOT (Scleroderma: Cyclophosphamide Or Transplantation) clinical trial demonstrated significant benefits of haematopoietic stem cell transplant (HSCT) versus cyclophosphamide (CTX) in patients with systemic sclerosis. The objective of this study was to test the hypothesis that transplantation stabilises the autoantibody repertoire in patients with favourable clinical outcomes. METHODS We used a bead-based array containing 221 protein antigens to profile serum IgG autoantibodies in participants of the SCOT trial. RESULTS Comparison of autoantibody profiles at month 26 (n=23 HSCT; n=22 CTX) revealed antibodies against two viral antigens and six self-proteins (SSB/La, CX3CL1, glycyl-tRNA synthetase (EJ), parietal cell antigen, bactericidal permeability-increasing protein and epidermal growth factor receptor (EGFR)) that were significantly different between treatment groups. Linear mixed model analysis identified temporal increases in antibody levels for hepatitis B surface antigen, CCL3 and EGFR in HSCT-treated patients. Eight of 32 HSCT-treated participants and one of 31 CTX-treated participants had temporally varying serum antibody profiles for one or more of 14 antigens. Baseline autoantibody levels against 20 unique antigens, including 9 secreted proteins (interleukins, IL-18, IL-22, IL-23 and IL-27), interferon-α2A, stem cell factor, transforming growth factor-β, macrophage colony-stimulating factor and macrophage migration inhibitory factor were significantly higher in patients who survived event-free to month 54. CONCLUSIONS Our results suggest that HSCT favourably alters the autoantibody repertoire, which remains virtually unchanged in CTX-treated patients. Although antibodies recognising secreted proteins are generally thought to be pathogenic, our results suggest a subset could potentially modulate HSCT in scleroderma.
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Affiliation(s)
- Burcu Ayoglu
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michele Donato
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Stanford Institute for Immunity Transplantation and Infection, Stanford, California, USA
| | - Daniel E Furst
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ellen Goldmuntz
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | - Judith James
- Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Susan Macwana
- Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Maureen D Mayes
- Department of Rheumatology, The University of Texas Health Science Center, Houston, Texas, USA
| | | | | | - Keith M Sullivan
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Beverly Welch
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | - Rong Mao
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Lorinda Chung
- Departments of Medicine & Dermatology, Stanford University, Stanford, California, USA.,Palo Alto VA Health Care System, Palo Alto, California, USA
| | - Purvesh Khatri
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA .,Stanford Institute for Immunity Transplantation and Infection, Stanford, California, USA
| | - Paul J Utz
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA .,Stanford Institute for Immunity Transplantation and Infection, Stanford, California, USA
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Sullivan KM, Farraye FA, Winthrop KL, Willer DO, Vink P, Tavares-Da-Silva F. Safety and efficacy of recombinant and live herpes zoster vaccines for prevention in at-risk adults with chronic diseases and immunocompromising conditions. Vaccine 2023; 41:36-48. [PMID: 36460534 DOI: 10.1016/j.vaccine.2022.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/30/2022]
Abstract
Compared with the general population, older adults with immune senescence and individuals who are immunocompromised (IC) due to disease or immunosuppressive therapy are at increased risk for herpes zoster (HZ) and its associated complications, which can be debilitating and life-threatening. Vaccination can be an effective strategy against HZ and studies have shown that HZ vaccination in IC individuals can elicit immune responses and provide protection from infection. Recently, the first approvals have been granted in the United States and the European Union for the recombinant HZ vaccine (RZV) in adults ≥ 18 years of age at risk of HZ due to immunodeficiency or immunosuppression. Existing systematic reviews have highlighted the risks for HZ in limited immunocompromising conditions and have only examined clinical data for RZV. This review details the risks and burden of HZ in a broad range of clinically relevant IC populations and summarizes key efficacy and safety data for RZV and live HZ vaccine in these individuals. Research has shown IC individuals can benefit from HZ vaccination; however, these insights have yet to be fully incorporated into vaccination guidelines and clinical care. Clinicians should consider HZ vaccination in eligible at-risk populations to protect against HZ and its associated complications and thereby, reduce the burden that HZ poses on the healthcare system. Electronic health records and linked personal health records could be used to identify and contact patients eligible for HZ vaccination and provide clinical decision support-generated alerts for missing or delayed vaccinations. This review will help clinicians identify eligible IC individuals who may benefit from HZ vaccination. A video abstract linked to this article is available on Figshare https://doi.org/10.6084/m9.figshare.21517605.
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Affiliation(s)
- Keith M Sullivan
- Duke University Medical Center, 200 Trent Dr, Durham, NC 27710, USA.
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Kevin L Winthrop
- Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA.
| | - David O Willer
- GSK Vaccines, 100 Milverton Drive Suite 800, Mississauga, ON, Canada.
| | - Peter Vink
- GSK Vaccines, 14200 Shady Grove Rd, Rockville, MD 20850, USA.
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12
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Schmalzing M, Henes J, van Laar JM, Sullivan KM. Editorial: Stem cell transplantation in autoimmune diseases (AID). Front Immunol 2023; 14:1150664. [PMID: 36936937 PMCID: PMC10014887 DOI: 10.3389/fimmu.2023.1150664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Marc Schmalzing
- Rheumatology/Clinical Immunology, Department of Internal Medicine II, University of Würzburg, Wuerzburg, Germany
- *Correspondence: Marc Schmalzing,
| | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II, University Hospital Tuebingen, Tuebingen, Germany
| | - Jacob M. van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Keith M. Sullivan
- Department of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, United States
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13
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Shah A, Storek J, Woolson R, Pinckney A, Keyes-Elstein L, Wallace PK, Sempowski GD, McSweeney P, Mayes MD, Crofford L, Csuka ME, Phillips K, Khanna D, Simms R, Ballen K, LeClercq S, Clair WS, Nixon AB, Nash R, Wener M, Brasington R, Silver R, Griffith LM, Furst DE, Goldmuntz E, Sullivan KM. Lymphocyte subset abnormalities in early severe scleroderma favor a Th2 phenotype and are not altered by prior immunosuppressive therapy. Rheumatology (Oxford) 2022; 61:4155-4162. [PMID: 35108379 PMCID: PMC9536786 DOI: 10.1093/rheumatology/keac015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/06/2021] [Revised: 12/14/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The Scleroderma: Cyclophosphamide or Transplantation (SCOT) trial compared hematopoietic stem cell transplant to CYC treatment in patients with early SSc with progressive skin and lung or kidney involvement. Here we describe lymphocyte phenotype abnormalities at study entry and the relation to prior DMARD therapy. METHODS Lymphocyte subsets (n = 26) measured by flow cytometry were compared in 123 heathy controls and 71 SCOT participants, including those given (n = 57) or not given (n = 14) DMARDs within 12 months of randomization. RESULTS Compared with healthy controls, individuals with SSc showed significant reductions in central memory CD8 T cells, activated total and CD4 T cells, γ/δ T cells, memory B cells, myeloid and plasmacytoid dendritic cells and FOXP3+CD25+ Treg cells and increases in naïve CD4 T cells, effector memory CD4 T cells and effector CD8 T cells. A greater bias towards a IL-4+ Th2/T cytotoxic 2 (Tc2) phenotype based on the Th2:Th1 CD4 ratio and Tc2:Tc1 CD8 T cells was also found. Notably, no difference in any lymphocyte subset was observed between those given or not given prior DMARDs. CONCLUSIONS In patients with early, severe SSc, significant lymphocyte subset abnormalities were observed. Prior treatment with immunosuppressive therapy did not impact the immunophenotype, suggesting that lymphocyte disturbances in scleroderma appeared to be due to the disease itself. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov), NCT00114530.
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Affiliation(s)
- Ankoor Shah
- Department of Medicine, Duke University, Durham, NC, USA
| | - Jan Storek
- Departments of Medicine and Oncology, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Paul K Wallace
- Department of Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Peter McSweeney
- Department of Hematology/Oncology, Colorado Blood Cancer Institute, Denver, CO
| | | | - Leslie Crofford
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - M E Csuka
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Kristine Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Robert Simms
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Karen Ballen
- Department of Medicine, University of Virginia, Charlottesville, VA
| | - Sharon LeClercq
- Departments of Medicine and Oncology, University of Calgary, Calgary, AB, Canada
| | | | - Andrew B Nixon
- Department of Medicine, Duke University, Durham, NC, USA
| | - Richard Nash
- Department of Hematology/Oncology, Colorado Blood Cancer Institute, Denver, CO
| | - Mark Wener
- Department of Oncology, Fred Hutchinson Cancer Research Center
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Richard Silver
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Linda M Griffith
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Daniel E Furst
- Department of Medicine, University of Washington, Seattle, WA
- Department of Medicine, University of California, Los Angeles, CA, USA
- University of Florence, Florence, Italy
| | - Ellen Goldmuntz
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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Sullivan KM, Winthrop KL, Willer DO, Vink P, Silva FTD. EPR22-118: Incidence of Herpes Zoster in Immunocompromised Individuals and Zoster Vaccination as an Effective Preventative Strategy. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7254] [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]
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Stadtmauer EA, Sullivan KM, El Idrissi M, Salaun B, Alonso Alonso A, Andreadis C, Anttila VJ, Bloor AJ, Broady R, Cellini C, Cuneo A, Dagnew AF, Di Paolo E, Eom H, González-Rodríguez AP, Grigg A, Guenther A, Heineman TC, Jarque I, Kwak JY, Lucchesi A, Oostvogels L, Polo Zarzuela M, Schuind AE, Shea TC, Sinisalo UM, Vural F, Yáñez San Segundo L, Zachée P, Bastidas A. Adjuvanted recombinant zoster vaccine in adult autologous stem cell transplant recipients: polyfunctional immune responses and lessons for clinical practice. Hum Vaccin Immunother 2021; 17:4144-4154. [PMID: 34406911 PMCID: PMC8828160 DOI: 10.1080/21645515.2021.1953346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 12/23/2022] Open
Abstract
Immunocompromised individuals, particularly autologous hematopoietic stem cell transplant (auHSCT) recipients, are at high risk for herpes zoster (HZ). We provide an in-depth description of humoral and cell-mediated immune (CMI) responses by age (protocol-defined) or underlying disease (post-hoc) as well as efficacy by underlying disease (post-hoc) of the adjuvanted recombinant zoster vaccine (RZV) in a randomized observer-blind phase III trial (ZOE-HSCT, NCT01610414). 1846 adult auHSCT recipients were randomized to receive a first dose of either RZV or placebo 50–70 days post-auHSCT, followed by the second dose at 1–2 months (M) later. In cohorts of 114–1721 participants, at 1 M post-second vaccine dose: Anti-gE antibody geometric mean concentrations (GMCs) and median gE-specific CD4[2+] T-cell frequencies (CD4 T cells expressing ≥2 of four assessed activation markers) were similar between 18–49 and ≥50-year-olds. Despite lower anti-gE antibody GMCs in non-Hodgkin B-cell lymphoma (NHBCL) patients, CD4[2+] T-cell frequencies were similar between NHBCL and other underlying diseases. The proportion of polyfunctional CD4 T cells increased over time, accounting for 79.6% of gE-specific CD4 T cells at 24 M post-dose two. Vaccine efficacy against HZ ranged between 42.5% and 82.5% across underlying diseases and was statistically significant in NHBCL and multiple myeloma patients. In conclusion, two RZV doses administered early post-auHSCT induced robust, persistent, and polyfunctional gE-specific immune responses. Efficacy against HZ was also high in NHBCL patients despite the lower humoral response.
What is the context?
After haematopoietic stem cell transplantation, patients have impaired immunity from conditioning chemotherapy regimens, often exacerbated by underlying diseases, putting them at high risk of developing herpes zoster. In this population, antiviral prophylaxis is the current standard of care to reduce herpes zoster risk. Vaccination provides an additional means to prevent herpes zoster. Live-attenuated vaccines are generally contraindicated in immunocompromised patients. A non-live, adjuvanted recombinant zoster vaccine (RZV, Shingrix, GSK), has been approved for use in adults ≥50 years of age in the European Union, United States, Canada, Australia, Japan, and China. This vaccine is highly efficacious at preventing herpes zoster in adults over 50 years of age, as demonstrated in large, placebo-controlled randomised trials. Importantly, Shingrix use is not contraindicated in immunocompromised conditions, and was found to be highly efficacious in adults who had recently undergone autologous haematopoietic stem cell transplant.
What is new?
In autologous haematopoietic stem cell transplant recipients in whom Shingrix has demonstrated efficacy, two doses elicited high and persistent immune responses. Date presented here further support our understanding of the impact of specific factors such as age or underlying diseases on the vaccine’s effect in the population studied, as well as the characteristics of the elicited cell-mediated immune responses.
What is the impact?
These results indicate that Shingrix, given shortly after haematopoietic stem cell transplant, can induce robust immune responses and reduce the risk of herpes zoster, even in individuals with immunosuppression due to underlying disease and/or use of immunosuppressive therapies, regardless of age or underlying disease.
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Affiliation(s)
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | - Veli-Jukka Anttila
- Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Adrian Jc Bloor
- Haematology and Transplant Unit, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Claudia Cellini
- U.O. di Ematologia, Ospedale Santa Maria Delle Croci, Ravenna, Italy
| | - Antonio Cuneo
- Unità Operativa di Ematologia, Azienda Osp. Universitaria Arcispedale S. Anna, Cona, Italy
| | | | | | - HyeonSeok Eom
- National Cancer Center, Goyang-si, Republic of Korea
| | | | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, Australia
| | | | | | - Isidro Jarque
- Hematology Department & CIBERONC, Instituto Carlos III, Hospital Universitario y Politécnico la fe, Valencia, Spain
| | - Jae-Yong Kwak
- Chonbuk National University Hospital, DukJin-Gu, Republic of Korea
| | - Alessandro Lucchesi
- Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | | | | | | | - Thomas C Shea
- Division of Hematology and Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ulla Marjatta Sinisalo
- Hematology Unit, Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Filiz Vural
- Ege University Medical Faculty Hospital, Izmir, Turkey
| | - Lucrecia Yáñez San Segundo
- Hematology Department, Hospital Universitario Marqués De Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Pierre Zachée
- Hematologie - Oncologie, Ziekenhuisnetwerk Antwerpen - ZNA Stuivenberg & ZNA Middelheim, Antwerpen, Belgium
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Shah A, Spierings J, van Laar JM, Sullivan KM. Re-evaluating inclusion criteria for autologous hematopoietic stem cell transplantation in advanced systemic sclerosis: Three successful cases and review of the literature. J Scleroderma Relat Disord 2021; 6:199-205. [PMID: 35386745 PMCID: PMC8892924 DOI: 10.1177/2397198320985766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/11/2020] [Indexed: 01/22/2024]
Abstract
Systemic sclerosis is a chronic autoimmune disease with a poor prognosis, particularly when a patient has rapidly progressive skin or pulmonary involvement. Autologous hematopoietic stem cell transplant is an emerging treatment for this condition, that has been demonstrated to be more effective than immunosuppressants. Careful selection of patients has reduced the transplant-related mortality and maximized the likelihood of benefit. In this report, we present three cases of successful autologous hematopoietic stem cell transplant in patients who would not have met inclusion criteria for entrance into the completed hematopoietic stem cell transplant. After >18 months of follow-up, three patients had clinically significant benefit in terms of skin tightening and pulmonary function tests. Future studies of hematopoietic stem cell transplant in systemic sclerosis may aim to carefully liberalize inclusion criteria to include patients who may not have otherwise been treated while still maintaining an acceptable safety profile.
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Affiliation(s)
- Ankoor Shah
- Division of Rheumatology, Duke University, Durham, NC, USA
| | - J Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - JM van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
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17
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Cardones AR, Hall RP, Sullivan KM, Hooten J, Lee SY, Liu B, Green CL, Chao NJ, Rowe Nichols K, Bañez LL, Shah A, Leung N, Palmeri ML. Quantifying Skin Stiffness in Graft-Versus-Host Disease, Morphea, and Systemic Sclerosis Using Acoustic Radiation Force Impulse Imaging and Shear Wave Elastography. J Invest Dermatol 2021; 141:924-927.e2. [DOI: 10.1016/j.jid.2020.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022]
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Sung AD, Miller HM, Romero K, MacDonald G, Bohannon L, Molinger J, Ren Y, Bush A, Lew M, Cohen HJ, Pastva A, Jung SH, Shah NR, Smith PJ, Wischmeyer PE, Wood WA, Alyea E, Choi T, Gasparetto C, Horwitz ME, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sullivan KM, Chao NJ, Bartlett DB. A Phase 1 Study of the Safety and Feasibility of Improving Cardiorespiratory Fitness through a Remotely Monitored, Mobile Health Supported High Intensity Interval Training Program (REMM-HIIT). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Bellocchi C, Ying J, Goldmuntz EA, Keyes-Elstein L, Varga J, Hinchcliff ME, Lyons MA, McSweeney P, Furst DE, Nash R, Crofford LJ, Welch B, Goldin JG, Pinckney A, Mayes MD, Sullivan KM, Assassi S. Large-Scale Characterization of Systemic Sclerosis Serum Protein Profile: Comparison to Peripheral Blood Cell Transcriptome and Correlations With Skin/Lung Fibrosis. Arthritis Rheumatol 2021; 73:660-670. [PMID: 33131208 DOI: 10.1002/art.41570] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide a large-scale assessment of serum protein dysregulation in diffuse cutaneous systemic sclerosis (dcSSc) and to investigate serum protein correlates of SSc fibrotic features. METHODS We investigated serum protein profiles of 66 participants with dcSSc at baseline who were enrolled in the Scleroderma: Cyclophosphamide or Transplant Trial and 66 age- and sex-matched healthy control subjects. A panel of 230 proteins, including several cytokines and chemokines, was investigated. Whole blood gene expression profiling in concomitantly collected samples was performed. RESULTS Among the participants with dcSSc, the mean disease duration was 2.3 years. All had interstitial lung disease (ILD), and none were being treated with immunosuppressive agents at baseline. Ninety proteins were differentially expressed in participants with dcSSc compared to healthy control subjects. Similar to previous global skin transcript results, hepatic fibrosis, granulocyte and agranulocyte adhesion, and diapedesis were the top overrepresented pathways. Eighteen proteins correlated with the modified Rodnan skin thickness score (MRSS). Soluble epidermal growth factor receptor was significantly down-regulated in dcSSc and showed the strongest negative correlation with the MRSS, being predictive of the score's course over time, whereas α1 -antichymotrypsin was significantly up-regulated in dcSSc and showed the strongest positive correlation with the MRSS. Furthermore, higher levels of cancer antigen 15-3 correlated with more severe ILD, based on findings of reduced forced vital capacity and higher scores of disease activity on high-resolution computed tomography. Only 14 genes showed significant differential expression in the same direction in serum protein and whole blood RNA gene expression analyses. CONCLUSION Diffuse cutaneous SSc has a distinct serum protein profile with prominent dysregulation of proteins related to fibrosis and immune cell adhesion/diapedesis. The differential expression for most serum proteins in SSc is likely to originate outside the peripheral blood cells.
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Affiliation(s)
- Chiara Bellocchi
- The University of Texas Health Science Center at Houston and McGovern Medical School, Houston, and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Jun Ying
- The University of Texas Health Science Center at Houston and McGovern Medical School, Houston
| | - Ellen A Goldmuntz
- National Institute of Allergy and Infectious Diseases, NIH, Rockville, Maryland
| | | | - John Varga
- Northwestern University, Chicago, Illinois
| | | | - Marka A Lyons
- The University of Texas Health Science Center at Houston and McGovern Medical School, Houston
| | | | - Daniel E Furst
- University of California Los Angeles, University of Washington, Seattle, and University of Florence, Florence, Italy
| | | | | | - Beverly Welch
- National Institute of Allergy and Infectious Diseases, NIH, Rockville, Maryland
| | | | | | - Maureen D Mayes
- The University of Texas Health Science Center at Houston and McGovern Medical School, Houston
| | | | - Shervin Assassi
- The University of Texas Health Science Center at Houston and McGovern Medical School, Houston
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20
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Maung KK, Chen BJ, Barak I, Li Z, Rizzieri DA, Gasparetto C, Sullivan KM, Long GD, Engemann AM, Waters-Pick B, Nichols KR, Lopez R, Kang Y, Sarantopoulos S, Sung AD, Chao NJ, Horwitz ME. Phase I dose escalation study of naive T-cell depleted donor lymphocyte infusion following allogeneic stem cell transplantation. Bone Marrow Transplant 2021; 56:137-143. [PMID: 32624583 PMCID: PMC10805111 DOI: 10.1038/s41409-020-0991-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022]
Abstract
Prophylactic donor lymphocyte infusions (DLI) are used to augment post-transplant immune recovery to reduce both infectious complications and disease recurrence. Preclinical studies implicate the naive T-cell subset as the primary driver of graft-versus-host disease (GvHD). In this phase I dose escalation study, we assessed the safety of a DLI that was depleted of CD45RA+ naive T cells. Sixteen adult patients received a prophylactic DLI at a median of 113 days (range 76-280 days) following an HLA-identical, non-myeloablative allogeneic hematopoietic stem cell transplantation. Three patients each received the naive T-cell depleted DLI with a CD3+ dose of 1 × 105/kg, 1 × 106/kg, and 5 × 106/kg. The maximum dose of 1 × 107/kg was expanded to 7 patients. No dose-limiting grade III/IV acute GvHD or adverse events attributable to the DLI were observed at any dose level. One patient developed grade 2 acute GvHD of skin and upper intestines, and another developed moderate chronic GvHD of the lungs following the DLI. With a median follow-up of 2.8 years, 2-year progression-free and overall survival is 50.0% and 68.8%, respectively. In conclusion, these data suggest that a DLI that has been depleted of CD45RA+ naive T cells is feasible and carries a low risk of acute or chronic GvHD.
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Affiliation(s)
- Ko K Maung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Benny J Chen
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Ian Barak
- Cancer Center Biostatistics, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Zhiguo Li
- Cancer Center Biostatistics, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Ashley M Engemann
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Barbara Waters-Pick
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Krista Rowe Nichols
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Yubin Kang
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA.
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Tay J, Beattie S, Bredeson C, Brazauskas R, He N, Ahmed IA, Aljurf M, Askar M, Atsuta Y, Badawy S, Barata A, Beitinjaneh AM, Bhatt NS, Buchbinder D, Cerny J, Ciurea S, D'Souza A, Dalal J, Farhadfar N, Freytes CO, Ganguly S, Gergis U, Gerull S, Lazarus HM, Hahn T, Hong S, Inamoto Y, Khera N, Kindwall-Keller T, Kamble RT, Knight JM, Koleva YN, Kumar A, Kwok J, Murthy HS, Olsson RF, Angel Diaz-Perez M, Rizzieri D, Seo S, Chhabra S, Schoemans H, Schouten HC, Steinberg A, Sullivan KM, Szer J, Szwajcer D, Ulrickson ML, Verdonck LF, Wirk B, Wood WA, Yared JA, Saber W. Pre-Transplant Marital Status and Hematopoietic Cell Transplantation Outcomes. Curr Oncol 2020; 27:e596-e606. [PMID: 33380875 PMCID: PMC7755447 DOI: 10.3747/co.27.6327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 12/13/2022] Open
Abstract
Background Evidence about the impact of marital status before hematopoietic cell transplantation (hct) on outcomes after hct is conflicting. Methods We identified patients 40 years of age and older within the Center for International Blood and Marrow Transplant Research registry who underwent hct between January 2008 and December 2015. Marital status before hct was declared as one of: married or living with a partner, single (never married), separated or divorced, and widowed. We performed a multivariable analysis to determine the association of marital status with outcomes after hct. Results We identified 10,226 allogeneic and 5714 autologous hct cases with, respectively, a median follow-up of 37 months (range: 1-102 months) and 40 months (range: 1-106 months). No association between marital status and overall survival was observed in either the allogeneic (p = 0.58) or autologous (p = 0.17) setting. However, marital status was associated with grades 2-4 acute graft-versus-host disease (gvhd), p < 0.001, and chronic gvhd, p = 0.04. The risk of grades 2-4 acute gvhd was increased in separated compared with married patients [hazard ratio (hr): 1.13; 95% confidence interval (ci): 1.03 to 1.24], and single patients had a reduced risk of grades 2-4 acute gvhd (hr: 0.87; 95% ci: 0.77 to 0.98). The risk of chronic gvhd was lower in widowed compared with married patients (hr: 0.82; 95% ci: 0.67 to 0.99). Conclusions Overall survival after hct is not influenced by marital status, but associations were evident between marital status and grades 2-4 acute and chronic gvhd. To better appreciate the effects of marital status and social support, future research should consider using validated scales to measure social support and patient and caregiver reports of caregiver commitment, and to assess health-related quality of life together with health care utilization.
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Affiliation(s)
- J Tay
- Alberta: Tom Baker Cancer Centre, University of Calgary, Calgary (Tay, Beattie)
| | - S Beattie
- Alberta: Tom Baker Cancer Centre, University of Calgary, Calgary (Tay, Beattie)
| | - C Bredeson
- Ontario: The Ottawa Hospital Blood and Marrow Transplant Program and The Ottawa Hospital Research Institute, Ottawa (Bredeson)
| | - R Brazauskas
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - N He
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - I A Ahmed
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - M Aljurf
- Saudi Arabia: Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh (Aljurf)
| | - M Askar
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - Y Atsuta
- Japan: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya (Atsuta); Nagoya University Graduate School of Medicine, Nagoya (Atsuta); Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo (Inamoto); Department of Hematology and Oncology, Dokkyo Medical University, Tochigi (Seo, Sullivan)
| | - S Badawy
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - A Barata
- Spain: Hospital de la Santa Creu i Sant Pau, Barcelona (Barata); Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid (Angel Diaz-Perez)
| | - A M Beitinjaneh
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - N S Bhatt
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - D Buchbinder
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - J Cerny
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - S Ciurea
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - A D'Souza
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - J Dalal
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - N Farhadfar
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - C O Freytes
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - S Ganguly
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - U Gergis
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - S Gerull
- Switzerland: Department of Hematology, University Hospital, Basel (Gerull)
| | - H M Lazarus
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - T Hahn
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - S Hong
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - Y Inamoto
- Japan: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya (Atsuta); Nagoya University Graduate School of Medicine, Nagoya (Atsuta); Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo (Inamoto); Department of Hematology and Oncology, Dokkyo Medical University, Tochigi (Seo, Sullivan)
| | - N Khera
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - T Kindwall-Keller
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - R T Kamble
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - J M Knight
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - Y N Koleva
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - A Kumar
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - J Kwok
- P.R.C.: Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong sar (Kwok)
| | - H S Murthy
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - R F Olsson
- Sweden: Department of Laboratory Medicine, Karolinska Institutet, Stockholm (Olsson); Centre for Clinical Research Sormland, Uppsala University, Uppsala (Olsson)
| | - M Angel Diaz-Perez
- Spain: Hospital de la Santa Creu i Sant Pau, Barcelona (Barata); Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid (Angel Diaz-Perez)
| | - D Rizzieri
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - S Seo
- Japan: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya (Atsuta); Nagoya University Graduate School of Medicine, Nagoya (Atsuta); Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo (Inamoto); Department of Hematology and Oncology, Dokkyo Medical University, Tochigi (Seo, Sullivan)
| | - S Chhabra
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - H Schoemans
- Belgium: University Hospital Leuven and KU Leuven, Leuven (Schoemans)
| | - H C Schouten
- Netherlands: Department of Hematology, Acadeische Ziekenhuis, Maastrict (Schouten); Department of Hematology/Oncology, Isala Clinic, Zwolle (Verdonck)
| | - A Steinberg
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - K M Sullivan
- Japan: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya (Atsuta); Nagoya University Graduate School of Medicine, Nagoya (Atsuta); Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo (Inamoto); Department of Hematology and Oncology, Dokkyo Medical University, Tochigi (Seo, Sullivan)
| | - J Szer
- Australia: Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Victoria (Szer)
| | - D Szwajcer
- Manitoba: CancerCare Manitoba, Winnipeg, MB (Szwajcer)
| | - M L Ulrickson
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - L F Verdonck
- Netherlands: Department of Hematology, Acadeische Ziekenhuis, Maastrict (Schouten); Department of Hematology/Oncology, Isala Clinic, Zwolle (Verdonck)
| | - B Wirk
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - W A Wood
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - J A Yared
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
| | - W Saber
- U.S.A.: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI (Brazauskas, He, D'Souza, Chhabra, Saber); Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI (Brazauskas); Department of Hematology, Oncology and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, MO (Ahmed); Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, TX (Askar, Kamble); Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago (Badawy); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago (Badawy); University of Miami, Miami (Beitinjaneh); St. Jude Children's Research Hospital, Memphis, TN (Bhatt); Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA (Buchbinder); Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA (Cerny); University of Texas MD Anderson Cancer Center, Houston, TX (Ciurea); Rainbow Babies and Children's Hospital, Cleveland, OH (Dalal); Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL (Farhadfar); Texas Transplant Institute, San Antonio, TX (Freytes); Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS (Ganguly); Haematologic Malignancies and Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (Gergis); Case Western Reserve University, Cleveland, OH (Lazarus); Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY (Hahn); Cleveland Clinic Taussig Cancer Center, Cleveland, OH (Hong); Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ (Khera); Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA (Kindwall-Keller); Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI (Knight); Tulane Cancer Center, New Orleans, LA (Koleva); Tufts Medical Center, Philadelphia, PA (Kumar); Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL (Murthy); Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC (Rizzieri); Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY (Steinberg); Banner MD Anderson Cancer Center, Gilbert, AZ (Ulrickson); Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA (Wirk); Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC (Wood); Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD (Yared)
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23
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Smith P, Thompson JC, Perea E, Wasserman B, Bohannon L, Racioppi A, Choi T, Gasparetto C, Horwitz ME, Long G, Lopez R, Rizzieri DA, Sarantopoulos S, Sullivan KM, Chao NJ, Sung AD. Clinical and Neuroimaging Correlates of Post-Transplant Delirium. Biol Blood Marrow Transplant 2020; 26:2323-2328. [PMID: 32961373 DOI: 10.1016/j.bbmt.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/14/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
Delirium is common among adults undergoing hematopoietic stem cell transplantation (HCT), although the clinical and neuroimaging correlates of post-HCT delirium have not been adequately delineated. We therefore examined the frequency of delirium and neuroimaging correlates of post-transplant delirium in a retrospective cohort of 115 adults undergoing neuroimaging after allogeneic HCT. Delirium was established using previously validated methods for retrospective identification of chart-assessed postprocedural delirium. Chart reviews were independently conducted by a multidisciplinary team with expertise in HCT, psychiatry, and psychology on consecutive allogeneic HCT patients who underwent neuroimaging assessments and transplantation at a single center between January 2009 and December 2016. Neuroimaging markers of white matter damage and brain volume loss were also recorded. In total, 115 patients were included, ranging in age from 20 to 74 years (mean [SD] age, 49 [13]). Fifty-three patients (46%) developed post-HCT delirium. In an adjusted model, delirium incidence was associated with older age (odds ratio [OR], 1.92 [1.28, 2.87] per decade, P = .002), greater severity of white matter hyperintensities (OR, 1.95 [1.06, 3.57], P = .031), and conditioning intensity (OR, 6.37 [2.20, 18.45], P < .001) but was unrelated to cortical atrophy (P = .777). Delirium was associated with fewer hospital-free days (P = .023) but was not associated with overall survival (hazard ratio, 0.95 [0.56, 1.61], P = .844). Greater incidence of delirium following HCT was associated with greater age, microvascular burden, and conditioning intensity. Pre-HCT consideration of microvascular burden and other neuroimaging biomarkers of risk may be warranted.
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Affiliation(s)
- Patrick Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Jillian C Thompson
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Elena Perea
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Brian Wasserman
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Lauren Bohannon
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Alessandro Racioppi
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Taewoong Choi
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Mitchell E Horwitz
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Gwynn Long
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Richard Lopez
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - David A Rizzieri
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Keith M Sullivan
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
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24
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Franks JM, Martyanov V, Wang Y, Wood TA, Pinckney A, Crofford LJ, Keyes-Elstein L, Furst DE, Goldmuntz E, Mayes MD, McSweeney P, Nash RA, Sullivan KM, Whitfield ML. Machine learning predicts stem cell transplant response in severe scleroderma. Ann Rheum Dis 2020; 79:1608-1615. [PMID: 32933919 DOI: 10.1136/annrheumdis-2020-217033] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The Scleroderma: Cyclophosphamide or Transplantation (SCOT) trial demonstrated clinical benefit of haematopoietic stem cell transplant (HSCT) compared with cyclophosphamide (CYC). We mapped PBC (peripheral blood cell) samples from the SCOT clinical trial to scleroderma intrinsic subsets and tested the hypothesis that they predict long-term response to HSCT. METHODS We analysed gene expression from PBCs of SCOT participants to identify differential treatment response. PBC gene expression data were generated from 63 SCOT participants at baseline and follow-up timepoints. Participants who completed treatment protocol were stratified by intrinsic gene expression subsets at baseline, evaluated for event-free survival (EFS) and analysed for differentially expressed genes (DEGs). RESULTS Participants from the fibroproliferative subset on HSCT experienced significant improvement in EFS compared with fibroproliferative participants on CYC (p=0.0091). In contrast, EFS did not significantly differ between CYC and HSCT arms for the participants from the normal-like subset (p=0.77) or the inflammatory subset (p=0.1). At each timepoint, we observed considerably more DEGs in HSCT arm compared with CYC arm with HSCT arm showing significant changes in immune response pathways. CONCLUSIONS Participants from the fibroproliferative subset showed the most significant long-term benefit from HSCT compared with CYC. This study suggests that intrinsic subset stratification of patients may be used to identify patients with SSc who receive significant benefit from HSCT.
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Affiliation(s)
- Jennifer M Franks
- Molecular and Systems Biology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,Biomedical Data Science, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Viktor Martyanov
- Molecular and Systems Biology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,Biomedical Data Science, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Yue Wang
- Molecular and Systems Biology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,Biomedical Data Science, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Tammara A Wood
- Molecular and Systems Biology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,Biomedical Data Science, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Ashley Pinckney
- Rho Federal Systems Division, Chapel Hill, North Carolina, USA
| | - Leslie J Crofford
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | - Daniel E Furst
- Department of Medicine, Division of Rheumatology, University of California at Los Angeles, Los Angeles, California, USA
| | | | - Maureen D Mayes
- Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center Houston Medical School, Houston, Texas, USA
| | - Peter McSweeney
- Rocky Mountain Blood and Marrow Transplant Program, Colorado Blood Cancer Institute, Denver, Colorado, USA
| | - Richard A Nash
- Rocky Mountain Blood and Marrow Transplant Program, Colorado Blood Cancer Institute, Denver, Colorado, USA
| | - Keith M Sullivan
- Duke University Medical Center, Durham, North Carolina, United States
| | - Michael L Whitfield
- Molecular and Systems Biology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA .,Biomedical Data Science, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
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Maung K, Ramalingam S, Chaudhry M, Ren Y, Jung SH, Romero K, Corbet K, Chao NJ, Choi T, Diehl AM, Diehl L, Gasparetto C, Horwitz M, Long GD, Lopez RD, Rizzieri DA, Sarantopoulos S, Sullivan KM, Bashir MR, Sung AD. Pre-transplant hepatic steatosis (fatty liver) is associated with chronic graft-vs-host disease but not mortality. PLoS One 2020; 15:e0238824. [PMID: 32915853 PMCID: PMC7485815 DOI: 10.1371/journal.pone.0238824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/23/2020] [Indexed: 12/17/2022] Open
Abstract
Allogeneic-HCT (allo-HCT), while potentially curative, can result in significant complications including graft versus host disease (GVHD). Prior studies suggest that metabolic syndrome may be one risk factor for GVHD. We hypothesized that hepatic steatosis on pre-HCT computed tomography (CT) scans may be a marker for development of GVHD and poor outcomes in allo-HCT. In this retrospective study, we reviewed the pre-HCT CT scans and transplant outcome data of patients who underwent allo-HCT at Duke University Medical Center from 2009 to 2017. The presence of steatosis was confirmed using CT attenuation measurements. We then assessed the association between pre-HCT hepatic steatosis and HCT-related outcomes including GVHD. 80 patients who had pre-HCT CT scans were included in the study. Pre-transplant hepatic steatosis was associated with the development of chronic GVHD (OR 4.2, p = 0.02), but was not associated with acute GVHD (OR 1.3, p = 0.7), non-relapse mortality (p = 0.81) or overall survival (p = 0.74). Based on this single center retrospective study, pre-transplant hepatic steatosis is associated with development of chronic GVHD. Further, prospective study with other imaging modalities including non-contrasted CT scans is needed to determine if this association is reproducible.
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Affiliation(s)
- Ko Maung
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sendhilnathan Ramalingam
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mohammad Chaudhry
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Yi Ren
- Duke Cancer Institute, Biostatistics Shared Resources, Duke University, Durham, North Carolina, United States of America
| | - Sin-Ho Jung
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kristi Romero
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kelly Corbet
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Nelson J. Chao
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Taewoong Choi
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Anna Mae Diehl
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Louis Diehl
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Mitchell Horwitz
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Gwynn Douglas Long
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Richard D. Lopez
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - David A. Rizzieri
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Keith M. Sullivan
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
| | - Mustafa R. Bashir
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Anthony D. Sung
- Division of Hematologic Malignancies and Cell Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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26
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Maung K, An Chao NJ, Corbet K, Engemann AM, Gasparetto C, Horwitz M, Kang Y, Long GD, Lopez RD, Rizzieri D, Sarantopoulos S, Sullivan KM, Sung AD, Choi T. CLO20-049: Retrospective Study of Safety and Toxicity Profile Comparison for Propylene Glycol-Free Melphalan (Evomela®) and Generic Melphalan. J Natl Compr Canc Netw 2020. [DOI: 10.6004/jnccn.2019.7412] [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)
- Ko Maung
- aDuke University Hospital, Durham, NC
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27
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Assassi S, Wang X, Chen G, Goldmuntz E, Keyes-Elstein L, Ying J, Wallace PK, Turner J, Zheng WJ, Pascual V, Varga J, Hinchcliff ME, Bellocchi C, McSweeney P, Furst DE, Nash RA, Crofford LJ, Welch B, Pinckney A, Mayes MD, Sullivan KM. Myeloablation followed by autologous stem cell transplantation normalises systemic sclerosis molecular signatures. Ann Rheum Dis 2019; 78:1371-1378. [PMID: 31391177 PMCID: PMC7167108 DOI: 10.1136/annrheumdis-2019-215770] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE In the randomised scleroderma: Cyclophosphamide Or Transplantation (SCOT trial) (NCT00114530), myeloablation, followed by haematopoietic stem cell transplantation (HSCT), led to improved clinical outcomes compared with monthly cyclophosphamide (CYC) treatment in systemic sclerosis (SSc). Herein, the study aimed to determine global molecular changes at the whole blood transcript and serum protein levels ensuing from HSCT in comparison to intravenous monthly CYC in 62 participants enrolled in the SCOT study. METHODS Global transcript studies were performed at pretreatment baseline, 8 months and 26 months postrandomisation using Illumina HT-12 arrays. Levels of 102 proteins were measured in the concomitantly collected serum samples. RESULTS At the baseline visit, interferon (IFN) and neutrophil transcript modules were upregulated and the cytotoxic/NK module was downregulated in SSc compared with unaffected controls. A paired comparison of the 26 months to the baseline samples revealed a significant decrease of the IFN and neutrophil modules and an increase in the cytotoxic/NK module in the HSCT arm while there was no significant change in the CYC control arm. Also, a composite score of correlating serum proteins with IFN and neutrophil transcript modules, as well as a multilevel analysis showed significant changes in SSc molecular signatures after HSCT while similar changes were not observed in the CYC arm. Lastly, a decline in the IFN and neutrophil modules was associated with an improvement in pulmonary forced vital capacity and an increase in the cytotoxic/NK module correlated with improvement in skin score. CONCLUSION HSCT contrary to conventional treatment leads to a significant 'correction' in disease-related molecular signatures.
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Affiliation(s)
- Shervin Assassi
- Rheumatology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Xuan Wang
- Biostatistics, Baylor Institute for Immunology Research, Dallas, Texas, USA
| | - Guocai Chen
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ellen Goldmuntz
- Allergy, Immunology, and Transplantation, NIH/NIAID, Bethesda, Maryland, USA
| | | | - Jun Ying
- Rheumatology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Paul K Wallace
- Flow and Image Cytometry, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Jacob Turner
- Mathematics and Statistics, Stephen F Austin State University, Nacogdoches, Texas, USA
| | - W Jim Zheng
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Virginia Pascual
- Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - John Varga
- Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Chiara Bellocchi
- Rheumatology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Peter McSweeney
- Rocky Mountain Blood and Marrow Transplant Program, Colorado Blood Cancer Institute, Denver, Colorado, USA
| | - Daniel E Furst
- Rheumatology, University of California Los Angeles, Los Angeles, California, USA
- Rheumatology, University of Washington, Seattle, Washington, USA
| | - Richard A Nash
- Rocky Mountain Blood and Marrow Transplant Program, Colorado Blood Cancer Institute, Denver, Colorado, USA
| | | | - Beverly Welch
- Allergy, Immunology, and Transplantation, NIH/NIAID, Bethesda, Maryland, USA
| | - Ashley Pinckney
- Rho Federal Systems Division, Chapel Hill, North Carolina, USA
| | - Maureen D Mayes
- Rheumatology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Keith M Sullivan
- Hematologic Malignancy and Cellular Therapy, Duke University, Durham, North Carolina, USA
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Curran D, Matthews S, Rowley SD, Young JAH, Bastidas A, Anagnostopoulos A, Barista I, Chandrasekar PH, Dickinson M, El Idrissi M, Heras I, Milliken ST, Monserrat Coll J, Navarro Matilla MB, Oostvogels L, Piątkowska-Jakubas B, Quiel D, Sabry W, Schwartz S, Selleslag DLD, Sullivan KM, Theunissen K, Yegin ZA, Yeh SP, Zaja F, Szer J. Recombinant Zoster Vaccine Significantly Reduces the Impact on Quality of Life Caused by Herpes Zoster in Adult Autologous Hematopoietic Stem Cell Transplant Recipients: A Randomized Placebo-Controlled Trial (ZOE-HSCT). Biol Blood Marrow Transplant 2019; 25:2474-2481. [PMID: 31394276 DOI: 10.1016/j.bbmt.2019.07.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/17/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 01/22/2023]
Abstract
Herpes zoster (HZ) can have a substantial impact on quality of life (QoL). The vaccine efficacy (VE) of a recombinant zoster vaccine (RZV) was 68.2% (95% confidence interval [CI], 55.6% to 77.5%) in a phase 3 study in adult autologous hematopoietic stem cell transplant (HSCT) recipients (NCT01610414). Herein, we report the impact of RZV on patients' QoL. Autologous HSCT recipients were randomized 1:1 to receive 2 doses of RZV or placebo, given 1 to 2 months apart. QoL was measured by the Short Form Survey-36 and Euro-QoL-5 Dimension at baseline, 1 month, and 1 year postdose 2 and during suspected HZ episodes with the Zoster Brief Pain Inventory (ZBPI). The RZV impact on ZBPI burden of illness and burden of interference scores was estimated. The 2 scores were calculated from the area under the curve (days 0 to 182) of the ZBPI worst pain and ZBPI activities of daily living scores, respectively, assuming a score of 0 for patients not having a confirmed HZ episode. The ZBPI maximum worst pain score was significantly lower in the RZV than placebo group (mean: 5.8 versus 7.1, P = .011). Consequently, the VE estimates for HZ burden of illness (82.5%; 95% CI, 73.6 to 91.4) and burden of interference (82.8%; 95% CI, 73.3 to 92.3) were higher than the HZ VE estimate (ie, 68.2%). RZV showed significantly better QoL scores than placebo 1 week following rash onset among patients with confirmed HZ. In addition to reducing the risk of HZ and its complications, RZV significantly reduced the impact of HZ on patients' QoL in those who developed breakthrough disease.
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Affiliation(s)
| | | | - Scott D Rowley
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | | | | | | | | | - Michael Dickinson
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Inmaculada Heras
- Hospital General Universitario J. M. Morales Meseguer, Murcia, Spain
| | - Samuel T Milliken
- Department of Haematology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | | | | | | | | | - Dimas Quiel
- Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panama, Panama
| | - Waleed Sabry
- Saskatoon Cancer Centre, Saskatoon, Saskatchewan, Canada
| | - Stefan Schwartz
- Department of Hematology and Oncology, Charité University Medical Center, Berlin, Germany
| | | | | | | | | | - Su-Peng Yeh
- Department of Hematology, China Medical University Hospital, Taichung, Taiwan
| | - Francesco Zaja
- Clinica Ematologica, Azienda Ospedaliero Universitaria S. Maria Misericordia, Friuli-Venezia-Giulia, Udine, Italy
| | - Jeff Szer
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Bastidas A, de la Serna J, El Idrissi M, Oostvogels L, Quittet P, López-Jiménez J, Vural F, Pohlreich D, Zuckerman T, Issa NC, Gaidano G, Lee JJ, Abhyankar S, Solano C, Perez de Oteyza J, Satlin MJ, Schwartz S, Campins M, Rocci A, Vallejo Llamas C, Lee DG, Tan SM, Johnston AM, Grigg A, Boeckh MJ, Campora L, Lopez-Fauqued M, Heineman TC, Stadtmauer EA, Sullivan KM. Effect of Recombinant Zoster Vaccine on Incidence of Herpes Zoster After Autologous Stem Cell Transplantation: A Randomized Clinical Trial. JAMA 2019; 322:123-133. [PMID: 31287523 PMCID: PMC6618796 DOI: 10.1001/jama.2019.9053] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [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: 12/25/2022]
Abstract
IMPORTANCE Herpes zoster, a frequent complication following autologous hematopoietic stem cell transplantation (HSCT), is associated with significant morbidity. A nonlive adjuvanted recombinant zoster vaccine has been developed to prevent posttransplantation zoster. OBJECTIVE To assess the efficacy and adverse event profile of the recombinant zoster vaccine in immunocompromised autologous HSCT recipients. DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, observer-blinded study conducted in 167 centers in 28 countries between July 13, 2012, and February 1, 2017, among 1846 patients aged 18 years or older who had undergone recent autologous HSCT. INTERVENTIONS Participants were randomized to receive 2 doses of either recombinant zoster vaccine (n = 922) or placebo (n = 924) administered into the deltoid muscle; the first dose was given 50 to 70 days after transplantation and the second dose 1 to 2 months thereafter. MAIN OUTCOMES AND MEASURES The primary end point was occurrence of confirmed herpes zoster cases. RESULTS Among 1846 autologous HSCT recipients (mean age, 55 years; 688 [37%] women) who received 1 vaccine or placebo dose, 1735 (94%) received a second dose and 1366 (74%) completed the study. During the 21-month median follow-up, at least 1 herpes zoster episode was confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94 per 1000 person-years, respectively), an incidence rate ratio (IRR) of 0.32 (95% CI, 0.22-0.44; P < .001), equivalent to 68.2% vaccine efficacy. Of 8 secondary end points, 3 showed significant reductions in incidence of postherpetic neuralgia (vaccine, n=1; placebo, n=9; IRR, 0.1; 95% CI, 0.00-0.78; P = .02) and of other prespecified herpes zoster-related complications (vaccine, n=3; placebo, n=13; IRR, 0.22; 95% CI, 0.04-0.81; P = .02) and in duration of severe worst herpes zoster-associated pain (vaccine, 892.0 days; placebo, 6275.0 days; hazard ratio, 0.62; 95% CI, 0.42-0.89; P = .01). Five secondary objectives were descriptive. Injection site reactions were recorded in 86% of vaccine and 10% of placebo recipients, of which pain was the most common, occurring in 84% of vaccine recipients (grade 3: 11%). Unsolicited and serious adverse events, potentially immune-mediated diseases, and underlying disease relapses were similar between groups at all time points. CONCLUSIONS AND RELEVANCE Among adults who had undergone autologous HSCT, a 2-dose course of recombinant zoster vaccine compared with placebo significantly reduced the incidence of herpes zoster over a median follow-up of 21 months. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01610414.
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Affiliation(s)
| | | | | | | | | | | | - Filiz Vural
- Ege University Medical School, Izmir, Turkey
| | | | | | - Nicolas C. Issa
- Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gianluca Gaidano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Je-Jung Lee
- Chonnam National University Hwasun Hospital, Jellanamdo, Republic of Korea
| | | | - Carlos Solano
- Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Perez de Oteyza
- Centro Integral Oncológico Clara Campal (CIOCC), Universidad CEU San Pablo, Madrid, Spain
| | | | - Stefan Schwartz
- Department of Hematology and Oncology, Charité University Medical Center, Berlin, Germany
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Alberto Rocci
- Haematology Department, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, England
- Faculty of Biology, Medicine and Health, School of Medical Science, Division of Cancer Sciences, University of Manchester, Manchester, England
| | | | - Dong-Gun Lee
- Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | | | | | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, Australia
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Cardones AR, Sullivan KM, Green C, Chao NJ, Rowe-Nichols K, Bañez LL, Burton CS, Horwitz ME, Long GD, Rao CL, Sarantopoulos S, Sidhu-Malik N, Sung AD, Hall RP. Interrater Reliability of Clinical Grading Measures for Cutaneous Chronic Graft-vs-Host Disease. JAMA Dermatol 2019; 155:833-837. [PMID: 30994873 PMCID: PMC6583829 DOI: 10.1001/jamadermatol.2018.5459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Cutaneous chronic graft-vs-host disease (cGVHD) is common after allogeneic hematopoietic stem cell transplant and is often associated with poor patient outcomes. A reliable and practical method for assessing disease severity and response to therapy among these patients is urgently needed. Objective To evaluate the interrater agreement and reliability of skin-specific and range of motion (ROM) variables of the 2014 National Institutes of Health (NIH) response criteria for cGVHD and a skin sclerosis grading scale (SSG). Design, Setting, and Participants In this observational study performed at a single tertiary academic center, 6 academic blood and marrow transplant specialists and 4 medical dermatologists examined 8 patients with diagnosed cutaneous cGVHD on July 10, 2015. The patient cohort was enriched for patients with sclerotic features. Each patient was evaluated by using the skin-specific and ROM criteria of the 2014 NIH response criteria for cGVHD and an SSG ranging from 0 to 3. Each patient was also asked to complete quality-of-life scoring instruments. Interrater agreement and reliability were estimated by calculating the Krippendorff α and Cohen κ statistics. Data were analyzed from September 29, 2015, through November 22, 2018. Main Outcomes and Measures Estimation of interrater agreement by interclass coefficient (Krippendorff α and Cohen κ statistics) for the skin-specific and ROM components of the 2014 NIH Response Criteria for Chronic GVHD and for the SSG. Results The median age of the patients evaluated was 54 years (range, 46-58 years). Patients were predominantly male (6 [75%]). Six of the 8 patients had a predominantly sclerotic cutaneous phenotype. Interrater agreement among our experts was acceptable for NIH skin feature score (0.68; 95% CI, 0.30-0.86) and good for NIH ROM scoring (0.80; 95% CI, 0.68-0.86). Dermatologists had acceptable agreement for NIH skin GVHD score (0.69; 95% CI, 0.25-0.82) and skin feature score (0.78; 95% CI, 0.17-0.98), good agreement in ROM grading (0.85; 95% CI, 0.69-0.90), and near perfect agreement in identifying sclerosis (0.82; 95% CI, 0.27-0.97). Conclusions and Relevance Although dermatologists had acceptable agreement in NIH skin GVHD score and skin features score, near perfect agreement in identifying cutaneous sclerosis, better agreement in grading severity of cutaneous cGVHD, especially in the intermediate grades, appears to be needed.
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Affiliation(s)
- Adela R Cardones
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Dermatology, Duke University, Durham, North Carolina.,Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Keith M Sullivan
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Cindy Green
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Krista Rowe-Nichols
- Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Lionel L Bañez
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Claude S Burton
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Mitchell E Horwitz
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Gwynn D Long
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Caroline L Rao
- Department of Dermatology, Duke University, Durham, North Carolina.,Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | | | - Anthony D Sung
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Russell P Hall
- Department of Dermatology, Duke University, Durham, North Carolina
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Blanchard SK, Sullivan KM, Hooten JN, Holcomb ZE, Rowe Nichols K, Selim MA, Rao CL, Hall RP, Chao NJ, Cardones AR. High-dose intravenous immunoglobulin as adjuvant treatment for grade IV acute cutaneous graft-versus-host disease. Br J Dermatol 2019; 181:869-871. [PMID: 31017659 DOI: 10.1111/bjd.18028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S K Blanchard
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A
| | - K M Sullivan
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A
| | - J N Hooten
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A
| | - Z E Holcomb
- Duke University School of Medicine, Durham, NC, U.S.A
| | - K Rowe Nichols
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A
| | - M A Selim
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A.,Department of Pathology, Duke University Medical Center, Durham, NC, U.S.A
| | - C L Rao
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A.,Durham VA Medical Center, Durham, NC, U.S.A
| | - R P Hall
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A
| | - N J Chao
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A
| | - A R Cardones
- Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A.,Durham VA Medical Center, Durham, NC, U.S.A
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Daniel SK, Sullivan KM, Labadie KP, Pillarisetty VG. Hypoxia as a barrier to immunotherapy in pancreatic adenocarcinoma. Clin Transl Med 2019; 8:10. [PMID: 30931508 PMCID: PMC6441665 DOI: 10.1186/s40169-019-0226-9] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/09/2019] [Indexed: 12/11/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDA) is a lethal disease with limited response to cytotoxic chemoradiotherapy, as well as newer immunotherapies. The PDA tumor microenvironment contains infiltrating immune cells including cytotoxic T cells; however, there is an overall immunosuppressive milieu. Hypoxia is a known element of the solid tumor microenvironment and may promote tumor survival. Through various mechanisms including, but not limited to, those mediated by HIF-1α, hypoxia also leads to increased tumor proliferation and metabolic changes. Furthermore, epithelial to mesenchymal transition is promoted through several pathways, including NOTCH and c-MET, regulated by hypoxia. Hypoxia-promoted changes also contribute to the immunosuppressive phenotype seen in many different cell types within the microenvironment and thereby may inhibit an effective immune system response to PDA. Pancreatic stellate cells (PSCs) and myofibroblasts appear to contribute to the recruitment of myeloid derived suppressor cells (MDSCs) and B cells in PDA via cytokines increased due to hypoxia. PSCs also increase collagen secretion in response to HIF-1α, which promotes a fibrotic stroma that alters T cell homing and migration. In hypoxic environments, B cells contribute to cytotoxic T cell exhaustion and produce chemokines to attract more immunosuppressive regulatory T cells. MDSCs inhibit T cell metabolism by hoarding key amino acids, modulate T cell homing by cleaving L-selectin, and prevent T cell activation by increasing PD-L1 expression. Immunosuppressive M2 phenotype macrophages promote T cell anergy via increased nitric oxide (NO) and decreased arginine in hypoxia. Increased numbers of regulatory T cells are seen in hypoxia which prevent effector T cell activation through cytokine production and increased CTLA-4. Effective immunotherapy for pancreatic adenocarcinoma and other solid tumors will need to help counteract the immunosuppressive nature of hypoxia-induced changes in the tumor microenvironment. Promising studies will look at combination therapies involving checkpoint inhibitors, chemokine inhibitors, and possible targeting of hypoxia. While no model is perfect, assuring that models incorporate the effects of hypoxia on cancer cells, stromal cells, and effector immune cells will be crucial in developing successful therapies.
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Affiliation(s)
- S K Daniel
- Department of Surgery, University of Washington, Seattle, USA
| | - K M Sullivan
- Department of Surgery, University of Washington, Seattle, USA
| | - K P Labadie
- Department of Surgery, University of Washington, Seattle, USA
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Krishnamurti L, Neuberg DS, Sullivan KM, Kamani NR, Abraham A, Campigotto F, Zhang W, Dahdoul T, De Castro L, Parikh S, Bakshi N, Haight A, Hassell KL, Loving R, Rosenthal J, Smith SL, Smith W, Spearman M, Stevenson K, Wu CJ, Wiedl C, Waller EK, Walters MC. Bone marrow transplantation for adolescents and young adults with sickle cell disease: Results of a prospective multicenter pilot study. Am J Hematol 2019; 94:446-454. [PMID: 30637784 PMCID: PMC6542639 DOI: 10.1002/ajh.25401] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/21/2022]
Abstract
We conducted a multicenter pilot investigation of the safety and feasibility of bone marrow transplantation (BMT) in adults with severe sickle cell disease (SCD) (NCT 01565616) using a reduced toxicity preparative regimen of busulfan (13.2 mg/kg), fludarabine (175 mg/m2 ) and thymoglobulin (6 mg/kg) and cyclosporine or tacrolimus and methotrexate for graft-vs-host disease (GVHD) prophylaxis. Twenty-two patients (median age 22 years; range 17-36) were enrolled at eight centers. Seventeen patients received marrow from an HLA-identical sibling donor and five patients received marrow from an 8/8 HLA-allele matched unrelated donor. Before BMT, patients had stroke, acute chest syndrome, recurrent pain events, were receiving regular red blood cell transfusions, or had an elevated tricuspid regurgitant jet (TRJ) velocity, which fulfilled eligibility criteria. Four patients developed grades II-III acute GVHD (18%) and six developed chronic GVHD (27%) that was moderate in two and severe in one patient. One patient died of intracranial hemorrhage and one of GVHD. Nineteen patients had stable donor chimerism, 1-year post-transplant. One patient who developed secondary graft failure survives disease-free after a second BMT. The one-year overall survival and event-free survival (EFS) are 91% (95% CI 68%-98%) and 86% (95% CI, 63%-95%), respectively, and 3-year EFS is 82%. Statistically significant improvements in the pain interference and physical function domains of health-related quality of life were observed. The study satisfied the primary endpoint of 1-year EFS ≥70%. This regimen is being studied in a prospective clinical trial comparing HLA-matched donor BMT with standard of care in adults with severe SCD (NCT02766465).
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Affiliation(s)
- Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Donna S Neuberg
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Keith M Sullivan
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapies, Duke University Medical Center, Durham, North Carolina
| | - Naynesh R Kamani
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC
| | - Allistair Abraham
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Federico Campigotto
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Wandi Zhang
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Thabat Dahdoul
- Division of Hematology/Oncology, Department of Medicine, University of Colorado, Denver, Colorado
| | - Laura De Castro
- Division of Hematology/Oncology, Department of Pediatrics, City of Hope Hospital, Duarte, California
| | - Suhag Parikh
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapies, Duke University Medical Center, Durham, North Carolina
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Ann Haight
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Kathryn L Hassell
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Richmond of Virginia Commonwealth University, Richmond, Virginia
| | - Rebekah Loving
- Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Joseph Rosenthal
- Division of Stem Cell Transplantation and Immunotherapy, Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Shannon L Smith
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Wally Smith
- Division of Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital of Oakland, Oakland, California
| | | | - Kristen Stevenson
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Catherine J Wu
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Christina Wiedl
- Division of Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital of Oakland, Oakland, California
| | - Edmund K Waller
- Division of Stem Cell Transplantation and Immunotherapy, Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Mark C Walters
- Division of Hematology/Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital of Oakland, Oakland, California
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Volkmann ER, Tashkin DP, Sim M, Li N, Goldmuntz E, Keyes-Elstein L, Pinckney A, Furst DE, Clements PJ, Khanna D, Steen V, Schraufnagel DE, Arami S, Hsu V, Roth MD, Elashoff RM, Sullivan KM. Short-term progression of interstitial lung disease in systemic sclerosis predicts long-term survival in two independent clinical trial cohorts. Ann Rheum Dis 2018; 78:122-130. [PMID: 30409830 DOI: 10.1136/annrheumdis-2018-213708] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/27/2018] [Accepted: 10/16/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess survival and identify predictors of survival in patients with systemic sclerosis-interstitial lung disease (SSc-ILD) who participated in the Scleroderma Lung Studies (SLS) I and II. METHODS SLS I randomised 158 patients with SSc-ILD to 1 year of oral cyclophosphamide (CYC) vs placebo. SLS II randomised 142 patients to 1 year of oral CYC followed by 1 year of placebo vs 2 years of mycophenolate mofetil. Counting process Cox proportional hazard modelling identified variables associated with long-term mortality in SLS I and II. Internal validation was performed using joint modelling. RESULTS After a median follow-up of 8 years, 42% of SLS I patients died, and when known the cause of death was most often attributable to SSc. There was no significant difference in the time to death between treatment arms in SLS I or II. Higher baseline skin score, older age, and a decline in the forced vital capacity (FVC) and the diffusing capacity for carbon monoxide (DLCO) over 2 years were independently associated with an increased risk of mortality in SLS I. The Cox model identified the same mortality predictor variables using the SLS II data. CONCLUSION In addition to identifying traditional mortality risk factors in SSc (skin score, age), this study demonstrated that a decline in FVC and DLCO over 2 years was a better predictor of mortality than baseline FVC and DLCO. These findings suggest that short-term changes in surrogate measures of SSc-ILD progression may have important effects on long-term outcomes.
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Affiliation(s)
- Elizabeth R Volkmann
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Donald P Tashkin
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Myung Sim
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Ning Li
- Department of Biomathematics, University of California, Los Angeles, California, USA
| | | | | | | | - Daniel E Furst
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Philip J Clements
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Dinesh Khanna
- Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Virginia Steen
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Dean E Schraufnagel
- Department of Medicine, University of Illinois Hospital, Chicago, Illinois, USA
| | - Shiva Arami
- Department of Medicine, University of Illinois Hospital, Chicago, Illinois, USA
| | - Vivien Hsu
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michael D Roth
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Robert M Elashoff
- Department of Biomathematics, University of California, Los Angeles, California, USA
| | - Keith M Sullivan
- Department of Medicine, Duke University, Durham, North Carolina, USA
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Sullivan KM, Shah A, Sarantopoulos S, Furst DE. Review: Hematopoietic Stem Cell Transplantation for Scleroderma: Effective Immunomodulatory Therapy for Patients With Pulmonary Involvement. Arthritis Rheumatol 2018; 68:2361-71. [PMID: 27213276 PMCID: PMC5042829 DOI: 10.1002/art.39748] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/05/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Keith M Sullivan
- Duke University and Duke University Medical Center, Durham, North Carolina.
| | - Ankoor Shah
- Duke University and Duke University Medical Center, Durham, North Carolina
| | | | - Daniel E Furst
- University of California, Los Angeles, and University of Washington, Seattle
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Sullivan KM, Majhail NS, Bredeson C, Carpenter PA, Chatterjee S, Crofford LJ, Georges GE, Nash RA, Pasquini MC, Sarantopoulos S, Storek J, Savani B, St Clair EW. Systemic Sclerosis as an Indication for Autologous Hematopoietic Cell Transplantation: Position Statement from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2018; 24:1961-1964. [PMID: 29953945 DOI: 10.1016/j.bbmt.2018.06.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 06/19/2018] [Indexed: 12/29/2022]
Abstract
Systemic sclerosis is a progressive inflammatory disease that is frequently fatal and has limited treatment options. High-dose chemotherapy with autologous hematopoietic cell transplantation (AHCT) has been evaluated as treatment for this disease in observational studies, multicenter randomized controlled clinical trials, and meta-analyses. On behalf of the American Society for Blood and Marrow Transplantation (ASBMT), a panel of experts in transplantation and rheumatology was convened to review available evidence and make a recommendation on AHCT as an indication for systemic sclerosis. Three randomized trials have compared the efficacy of AHCT with cyclophosphamide only, and all demonstrated benefit for the AHCT arm for their primary endpoint (improvement in the American Scleroderma Stem Cell versus Immune Suppression Trial, event-free survival in Autologous Stem Cell Transplantation International Scleroderma trial, and change in global rank composite score in Scleroderma: Cyclophosphamide or Transplantation trial). AHCT recipients also had better overall survival and a lower rate of disease progression. These findings have been confirmed in subsequent meta-analyses. Based on this high-quality evidence, the ASBMT recommends systemic sclerosis should be considered as a "standard of care" indication for AHCT. Close collaboration between rheumatologists and transplant clinicians is critical for optimizing patient selection and patient outcomes. Transplant centers in the United States are strongly encouraged to report patient and outcomes data to the Center for International Blood and Marrow Transplant Research on their patients receiving AHCT for this indication.
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Affiliation(s)
- Keith M Sullivan
- Department of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina.
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | | | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Soumya Chatterjee
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - George E Georges
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Richard A Nash
- Blood and Marrow Transplant Program, Colorado Blood Cancer Institute, Denver, Colorado
| | - Marcelo C Pasquini
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin
| | - Stefanie Sarantopoulos
- Department of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Jan Storek
- Blood and Marrow Transplant Program, University of Calgary, Calgary, Alberta, Canada
| | - Bipin Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - E William St Clair
- Department of Rheumatology and Immunology, Duke University School of Medicine, Durham, North Carolina
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Cardona DM, Detweiler CJ, Shealy MJ, Sung AD, Wild DM, Poleski MH, Balmadrid BL, Cirrincione CT, Howell DN, Sullivan KM. Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease. Arch Pathol Lab Med 2018; 142:1098-1105. [PMID: 29697275 DOI: 10.5858/arpa.2017-0054-oa] [Citation(s) in RCA: 4] [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: 01/22/2023]
Abstract
CONTEXT - Graft-versus-host disease of the gastrointestinal tract is a common complication of hematopoietic stem cell transplant associated with significant morbidity and mortality. Accurate diagnosis can be difficult and is a truly clinicopathologic endeavor. OBJECTIVES - To assess the diagnostic sensitivity of gastrointestinal graft-versus-host disease using the 2015 National Institutes of Health (NIH) histology consensus guidelines and to analyze histologic findings that support the guidelines. DESIGN - Patients with allogeneic hematopoietic stem cell transplants were identified via a retrospective search of our electronic medical records from January 1, 2005, to January 1, 2011. Endoscopies with available histology were reviewed by 2 pathologists using the 2015 NIH guidelines. The clinical diagnosis was used as the gold standard. A nontransplant set of endoscopic biopsies was used as a control. RESULTS - Of the 250 total endoscopies, 217 (87%) had a clinical diagnosis of gastrointestinal graft-versus-host disease. Use of the NIH consensus guidelines showed a sensitivity of 86% and a specificity of 65%. Thirty-seven of 58 (64%) cases with an initial false-negative histopathologic diagnosis were diagnosed as graft-versus-host disease on our review. CONCLUSIONS - Use of the NIH histology consensus guidelines results in a high sensitivity and specificity, thereby decreasing false-negatives. Additionally, use of the NIH guidelines aids in creating uniformity and diagnostic clarity. Correlation with clinical and laboratory findings is critical in evaluating the differential diagnosis and to avoid false-positives. As expected, increased apoptosis with decreased inflammation was associated with a pathologic diagnosis of graft-versus-host disease and supports the NIH guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Keith M Sullivan
- From the Departments of Pathology (Drs Cardona, Detweiler, Shealy, and Howell) and Internal Medicine (Drs Sung, Wild, Poleski, Balmadrid, and Sullivan), Duke University Medical Center, Durham, North Carolina; and the Department of Biostatistics (Ms Cirrincione), Duke Cancer Institute, Durham, North Carolina
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Sullivan KM, Horwitz M, Osunkwo I, Shah N, Strouse JJ. Shared Decision-Making in Hematopoietic Stem Cell Transplantation for Sickle Cell Disease. Biol Blood Marrow Transplant 2018; 24:883-884. [PMID: 29649619 DOI: 10.1016/j.bbmt.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina.
| | - Mitchell Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Ifeyinwa Osunkwo
- Sickle Cell Disease Enterprise, Levine Cancer Institute, Carolinas Healthcare, Atrium Health, Charlotte, North Carolina
| | - Nirmish Shah
- Adult Sickle Cell Center, Duke University Medical Center, Durham, North Carolina; Division of Hematology, Duke University Medical Center, Durham, North Carolina; Division of Pediatric Hematology/Oncology, Duke University Medical Center, Durham, North Carolina
| | - John J Strouse
- Adult Sickle Cell Center, Duke University Medical Center, Durham, North Carolina; Division of Hematology, Duke University Medical Center, Durham, North Carolina
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Somers TJ, Kelleher SA, Dorfman CS, Shelby RA, Fisher HM, Rowe Nichols K, Sullivan KM, Chao NJ, Samsa GP, Abernethy AP, Keefe FJ. An mHealth Pain Coping Skills Training Intervention for Hematopoietic Stem Cell Transplantation Patients: Development and Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e66. [PMID: 29555620 PMCID: PMC5881038 DOI: 10.2196/mhealth.8565] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Received: 07/27/2017] [Revised: 10/16/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pain is a challenge for patients following hematopoietic stem cell transplantation (HCT). OBJECTIVE This study aimed to develop and test the feasibility, acceptability, and initial efficacy of a Web-based mobile pain coping skills training (mPCST) protocol designed to address the needs of HCT patients. METHODS Participants had undergone HCT and reported pain following transplant (N=68). To guide intervention development, qualitative data were collected from focus group participants (n=25) and participants who completed user testing (n=7). After their input was integrated into the mPCST intervention, a pilot randomized controlled trial (RCT, n=36) was conducted to examine the feasibility, acceptability, and initial efficacy of the intervention. Measures of acceptability, pain severity, pain disability, pain self-efficacy, fatigue, and physical disability (self-report and 2-min walk test [2MWT]) were collected. RESULTS Participants in the focus groups and user testing provided qualitative data that were used to iteratively refine the mPCST protocol. Focus group qualitative data included participants' experiences with pain following transplant, perspectives on ways to cope with pain, and suggestions for pain management for other HCT patients. User testing participants provided feedback on the HCT protocol and information on the use of videoconferencing. The final version of the mPCST intervention was designed to bridge the intensive outpatient (1 in-person session) and home settings (5 videoconferencing sessions). A key component of the intervention was a website that provided personalized messages based on daily assessments of pain and activity. The website also provided intervention materials (ie, electronic handouts, short videos, and audio files). The intervention content included pain coping advice from other transplant patients and instructions on how to apply pain coping skills while engaging in meaningful and leisure activities. In the RCT phase of this research, HCT patients (n=36) were randomized to receive the mPCST intervention or to proceed with the treatment as usual. Results revealed that the mPCST participants completed an average of 5 out of 6 sessions. The participants reported that the intervention was highly acceptable (mean 3/4), and they found the sessions to be helpful (mean 8/10) and easy to understand (mean 7/7). The mPCST participants demonstrated significant improvements in pre- to post-treatment pain, self-efficacy (P=.03, d=0.61), and on the 2MWT (P=.03, d=0.66), whereas the patients in the treatment-as-usual group did not report any such improvements. Significant changes in pain disability and fatigue were found in both groups (multiple P<.02); the magnitudes of the effect sizes were larger for the mPCST group than for the control group (pain disability: d=0.79 vs 0.69; fatigue: d=0.94 vs 0.81). There were no significant changes in pain severity in either group. CONCLUSIONS Using focus groups and user testing, we developed an mPCST protocol that was feasible, acceptable, and beneficial for HCT patients with pain. TRIAL REGISTRATION ClinicalTrials.gov NCT01984671; https://clinicaltrials.gov/ct2/show/NCT01984671 (Archived by WebCite at http://www.webcitation.org/6xbpx3clZ).
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Affiliation(s)
- Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Krista Rowe Nichols
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, United States
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, United States
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, United States
| | - Gregory P Samsa
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States
| | - Amy P Abernethy
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
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Sullivan KM, Goldmuntz EA, Keyes-Elstein L, McSweeney PA, Pinckney A, Welch B, Mayes MD, Nash RA, Crofford LJ, Eggleston B, Castina S, Griffith LM, Goldstein JS, Wallace D, Craciunescu O, Khanna D, Folz RJ, Goldin J, St Clair EW, Seibold JR, Phillips K, Mineishi S, Simms RW, Ballen K, Wener MH, Georges GE, Heimfeld S, Hosing C, Forman S, Kafaja S, Silver RM, Griffing L, Storek J, LeClercq S, Brasington R, Csuka ME, Bredeson C, Keever-Taylor C, Domsic RT, Kahaleh MB, Medsger T, Furst DE. Myeloablative Autologous Stem-Cell Transplantation for Severe Scleroderma. N Engl J Med 2018; 378:35-47. [PMID: 29298160 PMCID: PMC5846574 DOI: 10.1056/nejmoa1703327] [Citation(s) in RCA: 336] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite current therapies, diffuse cutaneous systemic sclerosis (scleroderma) often has a devastating outcome. We compared myeloablative CD34+ selected autologous hematopoietic stem-cell transplantation with immunosuppression by means of 12 monthly infusions of cyclophosphamide in patients with scleroderma. METHODS We randomly assigned adults (18 to 69 years of age) with severe scleroderma to undergo myeloablative autologous stem-cell transplantation (36 participants) or to receive cyclophosphamide (39 participants). The primary end point was a global rank composite score comparing participants with each other on the basis of a hierarchy of disease features assessed at 54 months: death, event-free survival (survival without respiratory, renal, or cardiac failure), forced vital capacity, the score on the Disability Index of the Health Assessment Questionnaire, and the modified Rodnan skin score. RESULTS In the intention-to-treat population, global rank composite scores at 54 months showed the superiority of transplantation (67% of 1404 pairwise comparisons favored transplantation and 33% favored cyclophosphamide, P=0.01). In the per-protocol population (participants who received a transplant or completed ≥9 doses of cyclophosphamide), the rate of event-free survival at 54 months was 79% in the transplantation group and 50% in the cyclophosphamide group (P=0.02). At 72 months, Kaplan-Meier estimates of event-free survival (74% vs. 47%) and overall survival (86% vs. 51%) also favored transplantation (P=0.03 and 0.02, respectively). A total of 9% of the participants in the transplantation group had initiated disease-modifying antirheumatic drugs (DMARDs) by 54 months, as compared with 44% of those in the cyclophosphamide group (P=0.001). Treatment-related mortality in the transplantation group was 3% at 54 months and 6% at 72 months, as compared with 0% in the cyclophosphamide group. CONCLUSIONS Myeloablative autologous hematopoietic stem-cell transplantation achieved long-term benefits in patients with scleroderma, including improved event-free and overall survival, at a cost of increased expected toxicity. Rates of treatment-related death and post-transplantation use of DMARDs were lower than those in previous reports of nonmyeloablative transplantation. (Funded by the National Institute of Allergy and Infectious Diseases and the National Institutes of Health; ClinicalTrials.gov number, NCT00114530 .).
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Affiliation(s)
- Keith M Sullivan
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Ellen A Goldmuntz
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Lynette Keyes-Elstein
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Peter A McSweeney
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Ashley Pinckney
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Beverly Welch
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Maureen D Mayes
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Richard A Nash
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Leslie J Crofford
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Barry Eggleston
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Sharon Castina
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Linda M Griffith
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Julia S Goldstein
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Dennis Wallace
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Oana Craciunescu
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Dinesh Khanna
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Rodney J Folz
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Jonathan Goldin
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - E William St Clair
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - James R Seibold
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Kristine Phillips
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Shin Mineishi
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Robert W Simms
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Karen Ballen
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Mark H Wener
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - George E Georges
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Shelly Heimfeld
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Chitra Hosing
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Stephen Forman
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Suzanne Kafaja
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Richard M Silver
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Leroy Griffing
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Jan Storek
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Sharon LeClercq
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Richard Brasington
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Mary E Csuka
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Christopher Bredeson
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Carolyn Keever-Taylor
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Robyn T Domsic
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - M Bashar Kahaleh
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Thomas Medsger
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
| | - Daniel E Furst
- From the Duke University Medical Center (K.M.S., O.C., E.W.S.C.) and RTI International (D.W.), Durham, and Rho Federal Systems Division, Chapel Hill (L.K.-E., A.P., B.E., S.C.) - all in North Carolina; National Institute of Allergy and Infectious Diseases, Bethesda, MD (E.A.G., B.W., L.M.G., J.S.G.); Colorado Blood Cancer Institute, Denver (P.A.M., R.A.N.); University of Texas McGovern Medical School (M.D.M.) and M.D. Anderson Cancer Center (C.H.) - both in Houston; Vanderbilt University, Nashville (L.J.C., K.P.); University of Michigan, Ann Arbor (D.K., J.R.S.); Case Western Reserve University and University Hospitals, Cleveland (R.J.F.); University of Alabama, Birmingham (S.M.); Boston University, Boston (R.W.S.); University of Virginia, Charlottesville (K.B.); University of Washington (M.H.W., D.E.F.) and the Fred Hutchinson Cancer Research Center (G.E.G., S.H.) - both in Seattle; University of California, Los Angeles, Los Angeles (J.G., S.K., D.E.F.); City of Hope National Medical Center, Duarte, CA (S.F.); Medical University of South Carolina, Charleston (R.M.S.); Mayo Clinic, Scottsdale, AZ (L.G.); University of Calgary, Calgary, AB, Canada (J.S., S.L.); Washington University, St. Louis (R.B.); Medical College of Wisconsin, Milwaukee (M.E.C., C.K.-T.); Ottawa Hospital Research Institute, Ottawa (C.B.); University of Pittsburgh, Pittsburgh (T.M., R.T.D.); and University of Toledo Medical Center, Toledo, OH (M.B.K.)
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Sung AD, Hassan S, Cardona DM, Wild D, Nichols KR, Mehdikhani H, Balmadrid B, Detweiler CJ, Shealy M, Cirrincione C, Li Z, Poleski M, Dalton TE, Siamakpour-Reihani S, Chao NJ, Sullivan KM. Late Gastrointestinal Complications of Allogeneic Hematopoietic Stem Cell Transplantation in Adults. Biol Blood Marrow Transplant 2017; 24:734-740. [PMID: 29246821 DOI: 10.1016/j.bbmt.2017.12.772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/02/2017] [Indexed: 12/11/2022]
Abstract
Gastrointestinal (GI) complications including graft-versus-host disease (GVHD) are a major cause of morbidity and mortality in allogenic stem transplant recipients. Although several studies have previously looked into the acute GI complications, fewer smaller studies have reported late complications. In this large study we focus on the late (100 days post-transplant) GI complications in allogenic stem transplant recipients. In this single-center, retrospective study of all adult allogenic stem cell transplant recipients who had their transplant at Duke University over a 6-year period, 479 patients underwent allogenic stem cell transplant, of whom 392 recipients survived for at least 100 days post-transplant. Late GI symptoms were noted in 71 patients, prompting endoscopic evaluation. The primary endpoint of our study was the diagnosis of GI-GVHD based on endoscopic findings, whereas overall survival and nonrelapse mortality were the secondary endpoints. Of the 71 patients who underwent endoscopy, 45 (63%) had GI-GVHD. Of these 45 patients, 39 (87%) had late acute GVHD, 1 (2%) had chronic GVHD, and 5 patients (11%) had overlap disease. Of the patients who did not have GVHD, the symptoms were mostly related to infectious and inflammatory causes. Less common causes included drug toxicity, food intolerance, disease relapse, and motility issues. In a multivariate analysis the factors most indicative of GI-GVHD were histologic findings of apoptosis on the tissue specimen (odds ratio, 2.35; 95% confidence interval, 1.18 to 4.70; P = .015) and clinical findings of diarrhea (odds ratio, 5.43; 95% confidence interval, 1.25 to 23.54; P = .024). The median survival time from the first endoscopy was 8.5 months. The incidence of nonrelapse mortality at 6 months was 31% in patients with GI-GVHD and 19% in patients without GI-GVHD (P = .42). All patients with GI-GVHD were on steroid therapy, and 31% of them received total parenteral nutrition. In our population close to one-fifth of allogenic transplant recipients experienced late GI complications, warranting endoscopic evaluation. Most of these patients were found to have GI-GVHD that had a high incidence of nonrelapse mortality at 6 months and close to one-third of these patients needed total parenteral nutrition.
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Affiliation(s)
- Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina.
| | - Syed Hassan
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Diana M Cardona
- Department of Pathology, Duke University, Durham, North Carolina
| | - Daniel Wild
- Division of Gastroenterology, Duke University Medical Center, Durham, NC
| | - Krista Rowe Nichols
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Hossein Mehdikhani
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Bryan Balmadrid
- Division of Gastroenterology, Duke University Medical Center, Durham, NC
| | | | - Michael Shealy
- Department of Pathology, Duke University, Durham, North Carolina
| | - Constance Cirrincione
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Martin Poleski
- Division of Gastroenterology, Duke University Medical Center, Durham, NC
| | - Tara E Dalton
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Sharareh Siamakpour-Reihani
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
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44
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Sivaraj D, Bacon W, Long GD, Rizzieri DA, Horwitz ME, Sullivan KM, Kang Y, Li Z, Chao NJ, Gasparetto C. High-dose BCNU/Melphalan conditioning regimen before autologous stem cell transplantation in newly diagnosed multiple myeloma. Bone Marrow Transplant 2017; 53:34-38. [DOI: 10.1038/bmt.2017.208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/08/2017] [Accepted: 08/16/2017] [Indexed: 01/31/2023]
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Anand S, Thomas S, Corbet K, Gasparetto C, Long GD, Lopez R, Morris AK, Rizzieri DA, Sullivan KM, Sung AD, Sarantopoulos S, Chao NJ, Horwitz ME. Adult Umbilical Cord Blood Transplantation Using Myeloablative Thiotepa, Total Body Irradiation, and Fludarabine Conditioning. Biol Blood Marrow Transplant 2017; 23:1949-1954. [PMID: 28729147 DOI: 10.1016/j.bbmt.2017.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/26/2017] [Indexed: 12/16/2022]
Abstract
Treatment-related mortality (TRM) remains elevated in adult patients undergoing umbilical cord blood transplantation (UCBT), including an early rise in TRM suggestive of excessive toxicity associated with the standard myeloablative total body irradiation (TBI), fludarabine, and cyclophosphamide regimen. In an attempt to reduce regimen-related toxicity, we previously studied a modified myeloablative regimen with TBI (1350 cGy) and fludarabine (160 mg/m2); TRM was decreased, but neutrophil engraftment was suboptimal. Therefore, to improve engraftment while still minimizing regimen-related toxicity, we piloted a myeloablative regimen with the addition of thiotepa (10 mg/kg) to TBI and fludarabine conditioning. Thirty-one adult patients (median age, 46 years; range, 19 to 65) with hematologic malignancies (acute leukemia/myelodysplastic syndrome, 77%; lymphoid malignancy, 23%) underwent single (n = 1) or double (n = 30) UCBT from 2010 to 2015 at our institution. The cumulative incidence of neutrophil engraftment was 90% (95% confidence interval [CI], 70% to 97%) by 60 days, with a median time to engraftment of 21 days (95% CI, 19 to 26). The cumulative incidence of platelet engraftment was 77% (95% CI, 57% to 89%) by 100 days, with a median time to engraftment of 47 days (95% CI, 37 to 73). Cumulative incidences of grades II to IV and grades III to IV acute graft-versus-host disease (GVHD) at day 100 were 45% (95% CI, 27% to 62%) and 10% (95% CI, 2% to 23%), respectively. The overall incidence of chronic GVHD at 2 years was 40% (95% CI, 22% to 57%), with 17% of patients (95% CI, 6% to 33%) experiencing moderate to severe chronic GVHD by 2 years. TRM at 180 days was 13% (95% CI, 4% to 27%), at 1 year 24% (95% CI, 10% to 41%), and at 3 years 30% (95% CI, 13% to 49%). Relapse at 1 year was 13% (95% CI, 4% to 27%) and at 3 years 19% (95% CI, 6% to 38%). With a median follow-up of 35.5 months (95% CI, 12.7 to 52.2), disease-free and overall survival at 3 years were 51% (95% CI, 29% to 69%) and 57% (95% CI, 36% to 73%), respectively. This regimen represents a reasonable alternative to myeloablative conditioning with TBI, fludarabine, and cyclophosphamide and warrants further study.
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Affiliation(s)
- Sarah Anand
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Samantha Thomas
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Kelly Corbet
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Ashley K Morris
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina.
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Keever-Taylor CA, Heimfeld S, Steinmiller KC, Nash RA, Sullivan KM, Czarniecki CW, Granderson TC, Goldstein JS, Griffith LM. Manufacture of Autologous CD34 + Selected Grafts in the NIAID-Sponsored HALT-MS and SCOT Multicenter Clinical Trials for Autoimmune Diseases. Biol Blood Marrow Transplant 2017; 23:1463-1472. [PMID: 28602891 DOI: 10.1016/j.bbmt.2017.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/15/2017] [Indexed: 12/29/2022]
Abstract
To ensure comparable grafts for autologous hematopoietic cell transplantation (HCT) in the National Institute of Allergy and Infectious Diseases-sponsored Investigational New Drug protocols for multiple sclerosis (HALT-MS) and systemic sclerosis (SCOT), a Drug Master File approach to control manufacture was implemented, including a common Master Production Batch Record and site-specific standard operating procedures with "Critical Elements." We assessed comparability of flow cytometry and controlled rate cryopreservation among sites and stability of cryopreserved grafts using hematopoietic progenitor cells (HPCs) from healthy donors. Hematopoietic Progenitor Cells, Apheresis-CD34+ Enriched, for Autologous Use (Auto-CD34+HPC) graft specifications included ≥70% viable CD34+ cells before cryopreservation. For the 2 protocols, 110 apheresis collections were performed; 121 lots of Auto-CD34+HPC were cryopreserved, and 107 of these (88.4%) met release criteria. Grafts were infused at a median of 25 days (range, 17 to 68) post-apheresis for HALT-MS (n = 24), and 25 days (range, 14 to 78) for SCOT (n = 33). Subjects received precryopreservation doses of a median 5.1 × 106 viable CD34+ cells/kg (range, 3.9 to 12.8) for HALT-MS and 5.6 × 106 viable CD34+ cells/kg (range, 2.6 to 10.2) for SCOT. Recovery of granulocytes occurred at a median of 11 days (range, 9 to 15) post-HCT for HALT-MS and 10 days (range, 8 to 12) for SCOT, independent of CD34+ cell dose. Subjects received their last platelet transfusion at a median of 9 days (range, 6 to 16) for HALT-MS and 8 days (range, 6 to 23) for SCOT; higher CD34+/kg doses were associated with faster platelet recovery. Stability testing of cryopreserved healthy donor CD34+ HPCs over 6 months of vapor phase liquid nitrogen storage demonstrated consistent 69% to 73% recovery of viable CD34+ cells. Manufacturing of Auto-CD34+HPC for the HALT-MS and SCOT protocols was comparable across all sites and supportive for timely recovery of granulocytes and platelets.
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Affiliation(s)
- Carolyn A Keever-Taylor
- Departments of Medicine, Microbiology and Molecular Genetics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shelly Heimfeld
- Clinical Research Division, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, Washington; Nohla Therapeutics, Seattle, Washington
| | | | | | | | - Christine W Czarniecki
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Tomeka C Granderson
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Julia S Goldstein
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
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47
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Anand S, Thomas S, Hyslop T, Adcock J, Corbet K, Gasparetto C, Lopez R, Long GD, Morris AK, Rizzieri DA, Sullivan KM, Sung AD, Sarantopoulos S, Chao NJ, Horwitz ME. Transplantation of Ex Vivo Expanded Umbilical Cord Blood (NiCord) Decreases Early Infection and Hospitalization. Biol Blood Marrow Transplant 2017; 23:1151-1157. [PMID: 28392378 DOI: 10.1016/j.bbmt.2017.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023]
Abstract
Delayed hematopoietic recovery contributes to increased infection risk following umbilical cord blood (UCB) transplantation. In a Phase 1 study, adult recipients of UCB stem cells cultured ex vivo for 3 weeks with nicotinamide (NiCord) had earlier median neutrophil recovery compared with historical controls. To evaluate the impact of faster neutrophil recovery on clinically relevant early outcomes, we reviewed infection episodes and hospitalization during the first 100 days in an enlarged cohort of 18 NiCord recipients compared with 86 standard UCB recipients at our institution. The median time to neutrophil engraftment was shorter in NiCord recipients compared with standard UCB recipients (12.5 days versus 26 days; P < .001). Compared with standard UCB recipients, NiCord recipients had a significantly reduced risk for total infection (RR, 0.69; P = .01), grade 2-3 (moderate to severe) infection (RR, 0.36; P < .001), bacterial infection (RR, 0.39; P = .003), and grade 2-3 bacterial infection (RR, 0.21; P = .003) by Poisson regression analysis; this effect persisted after adjustment for age, disease stage, and grade II-IV acute GVHD. NiCord recipients also had significantly more time out of the hospital in the first 100 days post-transplantation after adjustment for age and Karnofsky Performance Status (69.9 days versus 49.7 days; P = .005). Overall, transplantation of NiCord was associated with faster neutrophil engraftment, fewer total and bacterial infections, and shorter hospitalization in the first 100 days compared with standard UCB transplantation. In conclusion, rapid hematopoietic recovery from an ex vivo expanded UCB transplantation approach is associated with early clinical benefit.
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Affiliation(s)
- Sarah Anand
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Samantha Thomas
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Janet Adcock
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Kelly Corbet
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Richard Lopez
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gwynn D Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Ashley K Morris
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University, Durham, North Carolina.
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48
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Huang LW, Bacon W, Cirrincione C, Peterson B, Long G, Rizzieri D, Sullivan KM, Corbet K, Horwitz M, Chao N, Gasparetto C, Tuchman SA. Efficacy and safety of high-dose chemotherapy with autologous stem cell transplantation in senior versus younger adults with newly diagnosed multiple myeloma. Hematol Oncol 2017; 35:752-759. [PMID: 28105753 DOI: 10.1002/hon.2379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/17/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 12/12/2022]
Abstract
We retrospectively studied 340 fit patients with multiple myeloma (MM) who underwent autologous stem cell transplantation (ASCT). We hypothesized that progression-free survival (PFS) of older patients was non-inferior to that of younger patients after ASCT. Our null hypothesis was that the PFS hazard ratio (HR) for a 5-year increase in age was ≥1.05; the alternative (non-inferiority) hypothesis was that the HR was ≤1. The observed HR was 0.94 (95% confidence interval [CI] 0.86-1.03); since the CI upper bound was <1.05, we reject the null hypothesis and conclude that PFS in older patients was at least as good as in younger patients. We cannot reject an analogous null hypothesis for overall survival (HR 1.06 [95% CI 0.94-1.19]), since the CI upper bound >1.05. Toxicity was similar across ages and transplant-related mortality was minimal. 28% of subjects <65 versus 45% of those ≥65 received maintenance therapy. In summary, ASCT prolongs PFS equally well in older vs. younger adults. Although we cannot exclude maintenance as a confounder, these data support ASCT for fit seniors with MM.
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Affiliation(s)
- Li-Wen Huang
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Wendi Bacon
- Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - Constance Cirrincione
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Bercedis Peterson
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Gwynn Long
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - David Rizzieri
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - Keith M Sullivan
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - Kelly Corbet
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - Mitchell Horwitz
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - Nelson Chao
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - Cristina Gasparetto
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA
| | - Sascha A Tuchman
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.,Division of Hematology and Oncology, University of North Carolina - Chapel Hill Comprehensive Cancer Center, Chapel Hill, NC, USA
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49
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Sivaraj D, Green MM, Li Z, Sung AD, Sarantopoulos S, Kang Y, Long GD, Horwitz ME, Lopez RD, Sullivan KM, Rizzieri DA, Chao NJ, Gasparetto C. Outcomes of Maintenance Therapy with Bortezomib after Autologous Stem Cell Transplantation for Patients with Multiple Myeloma. Biol Blood Marrow Transplant 2016; 23:262-268. [PMID: 27856369 DOI: 10.1016/j.bbmt.2016.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/10/2016] [Indexed: 12/21/2022]
Abstract
Comprehensive recommendations for maintenance therapy after autologous stem cell transplantation (ASCT) for patients with multiple myeloma (MM) have yet to be defined. Bortezomib has been utilized as maintenance therapy after ASCT, but data attesting to the safety and efficacy of this agent compared with lenalidomide in the post-ASCT setting are limited. Therefore, we retrospectively analyzed the outcomes of 102 patients with MM who received maintenance therapy with bortezomib after ASCT at Duke University's adult bone marrow transplant clinic between 2005 and 2015. Maintenance with bortezomib was initiated between 60 and 90 days after ASCT as a single agent 1.3 mg/m2 once every 2 weeks (n = 92) or in combination with lenalidomide (10 mg/day) (n = 10). The median age at ASCT was 64 (range, 31 to 78). Of the 99 patients with molecular data available, 42% had high-risk cytogenetics (including d17p, t(4;14), +1q, and t(14;16) by fluorescein in situ hybridization). Overall, 46% of patients experienced side effects from maintenance therapy, with 31% of all patients experiencing peripheral neuropathy. In total, 2% of patients required discontinuation of bortezomib maintenance because of adverse events. No secondary malignancies were reported from the therapy. The median progression-free survival (PFS) for patients receiving maintenance therapy with bortezomib after ASCT was 36.5 months (95% confidence interval [CI], 21.3 to not available) and median overall survival was 72.7 months (95% CI, 63.9 to not available). The PFS of patients with high-risk cytogenetics was not statistically significantly different from those with standard-risk cytogenetics, suggesting that maintenance with bortezomib may help overcome the impact of high-risk cytogenetics on early progression. These results indicate that maintenance therapy with bortezomib represents a safe, well-tolerated, and efficacious option for patients with high-risk cytogenetics, renal insufficiency, an inability to tolerate lenalidomide, or a previous history of another cancer.
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Affiliation(s)
- Dharshan Sivaraj
- Division of Cellular Therapy, Duke University, Durham, North Carolina.
| | - Michael M Green
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - Zhiguo Li
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Anthony D Sung
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | | | - Yubin Kang
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - Gwynn D Long
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | | | - Richard D Lopez
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - Keith M Sullivan
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - David A Rizzieri
- Division of Cellular Therapy, Duke University, Durham, North Carolina
| | - Nelson J Chao
- Division of Cellular Therapy, Duke University, Durham, North Carolina
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Green MMB, Chao N, Chhabra S, Corbet K, Gasparetto C, Horwitz A, Li Z, Venkata JK, Long G, Mims A, Rizzieri D, Sarantopoulos S, Stuart R, Sung AD, Sullivan KM, Costa L, Horwitz M, Kang Y. Plerixafor (a CXCR4 antagonist) following myeloablative allogeneic hematopoietic stem cell transplantation enhances hematopoietic recovery. J Hematol Oncol 2016; 9:71. [PMID: 27535663 PMCID: PMC4989381 DOI: 10.1186/s13045-016-0301-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 07/16/2016] [Accepted: 08/09/2016] [Indexed: 12/17/2022] Open
Abstract
Background The binding of CXCR4 with its ligand (stromal-derived factor-1) maintains hematopoietic stem/progenitor cells (HSPCs) in a quiescent state. We hypothesized that blocking CXCR4/SDF-1 interaction after hematopoietic stem cell transplantation (HSCT) promotes hematopoiesis by inducing HSC proliferation. Methods We conducted a phase I/II trial of plerixafor on hematopoietic cell recovery following myeloablative allogeneic HSCT. Patients with hematologic malignancies receiving myeloablative conditioning were enrolled. Plerixafor 240 μg/kg was administered subcutaneously every other day beginning day +2 until day +21 or until neutrophil recovery. The primary efficacy endpoints of the study were time to absolute neutrophil count >500/μl and platelet count >20,000/μl. The cumulative incidence of neutrophil and platelet engraftment of the study cohort was compared to that of a cohort of 95 allogeneic peripheral blood stem cell transplant recipients treated during the same period of time and who received similar conditioning and graft-versus-host disease prophylaxis. Results Thirty patients received plerixafor following peripheral blood stem cell (n = 28) (PBSC) or bone marrow (n = 2) transplantation. Adverse events attributable to plerixafor were mild and indistinguishable from effects of conditioning. The kinetics of neutrophil and platelet engraftment, as demonstrated by cumulative incidence, from the 28 study subjects receiving PBSC showed faster neutrophil (p = 0.04) and platelet recovery >20 K (p = 0.04) compared to the controls. Conclusions Our study demonstrated that plerixafor can be given safely following myeloablative HSCT. It provides proof of principle that blocking CXCR4 after HSCT enhances hematopoietic recovery. Larger, confirmatory studies in other settings are warranted. Trial registration ClinicalTrials.gov NCT01280955
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Affiliation(s)
- Michael M B Green
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Nelson Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly Corbet
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Ari Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Zhiguo Li
- Duke University Department of Biostatistics and Bioinformatics, Durham, NC, USA
| | - Jagadish Kummetha Venkata
- Division of Hematology/Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Gwynn Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Alice Mims
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Robert Stuart
- Division of Hematology/Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Luciano Costa
- Division of Hematology/Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Mitchell Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Yubin Kang
- Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA. .,Division of Hematological Malignancies and Cellular Therapy, Duke University Medical Center, Box 3961, 2400 Pratt Street, Durham, NC, 27710, USA.
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