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Khurana S, Heckman MG, Craig FE, Cochuyt JJ, Greipp P, Rahman ZA, Sproat LZ, Litzow M, Foran JM, Jiang LJ. Evaluation of Novel Targets, Including CC-Chemokine Receptor 4, in Adult T-Cell Acute Lymphoblastic Leukemia/Lymphoma: A Mayo Clinic Clinical and Pathologic Study. Arch Pathol Lab Med 2024; 148:471-475. [PMID: 37522711 DOI: 10.5858/arpa.2022-0482-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 08/01/2023]
Abstract
CONTEXT.— Unlike B-cell acute lymphoblastic leukemia/lymphoma (ALL/LBL), there have been few therapeutic advances in T-cell ALL (T-ALL)/LBL, an aggressive ALL/LBL subtype. OBJECTIVE.— To perform a focused tissue array study to elucidate tumor markers of therapeutic potential in T-ALL/LBL. DESIGN.— Using immunohistochemistry, we evaluated expression of leukemic antigens of interest, specifically CC-chemokine receptor 4 (CCR4), among others, on available remnant diagnostic material, including tumor tissue slides obtained from formalin-fixed, paraffin-embedded preserved tissues. RESULTS.— Our analysis identified, for the first time, expression of CCR4 in T-ALL/LBL in 11 of 27 cases (40.7%) and confirmed common expression of BCL2, CD38, and CD47, as reported previously. We also identified the expression of CD123 in 4 of 26 cases (15.4%), whereas BCL6 and PDL1 were expressed in a small number of T-ALL/LBL cases. The potential novel target CCR4 was significantly more common in the Pre/Pro-T immunophenotypic subtype, 6 of 9 (66.7%, P = .01). No additional differences in clinical and epidemiologic variables were noted among positive or negative CCR4 cases. CONCLUSIONS.— These findings support preclinical and clinical testing of therapies targeting CCR4, CD47, BCL2, CD38, and CD123 in T-ALL/LBL, and may help guide the development of targeted clinical trials in T-ALL/LBL, a rare disease in urgent need of novel therapies.
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Affiliation(s)
- Sharad Khurana
- From the Division of Hematology/Oncology, University of Arizona Cancer Center, Tucson (Khurana)
| | - Michael G Heckman
- the Departments of Biomedical Statistics and Informatics (Heckman, Cochuyt) and Laboratory Medicine and Pathology (Jiang), and the Division of Hematology and Medical Oncology (Foran), Mayo Clinic Florida, Jacksonville
| | - Fiona E Craig
- the Divisions of Hematopathology (Craig) and Hematology and Medical Oncology (Sproat), Mayo Clinic Arizona, Phoenix
| | - Jordan J Cochuyt
- the Departments of Biomedical Statistics and Informatics (Heckman, Cochuyt) and Laboratory Medicine and Pathology (Jiang), and the Division of Hematology and Medical Oncology (Foran), Mayo Clinic Florida, Jacksonville
| | - Patricia Greipp
- the Divisions of Laboratory Genetics (Greipp) and Hematology (Litzow), Mayo Clinic, Rochester, Minnesota
| | - Zaid Abdel Rahman
- the Division of Hematology and Medical Oncology, Sanford Roger Maris Cancer Center, Fargo, North Dakota (Rahman)
| | - Lisa Z Sproat
- the Divisions of Hematopathology (Craig) and Hematology and Medical Oncology (Sproat), Mayo Clinic Arizona, Phoenix
| | - Mark Litzow
- the Divisions of Laboratory Genetics (Greipp) and Hematology (Litzow), Mayo Clinic, Rochester, Minnesota
| | - James M Foran
- the Departments of Biomedical Statistics and Informatics (Heckman, Cochuyt) and Laboratory Medicine and Pathology (Jiang), and the Division of Hematology and Medical Oncology (Foran), Mayo Clinic Florida, Jacksonville
| | - Liuyan Jennifer Jiang
- the Departments of Biomedical Statistics and Informatics (Heckman, Cochuyt) and Laboratory Medicine and Pathology (Jiang), and the Division of Hematology and Medical Oncology (Foran), Mayo Clinic Florida, Jacksonville
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2
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Ferrer A, Lasho T, Fernandez JA, Steinauer NP, Simon RA, Finke CM, Carmona EM, Wylam ME, Ongie LJ, Burnap BN, Arana Yi C, Sproat LZ, Foran J, Badar T, Mangaonkar AA, Patnaik MM. Patients with telomere biology disorders show context specific somatic mosaic states with high frequency of U2AF1 variants. Am J Hematol 2023; 98:E357-E359. [PMID: 37665761 DOI: 10.1002/ajh.27086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
Somatic mosaic states in telomere biology disorders are characterized by somatic variants in the spliceosome and DNA damage response and repair pathways. A likely maladaptive response to short telomeres that may lead to increased hematological cancer.
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Affiliation(s)
- Alejandro Ferrer
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Terra Lasho
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jenna A Fernandez
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Rachel A Simon
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christy M Finke
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eva M Carmona
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark E Wylam
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura J Ongie
- Department of Clinical Genetics, Mayo Clinic, Rochester, Minnesota, USA
| | - Brittany N Burnap
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cecilia Arana Yi
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa Z Sproat
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - James Foran
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Talha Badar
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Abhishek A Mangaonkar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mrinal M Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
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3
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Aviles-Hernandez X, Rahman ZA, Heckman M, Miller KC, Alkhateeb HB, Patnaik MM, Sproat LZ, Jiang L, Roy V, Murthy H, Ayala E, Hogan WJ, Greipp PT, Kharfan-Dabaja MA, Litzow MR, Ray JC, Foran J. Prediction of Atrial Arrhythmia after Allogenic Transplantation Using Artificial Intelligence-Enabled ECG. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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4
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Baranwal A, Langer KJ, Ali K, Kharfan-Dabaja MA, Ayala E, Foran J, Murthy H, Badar T, Iqbal M, Palmer J, Sproat LZ, Durani U, Mangaonkar A, Shah MV, Litzow MR, Hogan WJ, Alkhateeb HB. Surrogates of Endothelial Injury Predict Non-Relapse Mortality Among Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation with Post-Transplant Cyclophosphamide-Based Gvhd Prophylaxis. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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5
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Numan Y, Abdel Rahman Z, Grenet J, Boisclair S, Bewersdorf JP, Collins C, Barth D, Fraga M, Bixby DL, Zeidan AM, Yilmaz M, Desai P, Mannis G, Deutsch YE, Abaza Y, Dinner S, Frankfurt O, Litzow M, Al‐Kali A, Foran JM, Sproat LZ, Jovanovic B, Daver N, Perl AE, Altman JK. Gilteritinib clinical activity in relapsed/refractory FLT3 mutated acute myeloid leukemia previously treated with FLT3 inhibitors. Am J Hematol 2022; 97:322-328. [PMID: 34981560 DOI: 10.1002/ajh.26447] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/26/2023]
Abstract
Gilteritinib is approved for the treatment of relapsed/refractory (R/R) acute myeloid leukemia (AML) with an FLT3-mutation (FLT3mut+ ). However, the gilteritinib phase 3 ADMIRAL study (Perl et al NEJM 2019) was conducted prior to widespread adoption of either midostaurin as a component of standard intensive induction and consolidation or posttransplant FLT3 inhibitor maintenance. We performed a retrospective analysis using data from 11 US centers and where we identified 113 patients who received gilteritinib alone or as combination therapy for the treatment of R/R FLT3mut+ AML. The composite complete remission (CR) rate (CRc, defined as CR + CRi + CR with incomplete platelet recovery [CRp]) was 48.7% (n = 55). The CRc rate after treatment with gilteritinib in patients who were treated with only prior 7+3 and midostaurin with or without consolidation was 58% with a median survival of 7.8 months. Survival was longest in patients who obtained a CR, particularly a cMRD (clinical minimal or measurable residual disease) negative response; this remained significant after censoring at the time of stem cell transplant. The mitogen-activated protein kinase pathway activating mutations that are known for gilteritinib resistance (NRAS, KRAS, and PTPN11) had lower CRc (35% vs. 60.5%) and lower median overall survival than patients' whose leukemia did not express these mutations (4.9 months vs. 7.8 months) (HR 2.4; 95% CI 1. 5.4) p value <.01.
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Affiliation(s)
- Yazan Numan
- Division of Hematology and Oncology Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Zaid Abdel Rahman
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Rochester Minnesota USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Phoenix Arizona USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Jacksonville Florida USA
| | - Justin Grenet
- Department of Internal Medicine Weill Cornell, New York USA
| | - Stephanie Boisclair
- Department of Malignant Hematology and Cellular Therapy at Memorial Health System Moffitt Cancer Center Pembroke Pines Florida USA
| | - Jan Philipp Bewersdorf
- Department of Internal Medicine, Section of Hematology Yale University School of Medicine New Haven Connecticut USA
| | - Cailin Collins
- Department of Hematology and Oncology Stanford University Stanford California USA
| | - Dylan Barth
- Department of Pharmacy Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Martina Fraga
- Department of Pharmacy University of Michigan Ann Arbor Michigan USA
| | - Dale L. Bixby
- Department of Hematology and Oncology University of Michigan Ann Arbor Michigan USA
| | - Amer M. Zeidan
- Yale University School of Medicine and Yale Cancer Center New Haven Connecticut USA
| | - Musa Yilmaz
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Pankil Desai
- Department of Internal Medicine Weill Cornell, New York USA
| | - Gabriel Mannis
- Department of Hematology and Oncology Stanford University Stanford California USA
| | - Yehuda E. Deutsch
- Department of Malignant Hematology and Cellular Therapy at Memorial Health System Moffitt Cancer Center Pembroke Pines Florida USA
| | - Yasmin Abaza
- Division of Hematology and Oncology Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Shira Dinner
- Division of Hematology and Oncology Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Olga Frankfurt
- Division of Hematology and Oncology Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Mark Litzow
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Rochester Minnesota USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Phoenix Arizona USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Jacksonville Florida USA
| | - Aref Al‐Kali
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Rochester Minnesota USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Phoenix Arizona USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Jacksonville Florida USA
| | - James M. Foran
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Rochester Minnesota USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Phoenix Arizona USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Jacksonville Florida USA
| | - Lisa Z. Sproat
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Rochester Minnesota USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Phoenix Arizona USA
- Division of Hematology and Medical Oncology Mayo Clinic Health Care System Jacksonville Florida USA
| | - Borko Jovanovic
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Naval Daver
- Department of Leukemia MD Anderson Cancer Center Houston Texas USA
| | - Alexander E. Perl
- Division of Hematology‐Oncology/Department of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Jessica K. Altman
- Division of Hematology and Oncology Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine Chicago Illinois USA
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6
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Abdel Rahman ZH, Parrondo RD, Heckman MG, Wieczorek M, Miller KC, Alkhateeb H, Sproat LZ, Murthy H, Hogan WJ, Kharfan-Dabaja MA, Peterson JF, Baughn LB, Hoppman N, Litzow MR, Ketterling RP, Greipp PT, Foran JM. Comparative study of therapy-related and de novo adult b-cell acute lymphoblastic leukaemia. Br J Haematol 2021; 196:963-968. [PMID: 34697797 PMCID: PMC9034764 DOI: 10.1111/bjh.17906] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/18/2023]
Abstract
We report a comparative analysis of patients with therapy‐related acute lymphoblastic leukaemia (tr‐ALL) vs de novo ALL. We identified 331 patients with B‐ALL; 69 (21%) were classified as tr‐ALL. The most common prior malignancies were breast (23·2%) and plasma cell disorders (20·3%). Patients with tr‐ALL were older (median 63·2 vs. 46·2 years, P < 0.001), more often female (66·7% vs. 43·5%, P < 0·001), and more likely to have hypodiploid cytogenetics (18·8% vs. 5·0%, P < 0·001). In multivariable analysis, patients with tr‐ALL were less likely to achieve complete remission [odds ratio (OR) = 0·16, P < 0·001] and more likely to be minimal residual disease‐positive (OR = 4·86, P = 0·01) but had similar OS after diagnosis and allo‐haematopoietic cell transplantation.
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Affiliation(s)
| | | | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Mikolaj Wieczorek
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Kevin C Miller
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Lisa Z Sproat
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Hemant Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic, USA
| | | | | | - Jess F Peterson
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Linda B Baughn
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Nicole Hoppman
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - James M Foran
- Division of Hematology and Medical Oncology, Mayo Clinic, USA
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7
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Abdel-Rahman ZH, Heckman MG, Anagnostou T, White LJ, Kloft-Nelson SM, Knudson RA, Alkhateeb HB, Sproat LZ, Khera N, Murthy HS, Ayala E, Hogan WJ, Roy V, Peterson JF, Kharfan-Dabaja MA, Ketterling RP, Litzow MR, Baughn LB, Patnaik M, Greipp PT, Foran JM. Identification of adult Philadelphia-like acute lymphoblastic leukemia using a FISH-based algorithm distinguishes prognostic groups and outcomes. Blood Cancer J 2021; 11:156. [PMID: 34548472 PMCID: PMC8455651 DOI: 10.1038/s41408-021-00538-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Zaid H Abdel-Rahman
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Theodora Anagnostou
- Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Launia J White
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Sara M Kloft-Nelson
- Cytogenetics Core Laboratory, Medical Genome Facility, Mayo Clinic, Rochester, MN, USA
| | - Ryan A Knudson
- Cytogenetics Core Laboratory, Medical Genome Facility, Mayo Clinic, Rochester, MN, USA
| | | | - Lisa Z Sproat
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Nandita Khera
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Hemant S Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Ernesto Ayala
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Vivek Roy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Jess F Peterson
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | | | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Linda B Baughn
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | | | - Patricia T Greipp
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - James M Foran
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA.
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8
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Abdel Rahman ZH, Heckman MG, Miller K, Alkhateeb H, Patnaik MS, Sproat LZ, Jiang L, Roy V, Murthy HS, Ayala E, Hogan WJ, Greipp PT, Kharfan-Dabaja MA, Litzow MR, Foran JM. Impact of Novel Targeted Therapies and Cytogenetic Risk Groups on Outcome After Allogeneic Transplantation for Adult ALL. Transplant Cell Ther 2020; 27:165.e1-165.e11. [PMID: 33830026 DOI: 10.1016/j.jtct.2020.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 11/26/2022]
Abstract
Novel high-risk groups have recently been identified in adult acute lymphoblastic leukemia (ALL), including Philadelphia-like, therapy-related, and measurable residual disease after induction therapy. Furthermore, modern targeted therapies have recently been incorporated into ALL management; rituximab for CD20-positive and blinatumomab for measurable residual disease after induction therapy or relapsed or refractory disease. Allogeneic hematopoietic cell transplantation (allo-HCT) is recommended as consolidation therapy for high-risk ALL; however, its relative benefit for these high-risk groups and after novel therapies is unclear. We performed an analysis of posttransplantation outcomes in a cohort of 261 consecutive patients who underwent allo-HCT for ALL at the 3-site Mayo Clinic Cancer Center (January 1, 2008-December 31, 2018). With a median (range) follow-up of 22.4 months (0.5-135.0), the 100-day and 5-year cumulative incidences of nonrelapse mortality rates were 6.5% and 26.7%, respectively. The 5-year cumulative incidences of relapse and death were 22.6% and 46.2%, respectively. The 1-year estimate of the composite endpoint of graft-versus-host disease/relapse-free survival was 39.3%. We observed no associations of novel high-risk groups or modern targeted therapies with overall survival, nonrelapse mortality, or relapse in multivariable analysis. An increased risk of relapse was observed with T-ALL (hazard ratio, 2.16; 95% confidence interval, 1.14-4.09; P = .02) and hypodiploidy/near-triploidy (hazard ratio, 2.84; 95% confidence interval, 1.06-7.62; P = .04). Our analysis suggests that novel high-risk groups derive a similar benefit from allo-HCT as traditional high-risk adult ALL and that novel targeted therapies do not seem to independently predict for posttransplantation outcomes. It also calls for further exploration of maintenance strategies after Allo-HCT to prevent relapse in high-risk subgroups.
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Affiliation(s)
- Zaid H Abdel Rahman
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Kevin Miller
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Lisa Z Sproat
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | - Liuyan Jiang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida
| | - Vivek Roy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Hemant S Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Ernesto Ayala
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - James M Foran
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida.
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9
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Mountjoy L, Palmer J, Kunze KL, Khera N, Sproat LZ, Leis JF, Noel P, Slack JL, Jain T. Does early chimerism testing predict outcomes after allogeneic hematopoietic stem cell transplantation? Leuk Lymphoma 2020; 62:252-254. [PMID: 33012186 DOI: 10.1080/10428194.2020.1827249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Luke Mountjoy
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jeanne Palmer
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Katie L Kunze
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix, AZ, USA
| | - Nandita Khera
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Lisa Z Sproat
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Jose F Leis
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Pierre Noel
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - James L Slack
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Tania Jain
- Department of Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
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10
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Mountjoy L, Jain T, Kunze KL, Khera N, Sproat LZ, Jennifer W, McCallen M, Leis JF, Noel P, Slack JL, Palmer J. Clinical outcomes with low dose anti-thymocyte globulin in patients undergoing matched unrelated donor allogeneic hematopoietic cell transplantation. Leuk Lymphoma 2020; 61:1996-2002. [PMID: 32281491 DOI: 10.1080/10428194.2020.1747067] [Citation(s) in RCA: 5] [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] [Indexed: 01/17/2023]
Abstract
Anti-thymocyte globulin (ATG) has been associated with decreased rates graft versus host disease (GVHD) but with a potential risk of increasing risk of infection and relapse. We retrospectively studied the impact of single dose low dose (2.5 mg/kg) ATG in patients undergoing allogenic hematopoietic cell transplantation (HCT) from 8/8 matched unrelated donors (MUD). Of the total 209 patients identified, 129 received ATG. At baseline, the ATG group had more intermediate and high disease risk index (DRI) (64.6% vs. 54.3%) (28.3% vs. 23.7%) p < .001, respectively, and who received reduced intensity or non-myeloablative conditioning (RIC) (69.0% vs. 47.5%, p .003). There was no significant difference in the overall survival (OS) HR = 1.3, 95% CI [0.99, 1.0], p = .350 or relapse-free survival (RFS) HR = 1.2, 95% CI [0.74, 1.8], p = .526 between the two groups. Patients receiving ATG had a lower incidence of chronic GVHD (cGVHD) (10.1% vs. 25%, p = .007) and less moderate to severe cGVHD (8.5% vs. 25%, p = .002). ATG was associated with a reduced incidence of moderate to severe cGVHD OR = 0.28, 95% CI [0.12, 0.61], p < .01. There was no difference in the incidence of Epstein-Barr Virus (EBV) or cytomegalovirus (CMV) reactivation, CMV disease, invasive fungal infection, or grade III-IV acute GVHD (aGVHD). Our study shows that low dose ATG results in similar OS and RFS with lower rates of cGVHD. Additional prospective studies are needed to confirm these findings.
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Affiliation(s)
- Luke Mountjoy
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Tania Jain
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA.,Hematologic Malignancies and Bone Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie L Kunze
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Phoenix, AZ, USA
| | - Nandita Khera
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Lisa Z Sproat
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Woodburn Jennifer
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Margaret McCallen
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Jose F Leis
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Pierre Noel
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - James L Slack
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Jeanne Palmer
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
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Mountjoy L, Kunze KL, Jain T, Slack JL, Khera N, Leis JF, Noel P, Sproat LZ, Palmer J. Clinical Outcomes of Matched Unrelated Allogeneic Stem Cell Transplant Patients: Low Dose ATG Vs. No ATG. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Jain T, Kunze KL, Khetarpal BK, McCallen MR, Betcher JA, Ofori HT, Khera N, Slack JL, Leis JF, Sproat LZ, Noel P, Palmer J. Early fluctuations in busulfan levels with therapeutic dose monitoring during allogeneic stem cell transplantation: do they matter? Leuk Lymphoma 2019; 60:2034-2041. [PMID: 30626239 DOI: 10.1080/10428194.2018.1562183] [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] [Indexed: 10/27/2022]
Abstract
Therapeutic dose monitoring is widely adopted for determination of busulfan (Bu) dose for use as a conditioning regimen. However, while dose adjustments are being incorporated, transient fluctuations of Bu levels may occur. We aim to understand if these fluctuations affect clinical outcomes of these patients. We compared outcomes in patients in whom the absolute dose changes and fluctuation of AUC were ≥ median% versus < median%. Rates of sinusoidal obstructive syndrome, grades 2-4/grades 3-4 acute and chronic graft versus host disease were not different between the two cohorts. The Kaplan-Meier curves for overall survival showed no significant differences. Six patients required >50% dose adjustment and four had a fluctuation in AUC of >50%. One of these patients died of sinusoidal obstruction syndrome and two died of infections. In our study, the transient fluctuations in Bu levels did not affect clinical outcomes; hence obviating the need for test dose strategy.
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Affiliation(s)
- Tania Jain
- a Division of Hematology/Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Katie L Kunze
- b Division of Biostatistics , Mayo Clinic , Phoenix , AZ , USA
| | | | | | | | - Henry T Ofori
- d Division of Pharmacy , Mayo Clinic , Phoenix , AZ , USA
| | - Nandita Khera
- a Division of Hematology/Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - James L Slack
- a Division of Hematology/Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Jose F Leis
- a Division of Hematology/Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Lisa Z Sproat
- a Division of Hematology/Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Pierre Noel
- a Division of Hematology/Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Jeanne Palmer
- a Division of Hematology/Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
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Miller KC, Al-Kali A, Shah MV, Hogan WJ, Elliott MA, Begna KH, Gangat N, Patnaik MM, Viswanatha DS, He R, Greipp PT, Sproat LZ, Foran JM, Litzow MR, Alkhateeb HB. Elderly acute lymphoblastic leukemia: a Mayo Clinic study of 124 patients. Leuk Lymphoma 2018; 60:990-999. [PMID: 30277111 DOI: 10.1080/10428194.2018.1509318] [Citation(s) in RCA: 8] [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] [Indexed: 10/28/2022]
Abstract
Poor outcomes in elderly acute lymphoblastic leukemia (ALL) are well recognized, but the contributors are ill-defined. We characterized 124 patients ≥60 years old at our institution. The majority (n = 102, 82%) were treated with intensive chemotherapy. Of these, 8/102 (8%) died within the first 100 days; 92/102 (90%) achieved complete remission (CR/CRi). Only 31/124 (25%) patients underwent allogeneic hematopoietic stem cell transplantation. The median overall survival (OS) for the entire cohort was 19.8 months. In a multivariate analysis, ECOG performance status ≥2, high white blood cell count, and high lactate dehydrogenase (at time of diagnosis) negatively influenced OS (p<.01). In a subgroup analysis of the intensive treatment group, BCR-ABL1+ patients had markedly better OS (hazard ratio 0.3, 95% CI 0.1-0.7; p<.01). In summary, despite few early deaths and a high CR/CRi rate, elderly ALL continues to have a poor prognosis, underscoring the need for more effective therapies.
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Affiliation(s)
- Kevin C Miller
- a Mayo Clinic School of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Aref Al-Kali
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Mithun V Shah
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - William J Hogan
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | - Kebede H Begna
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Naseema Gangat
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | | | - Rong He
- c Division of Hematopathology , Mayo Clinic , Rochester , MN , USA
| | - Patricia T Greipp
- d Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
| | - Lisa Z Sproat
- e Division of Hematology and Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - James M Foran
- f Division of Hematology/Oncology , Mayo Clinic , Jacksonville , FL , USA
| | - Mark R Litzow
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
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14
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Jain T, Kosiorek HE, Grys TE, Kung ST, Shah VS, Betcher JA, Slack JL, Leis JF, Khera N, Noel P, Palmer JM, Sproat LZ. Single dose versus multiple doses of rituximab for preemptive therapy of Epstein-Barr virus reactivation after hematopoietic cell transplantation. Leuk Lymphoma 2018; 60:110-117. [PMID: 29979906 DOI: 10.1080/10428194.2018.1459603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Epstein-Barr virus (EBV) reactivation is an unresolved medical issue after allogeneic hematopoietic stem cell transplantation (HSCT). Rituximab treatment is recommended for EBV reactivation after HSCT but the number of doses of rituximab to use is unclear. In this study, risk factors and outcomes of patients who needed 1 dose vs >1 doses of preemptive rituximab to clear EBV viremia were compared. A higher viral load was more likely to be associated with higher doses of rituximab. Patients whose EBV viremia cleared with 1 dose of rituximab were more likely to have a preceding reduction of immunosuppression. Overall survival (OS) in these 2 cohorts was not different (18.7 vs 26.6 months, respectively, p = .96). Since rituximab can have side effects and is fairly costly, a predictive model to determine the number of rituximab doses using viral load would be a useful and cost-effective manner to utilize rituximab for this indication.
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Affiliation(s)
- Tania Jain
- a Division of Hematology and Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Heidi E Kosiorek
- b Division of Biostatistics, Mayo Clinic , Scottsdale , AZ , USA
| | - Thomas E Grys
- c Department of Laboratory Medicine and Pathology , Mayo Clinic , Phoenix , AZ , USA
| | - Shu Ting Kung
- d Department of Internal Medicine , Mayo Clinic , Phoenix , AZ , USA
| | - Vishal S Shah
- e Division of Pharmacy , Mayo Clinic , Phoenix , AZ , USA
| | | | - James L Slack
- a Division of Hematology and Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Jose F Leis
- a Division of Hematology and Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Nandita Khera
- a Division of Hematology and Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Pierre Noel
- a Division of Hematology and Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Jeanne M Palmer
- a Division of Hematology and Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
| | - Lisa Z Sproat
- a Division of Hematology and Medical Oncology , Mayo Clinic , Phoenix , AZ , USA
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Tai J, Buras M, Leis JF, Noel P, Palmer J, Slack JL, Sproat LZ. Impact of Body Mass Index on Outcomes in Allogeneic Stem Cell Transplant. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Scheckel C, Betcher JA, Sproat LZ, Tibes R, Slack JL, Leis JF, Noel P, Mi L, Palmer J. Comparison of Mitoxantrone-Based Salvage Therapies (MEC vs CLAG-M) in Relapsed or Refractory Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Scheckel C, Betcher JA, Sproat LZ, Khera N, Slack JL, Leis JF, Noel P, Tibes R, Mi L, Palmer J. A Single Center Analysis of Clofarabine Use Prior to Bone Marrow Transplantation in Patients with Relapsed/Refractory Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jain T, Kunze KL, Khetarpal BK, McCallen MR, Betcher JA, Khera N, Slack JL, Noel P, Sproat LZ, Leis JF, Palmer J. Early Fluctuations in Busulfan Levels When Using Pharmacokinetically Guided Dosing Does Not Affect Transplantation Outcomes with Busulfan-Based Conditioning Regimen. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kim S, Larkey L, Meeker C, Jo S, Fonseca R, Leis JF, Mikhael JR, Noel P, Palmer J, Slack JL, Sproat LZ, Reeder C, Rosenthal A, Langer S, Khera N. Feasibility and Impact of Digital Stories Intervention on Psychosocial Well-Being among Patients Undergoing Hematopoietic Cell Transplantation: A Pilot Study. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ertz-Archambault N, Kosiorek H, Taylor GE, Kelemen K, Dueck A, Castro J, Marino R, Gauthier S, Finn L, Sproat LZ, Palmer J, Mesa RA, Al-Kali A, Foran J, Tibes R. Association of Therapy for Autoimmune Disease With Myelodysplastic Syndromes and Acute Myeloid Leukemia. JAMA Oncol 2017; 3:936-943. [PMID: 28152123 DOI: 10.1001/jamaoncol.2016.6435] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Therapy-related myeloid neoplasms are a potentially life-threatening consequence of treatment for autoimmune disease (AID) and an emerging clinical phenomenon. Objective To query the association of cytotoxic, anti-inflammatory, and immunomodulating agents to treat patients with AID with the risk for developing myeloid neoplasm. Design, Setting, and Participants This retrospective case-control study and medical record review included 40 011 patients with an International Classification of Diseases, Ninth Revision, coded diagnosis of primary AID who were seen at 2 centers from January 1, 2004, to December 31, 2014; of these, 311 patients had a concomitant coded diagnosis of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Eighty-six cases met strict inclusion criteria. A case-control match was performed at a 2:1 ratio. Main Outcomes and Measures Odds ratio (OR) assessment for AID-directed therapies. Results Among the 86 patients who met inclusion criteria (49 men [57%]; 37 women [43%]; mean [SD] age, 72.3 [15.6] years), 55 (64.0%) had MDS, 21 (24.4%) had de novo AML, and 10 (11.6%) had AML and a history of MDS. Rheumatoid arthritis (23 [26.7%]), psoriasis (18 [20.9%]), and systemic lupus erythematosus (12 [14.0%]) were the most common autoimmune profiles. Median time from onset of AID to diagnosis of myeloid neoplasm was 8 (interquartile range, 4-15) years. A total of 57 of 86 cases (66.3%) received a cytotoxic or an immunomodulating agent. In the comparison group of 172 controls (98 men [57.0%]; 74 women [43.0%]; mean [SD] age, 72.7 [13.8] years), 105 (61.0%) received either agent (P = .50). Azathioprine sodium use was observed more frequently in cases (odds ratio [OR], 7.05; 95% CI, 2.35- 21.13; P < .001). Notable but insignificant case cohort use among cytotoxic agents was found for exposure to cyclophosphamide (OR, 3.58; 95% CI, 0.91-14.11) followed by mitoxantrone hydrochloride (OR, 2.73; 95% CI, 0.23-33.0). Methotrexate sodium (OR, 0.60; 95% CI, 0.29-1.22), mercaptopurine (OR, 0.62; 95% CI, 0.15-2.53), and mycophenolate mofetil hydrochloride (OR, 0.66; 95% CI, 0.21-2.03) had favorable ORs that were not statistically significant. No significant association between a specific length of time of exposure to an agent and the drug's category was observed. Conclusions and Relevance In a large population with primary AID, azathioprine exposure was associated with a 7-fold risk for myeloid neoplasm. The control and case cohorts had similar systemic exposures by agent category. No association was found for anti-tumor necrosis factor agents. Finally, no timeline was found for the association of drug exposure with the incidence in development of myeloid neoplasm.
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Affiliation(s)
| | - Heidi Kosiorek
- Division of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Phoenix, Arizona
| | | | - Katalin Kelemen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona
| | - Amylou Dueck
- Division of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Phoenix, Arizona
| | - Janna Castro
- Department of Information Technology, Mayo Clinic, Phoenix, Arizona
| | - Robert Marino
- Division of Planning and Practice Analysis, Mayo Clinic, Phoenix, Arizona
| | - Susanne Gauthier
- Division of Planning and Practice Analysis, Mayo Clinic, Phoenix, Arizona
| | - Laura Finn
- Department of Hematology and Oncology, Mayo Clinic, Rochester, Minnesota
| | - Lisa Z Sproat
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
| | - Jeanne Palmer
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
| | - Ruben A Mesa
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
| | - Aref Al-Kali
- Department of Hematology and Oncology, Mayo Clinic, Rochester, Minnesota
| | - James Foran
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Raoul Tibes
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
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Jain T, Temkit M, Partain DK, Patnaik MS, Slack JL, Khera N, Hogan WJ, Roy V, Noel P, Leis J, Sproat LZ, Fauble V, Mesa RA, Palmer J. Comparison of Reduced-Intensity Conditioning Regimens Used in Patients Undergoing Hematopoietic Stem Cell Transplantation for Myelofibrosis. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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