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Blake JT, Ganz K, Seftel M, Allan D. Determining the impact of current Canadian stem cell registry policy on donor availability via dynamic registry simulation. Vox Sang 2024. [PMID: 38523418 DOI: 10.1111/vox.13619] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/10/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND OBJECTIVES When a haematopoietic stem cell registry size is constrained by limits on recruiting, as in Canada, identifying the right person to recruit is a critical determinant of effectiveness. The aim of this study was to evaluate the impact of changes to donor recruitment effort, within ethnic groups, on the matching effectiveness of the Canadian registry as it evolves over time. MATERIALS AND METHODS Simulation methods are applied to create a cohort of donor recruits and patients over a 10-year time horizon. New recruits are added to the registry each year, while some existing donors 'age-out' upon reaching their 36th birthday. In a similar fashion, simulated patient lists are created. At the end of each simulated year, simulated patients are matched against the simulated registry. RESULTS There are increased matches in non-White populations when diverse registrants are preferentially recruited, but there are larger decreases in the number of matches for Caucasian patients. Additionally, ethnic communities that have limited registrants in the Canadian registry in 2021 do not benefit from increased recruiting efforts as much as communities with a larger initial number of registrants. CONCLUSION Preferentially recruiting from non-Caucasian populations reduces the number of matches from Canadian sources because increases in non-Caucasian populations will not fully counterbalance decreases to Caucasian patient matches. Nevertheless, more than 80% of all matches are for Caucasian patients, regardless of the donor recruiting effort within ethnic groups.
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Affiliation(s)
- John T Blake
- Industrial Engineering, Dalhousie University, Halifax, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Kathy Ganz
- Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - David Allan
- Canadian Blood Services, Ottawa, Ontario, Canada
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2
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Cheung MC, Kunkle R, Plovnick R, Lottenberg R, Rezende SM, Silverstein R, Pai M, Seftel M, Cuker A. ASH Clinical Practice Guidelines: strategies to stay up-to-date. Blood Adv 2023; 7:6707-6709. [PMID: 37738156 PMCID: PMC10641472 DOI: 10.1182/bloodadvances.2023011481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023] Open
Affiliation(s)
- Matthew C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Rob Kunkle
- American Society of Hematology, Washington, DC
| | | | - Richard Lottenberg
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | - Suely M Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Roy Silverstein
- Medical College of Wisconsin and Versiti Blood Research Institute, Milwaukee, WI
| | - Menaka Pai
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew Seftel
- University of British Columbia and Canadian Blood Services, Vancouver, BC, Canada
| | - Adam Cuker
- Hematology, University of Pennsylvania, Philadelphia, PA
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3
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Tordon B, Drews SJ, Flahr F, Bennett K, Gaziano T, Anderson D, Nahirniak S, Gerges H, Tyrrell GJ, Mah J, Ndao M, Bigham M, Seftel M. Canadian Blood Services traceback investigation of a suspected case of transfusion-transmitted malaria. Transfusion 2023; 63:2001-2006. [PMID: 37715564 DOI: 10.1111/trf.17549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND A 4-month-old infant hospitalized since birth received multiple blood transfusions. In March 2022, Plasmodium falciparum was confirmed with nucleic acid testing. As the mother was assessed as unlikely to be the source of infection, the blood operator initiated a traceback investigation for a potential blood donor source. The patient had received 13 red blood cell (RBC) transfusions (aliquoted from 11 donors), 4 apheresis platelet (PLT) transfusions and 16 buffy coat pooled PLT transfusions. The blood operator medical team developed a supplementary malaria infection risk questionnaire to identify donors at highest risk of life-time malaria infection, based on birthplace, residence, or travel in malaria-endemic regions. RESULTS With 79 donors initially implicated, initial focus was on donors of RBC components. The 11 RBC donors were contacted and assessed using the supplementary questionnaire. Three donors, all of whom met current malaria-related donor eligibility criteria, were deemed high risk of prior malaria infection. These donors consented to P. falciparum serology and nucleic acid testing (NAT). One donor who was born and had resided in an endemic West African country for 14 years, was positive for P. falciparum by serology (indirect fluorescent antibody test) and NAT-(Ct ≥32). Lookback of this donor's transfused fresh co-components and prior donation identified no other malaria cases. CONCLUSION This was a probable transfusion-transmitted malaria (TTM) case from an eligible donor who in retrospect was found to have unrecognized, asymptomatic, semi-immune malaria infection, and who was potentially infectious. Blood donor lack of recall of prior malaria infection does not negate the risk of TTM from those who have lived in malaria-endemic countries.
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Affiliation(s)
- Bryan Tordon
- Alberta Precision Laboratories (APL), Calgary, Alberta, Canada
| | - Steven J Drews
- Microbiology, Donation Policy & Studies, Canadian Blood Services, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Susan Nahirniak
- University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories (APL), Edmonton, Alberta, Canada
| | - Hanan Gerges
- University of Alberta, Edmonton, Alberta, Canada
| | - Gregory J Tyrrell
- University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- APL Public Health, Edmonton, Alberta, Canada
| | - Jordan Mah
- University of Alberta, Edmonton, Alberta, Canada
| | - Momar Ndao
- National Reference Centre for Parasitology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases, McGill University, Montreal, Quebec, Canada
| | - Mark Bigham
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Matthew Seftel
- Canadian Blood Services, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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4
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Byrne M, Mattison R, Bercovitz R, Lottenberg R, Rezende SM, Silverstein R, Terrell D, Kunkle R, Smith D, Bollard C, Haberichter S, Holter-Chakrabarty J, Pai M, Cheung M, Cuker A, Seftel M, Djulbegovic B. Identifying experts for clinical practice guidelines: perspectives from the ASH Guideline Oversight Subcommittee. Blood Adv 2023; 7:4323-4326. [PMID: 37186271 PMCID: PMC10424133 DOI: 10.1182/bloodadvances.2023010039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
| | - Ryan Mattison
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison, Madison, WI
| | | | - Richard Lottenberg
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
| | - Suely M. Rezende
- Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Roy Silverstein
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Deirdra Terrell
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rob Kunkle
- American Society of Hematology, Washington, DC
| | - Deion Smith
- American Society of Hematology, Washington, DC
| | - Catherine Bollard
- Children's National Medical/George Washington University, Washington, DC
| | | | - Jennifer Holter-Chakrabarty
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Menaka Pai
- Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada
| | | | - Adam Cuker
- Department of Pathology/Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew Seftel
- Department of Medicine, Division of Hematology, University of British Columbia and Canadian Blood Services, Vancouver, BC, Canada
| | - Benjamin Djulbegovic
- Department of Medicine, Division of Hematology/Medical Oncology, Medical University of South Carolina, Charleston, SC
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5
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Blake J, Parmar G, Ganz K, Liwski R, Weiss JT, Seftel M, Allan D. Modelling Unrelated Blood Stem Cell Donor Recruitment Using Simulated Registrant Cohorts: Assessment of HLA Matching across Ethnicity Groups. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00303-2] [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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6
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Allan DS, Green M, Morris G, Weiss J, Dibdin N, Mercer D, Seftel M. Demand and usage of unrelated donor products for allogeneic haematopoietic cell transplantation during the COVID-19 pandemic: A Canadian Blood Services Stem Cell Registry analysis. Vox Sang 2022; 117:1121-1125. [PMID: 35583125 PMCID: PMC9347538 DOI: 10.1111/vox.13294] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/31/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
Background and Objectives Understanding changes in the demand and usage of unrelated allogeneic haematopoietic cell transplantation (HCT) donors during the COVID‐19 pandemic is needed to optimize pandemic preparedness of registry and donor collection services. The aim of this study was to understand the extent to which the pandemic has impacted the demand and usage of unrelated donors and cord blood units (CBUs) at Canadian Blood Services (CBS). Materials and Methods Data regarding stem cell donor interest and product usage for unrelated allogeneic HCT were retrieved from the database at CBS using de‐identified anonymous information. Results Unrelated donor searches for Canadian patients remained unchanged by the pandemic, reflecting stable demand. The number of unrelated allogeneic transplants performed within Canada also remained stable, while the number of cord blood transplants increased, chiefly for paediatric patients. Requests for donor verification typing, a first signal of potential interest, increased from domestic centres during the first 6 months of the pandemic and decreased from international centres, before returning to baseline levels. The proportion of transplants for Canadian patients who used stem cell products procured from Canadian donors increased between 3 and 6 months after the start of the pandemic before returning to baseline and appears to be increasing again more than 1 year after the start of the pandemic. Use of CBUs for Canadian paediatric patients increased and remains elevated. Conclusion Demand for unrelated adult HCT donors has remained stable despite the evolving pandemic with a transient and recurring increased interest and usage of domestic adult donors. Use of CBUs for paediatric patients has increased and remains elevated. Registries and donor collection centres should maintain the capacity to expand services for domestic donor collection during pandemics to offset threats to international donor usage.
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Affiliation(s)
- David S Allan
- Stem Cells, Canadian Blood Services, Ottawa, Ontario, Canada.,Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine and Biochemistry, Microbiology & Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Meagan Green
- Stem Cells, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Gail Morris
- Stem Cells, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Jason Weiss
- Stem Cells, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Nicholas Dibdin
- Stem Cells, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Dena Mercer
- Stem Cells, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Matthew Seftel
- Stem Cells, Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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7
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Seftel M, Lemieux C, Cameron D, Ball G. Cost-Effectiveness of Brexucabtagene Autoleucel Versus Best Supportive Care for the Treatment of Relapsed/ Refractory Mantle Cell Lymphoma Following Treatment with a Bruton’s Tyrosine Kinase Inhibitor in Canada. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00583-8] [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: 10/18/2022]
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8
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du Toit JR, Mcdonald A, Brittain D, Cass M, Thomson J, Oosthuizen J, du Toit C, Seftel M, Louw VJ, Verburgh E. Is Haploidentical Hematopoietic Cell Transplantation Using Post-Transplantation Cyclophosphamide Feasible in Sub-Saharan Africa? Transplant Cell Ther 2021; 27:1002.e1-1002.e8. [PMID: 34478910 PMCID: PMC10961300 DOI: 10.1016/j.jtct.2021.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/04/2021] [Accepted: 08/22/2021] [Indexed: 01/09/2023]
Abstract
Identifying a suitable volunteer unrelated donor (UD) in South Africa is challenging due to the highly diverse ethnic groups and mixed-race populations in this region. Haploidentical hematopoietic cell transplantation (haploHCT) is thus an attractive procedure for patients with high-risk hematologic malignancies. This study was conducted to assess the safety and feasibility of haploHCT in South Africa. We retrospectively analyzed the outcome of 134 patients with hematologic malignancies who received unmanipulated haploHCT with post-transplantation cyclophosphamide at 2 high-volume HCT centers between 2014 and 2019. We assessed overall survival (OS), disease-free survival (DFS), nonrelapse mortality (NRM), relapse incidence (RI), and incidence of acute GVHD. The median recipient age was 44 years (range, 15 to 73 years) and the median donor age was 36 years (range, 9 to 68 years). Acute myelogenous leukemia or myelodysplastic syndrome (AML/MDS) and acute lymphoblastic leukemia (ALL) were the most common indications for haploHCT (61.2%). The European Society for Blood and Marrow Transplantation risk score was ≥5 in 44 patients (32.8%). Seventy-seven patients (57.4%) received a myeloablative conditioning regimen. The majority of patients received a sex-matched transplant (57.4%) and had peripheral blood stem cells (PBSCs) as the stem cell source (70.9%). Sixteen patients (11.9%) had an incongruent cytomegalovirus serostatus at transplantation. The median duration of follow-up was 10.8 months (range, 0.36 to 70.8 months). OS was 56% (95% confidence interval [CI], 47% to 64%) at 1 year and 37% (95% CI, 28% to 47%) at 3 years. DFS was 47% (95% CI, 38% to 55%) at 1 year and 32% (95% CI, 24% to 41%) at 3 years. The 100-day and 3-year cumulative incidence of NRM was 18% (95% CI, 11% to 25%) and 41% (95% CI, 32% to 50%), respectively, and the 1- and 3-year cumulative RI was 16% (95% CI, 11% to 24%) and 21% (95% CI, 14% to 29%), respectively. The 1-year OS was 55% (95% CI, 40% to 67%) for the patients with AML/MDS versus 41% (95% CI, 21% to 60%) for those with ALL. Forty-five patients (41.7%) developed acute GVHD by day +100; of these, 80% had grade I-II disease. Fifty patients (37.5%) developed cytomegalovirus infection that required therapy. On multivariable analysis, older donor age was an independent risk factor for lower DFS. RI was higher for diagnoses other than acute leukemia/MDS (relative risk [RR], 2.62; 95% CI, 1.12 to 6.15; P = .027), decreased for PBSC versus bone marrow (RR, 0.43; 95% CI, 0.19 to 0.95; P = .038) and decreased for offspring donors (RR, 0.25; 95% CI, 0.09 to 0.67; P = .006). These data support the feasibility of haploHCT and suggest that unmanipulated haploHCT using a younger parent or offspring donor is a viable option for adults in sub-Saharan Africa with acute leukemia and MDS who lack a suitable related or unrelated donor.
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Affiliation(s)
- Justin Rudolph du Toit
- Cellular and Immunotherapy Centre, Wits Donald Gordon Medical Centre, Johannesburg, South Africa; Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - Andrew Mcdonald
- ACTLIFE, Pretoria East Netcare Hospital, Pretoria, South Africa
| | - David Brittain
- ACTLIFE, Pretoria East Netcare Hospital, Pretoria, South Africa
| | - Michael Cass
- ACTLIFE, Pretoria East Netcare Hospital, Pretoria, South Africa
| | - Jacqueline Thomson
- Cellular and Immunotherapy Centre, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Jenna Oosthuizen
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Cecile du Toit
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Matthew Seftel
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Vernon Johan Louw
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Estelle Verburgh
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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9
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Lazaryan A, Dolan M, Zhang MJ, Wang HL, Kharfan-Dabaja MA, Marks DI, Bejanyan N, Copelan E, Majhail NS, Waller EK, Chao N, Prestidge T, Nishihori T, Kebriaei P, Inamoto Y, Hamilton B, Hashmi SK, Kamble RT, Bacher U, Hildebrandt GC, Stiff PJ, McGuirk J, Aldoss I, Beitinjaneh AM, Muffly L, Vij R, Olsson RF, Byrne M, Schultz KR, Aljurf M, Seftel M, Savoie ML, Savani BN, Verdonck LF, Cairo MS, Hossain N, Bhatt VR, Frangoul HA, Abdel-Azim H, Al Malki M, Munker R, Rizzieri D, Khera N, Nakamura R, Ringdén O, Van der Poel M, Murthy HS, Liu H, Mori S, De Oliveira S, Bolaños-Meade J, Elsawy M, Barba P, Nathan S, George B, Pawarode A, Grunwald M, Agrawal V, Wang Y, Assal A, Caro PC, Kuwatsuka Y, Seo S, Ustun C, Politikos I, Lazarus HM, Saber W, Sandmaier BM, De Lima M, Litzow M, Bachanova V, Weisdorf D. Impact of cytogenetic abnormalities on outcomes of adult Philadelphia-negative acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: a study by the Acute Leukemia Working Committee of the Center for International Blood and Marrow Transplant Research. Haematologica 2021; 106:2295-2296. [PMID: 34333962 PMCID: PMC8327734 DOI: 10.3324/haematol.2021.279046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Michelle Dolan
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Mei-Jie Zhang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hai-Lin Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Edward Copelan
- Levine Cancer Institute, Atrium Health, Carolinas HealthCare System, Charlotte, NC, USA
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Nelson Chao
- Division of Cell Therapy and Hematology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Betty Hamilton
- Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, MN, USA; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, Switzerland
| | | | | | | | - Ibrahim Aldoss
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, the Netherlands
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Nasheed Hossain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Monzr Al Malki
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Reinhold Munker
- Section of Hematology/Oncology, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Olle Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm Sweden
| | | | | | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | - Shahram Mori
- Blood and Marrow Transplant Center, Florida Hospital Medical Group, Orlando, FL, USA
| | | | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Mahmoud Elsawy
- QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pere Barba
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Vaibhav Agrawal
- Division of Hematology- Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Youjin Wang
- National Cancer Institute (NCI), Rockville, MD, USA
| | - Amer Assal
- New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Celalettin Ustun
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, IL, USA
| | | | | | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcos De Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN, USA
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA; CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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10
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Khalife R, Montroy J, Grigor EJM, Fergusson DA, Atkins H, Seftel M, Presseau J, Thavorn K, Holt RA, Hay K, Lalu MM, Kekre N. Building Canadian capacity for CAR-T cells in relapsed/refractory acute lymphoblastic leukaemia: a retrospective cohort study. Br J Haematol 2020; 191:e14-e19. [PMID: 32688454 DOI: 10.1111/bjh.16940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Roy Khalife
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Montroy
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada
| | - Emma J M Grigor
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Pubic Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Harold Atkins
- Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ontario, Ottawa, Canada
| | - Matthew Seftel
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada.,School of Epidemiology and Pubic Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada.,School of Epidemiology and Pubic Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert A Holt
- Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kevin Hay
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ontario, Ottawa, Canada
| | - Natasha Kekre
- Clinical Epidemiology Program, Ottawa Hospital Research Institiute, Ottawa, Ontario, Canada.,Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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11
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Lazaryan A, Dolan M, Zhang MJ, Wang HL, Kharfan-Dabaja MA, Marks DI, Bejanyan N, Copelan E, Majhail NS, Waller EK, Chao N, Prestidge T, Nishihori T, Kebriaei P, Inamoto Y, Hamilton B, Hashmi SK, Kamble RT, Bacher U, Hildebrandt GC, Stiff PJ, McGuirk J, Aldoss I, Beitinjaneh AM, Muffly L, Vij R, Olsson RF, Byrne M, Schultz KR, Aljurf M, Seftel M, Savoie ML, Savani BN, Verdonck LF, Cairo MS, Hossain N, Bhatt VR, Frangoul HA, Abdel-Azim H, Malki MA, Munker R, Rizzieri D, Khera N, Nakamura R, Ringdén O, van der Poel M, Murthy HS, Liu H, Mori S, De Oliveira S, Bolaños-Meade J, Elsawy M, Barba P, Nathan S, George B, Pawarode A, Grunwald M, Agrawal V, Wang Y, Assal A, Caro PC, Kuwatsuka Y, Seo S, Ustun C, Politikos I, Lazarus HM, Saber W, Sandmaier BM, De Lima M, Litzow M, Bachanova V, Weisdorf D. Impact of cytogenetic abnormalities on outcomes of adult Philadelphia-negative acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: a study by the Acute Leukemia Working Committee of the Center for International Blood and Marrow Transplant Research. Haematologica 2019; 105:1329-1338. [PMID: 31558669 PMCID: PMC7193485 DOI: 10.3324/haematol.2019.220756] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/20/2019] [Indexed: 11/11/2022] Open
Abstract
Cytogenetic risk stratification at diagnosis has long been one of the most useful tools to assess prognosis in acute lymphoblastic leukemia (ALL). To examine the prognostic impact of cytogenetic abnormalities on outcomes after allogeneic hematopoietic cell transplantation, we studied 1731 adults with Philadelphia-negative ALL in complete remission who underwent myeloablative or reduced intensity/non-myeloablative conditioning transplant from unrelated or matched sibling donors reported to the Center for International Blood and Marrow Transplant Research. A total of 632 patients had abnormal conventional metaphase cytogenetics. The leukemia-free survival and overall survival rates at 5 years after transplantation in patients with abnormal cytogenetics were 40% and 42%, respectively, which were similar to those in patients with a normal karyotype. Of the previously established cytogenetic risk classifications, modified Medical Research Council-Eastern Cooperative Oncology Group score was the only independent prognosticator of leukemia-free survival (P=0.03). In the multivariable analysis, monosomy 7 predicted post-transplant relapse [hazard ratio (HR)=2.11; 95% confidence interval (95% CI): 1.04-4.27] and treatment failure (HR=1.97; 95% CI: 1.20-3.24). Complex karyotype was prognostic for relapse (HR=1.69; 95% CI: 1.06-2.69), whereas t(8;14) predicted treatment failure (HR=2.85; 95% CI: 1.35-6.02) and overall mortality (HR=3.03; 95% CI: 1.44-6.41). This large study suggested a novel transplant-specific cytogenetic scheme with adverse [monosomy 7, complex karyotype, del(7q), t(8;14), t(11;19), del(11q), tetraploidy/near triploidy], intermediate (normal karyotype and all other abnormalities), and favorable (high hyperdiploidy) risks to prognosticate leukemia-free survival (P=0.02). Although some previously established high-risk Philadelphia-negative cytogenetic abnormalities in ALL can be overcome by transplantation, monosomy 7, complex karyotype, and t(8;14) continue to pose significant risks and yield inferior outcomes.
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Affiliation(s)
| | - Michelle Dolan
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Mei-Jie Zhang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hai-Lin Wang
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Nelli Bejanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Edward Copelan
- Levine Cancer Institute, Atrium Health, Carolinas HealthCare System, Charlotte, NC, USA
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Nelson Chao
- Division of Cell Therapy and Hematology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Betty Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, MN, USA.,Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, Switzerland
| | | | | | | | - Ibrahim Aldoss
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA
| | - Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard F Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leo F Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, the Netherlands
| | - Mitchell S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Nasheed Hossain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Vijaya Raj Bhatt
- The Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Haydar A Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Monzr Al Malki
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Reinhold Munker
- Section of Hematology/Oncology, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Olle Ringdén
- Translational Cell Therapy Group, CLINTEC (Clinical Science, Intervention and Technology), Karolinska Institutet, Stockholm Sweden
| | | | | | - Hongtao Liu
- University of Chicago Medicine, Chicago, IL, USA
| | - Shahram Mori
- Blood & Marrow Transplant Center, Florida Hospital Medical Group, Orlando, FL, USA
| | | | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Mahmoud Elsawy
- QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pere Barba
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Vaibhav Agrawal
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Youjin Wang
- National Cancer Institute (NCI), Rockville, MD, USA
| | - Amer Assal
- New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Celalettin Ustun
- Division of Hematology/Oncology/Cell Therapy, Rush University, Chicago, IL, USA
| | | | | | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brenda M Sandmaier
- Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcos De Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, MN, USA
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
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12
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Paulson K, Brazauskas R, Khera N, He N, Majhail N, Akpek G, Aljurf M, Buchbinder D, Burns L, Beattie S, Freytes C, Garcia A, Gajewski J, Hahn T, Knight J, LeMaistre C, Lazarus H, Szwajcer D, Seftel M, Wirk B, Wood W, Saber W. Inferior Access to Allogeneic Transplant in Disadvantaged Populations: A Center for International Blood and Marrow Transplant Research Analysis. Biol Blood Marrow Transplant 2019; 25:2086-2090. [PMID: 31228584 DOI: 10.1016/j.bbmt.2019.06.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) is offered in a limited number of medical centers and is associated with significant direct and indirect costs. The degree to which social and geographic barriers reduce access to alloHCT is unknown. Data from the Surveillance, Epidemiology and End Results Program (SEER) and the Center for International Blood and Marrow Transplant Research (CIBMTR) were integrated to determine the rate of unrelated donor (URD) alloHCT for acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome (MDS) performed between 2000 and 2010 in the 612 counties covered by SEER. The total incidence of AML, ALL, and MDS was determined using SEER, and the number of alloHCTs performed in the same time period and geographic area were determined using the CIBMTR database. We then determined which sociodemographic attributes influenced the rate of alloHCT (rural/urban status, median family size, percentage of residents below the poverty line, and percentage of minority race). In the entire cohort, higher levels of poverty were associated with lower rates of alloHCT (estimated rate ratio [ERR], .86 for a 10% increase in the percentage of the population below the poverty line; P < .01), whereas rural location was not (ERR, .87; P = .11). Thus, patients from areas with higher poverty rates diagnosed with ALL, AML, and MDS are less likely patients from wealthier counties to undergo URD alloHCT. There is need to better understand the reasons for this disparity and to encourage policy and advocacy efforts to improve access to medical care for all.
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Affiliation(s)
- Kristjan Paulson
- CancerCare Manitoba/University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Ruta Brazauskas
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Naya He
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Navneet Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Gorgun Akpek
- Stem Cell Transplantation and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - David Buchbinder
- Division of Pediatrics Hematology, Children's Hospital of Orange County, Orange, California
| | - Linda Burns
- Be The Match/National Marrow Donor Program, Minneapolis, Minnesota
| | - Sara Beattie
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | | | - Anne Garcia
- MedStar Georgetown University Hospital, Washington, DC
| | | | - Theresa Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Jennifer Knight
- Department of Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Charles LeMaistre
- Hematology and Bone Marrow Transplant, Sarah Cannon, Nashville, Tennessee
| | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - David Szwajcer
- CancerCare Manitoba/University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Seftel
- CancerCare Manitoba/University of Manitoba, Winnipeg, Manitoba, Canada
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - William Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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13
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Wood WA, Brazauskas R, Hu ZH, Abdel-Azim H, Ahmed IA, Aljurf M, Badawy S, Beitinjaneh A, George B, Buchbinder D, Cerny J, Dedeken L, Diaz MA, Freytes CO, Ganguly S, Gergis U, Almaguer DG, Gupta A, Hale G, Hashmi SK, Inamoto Y, Kamble RT, Adekola K, Kindwall-Keller T, Knight J, Kumar L, Kuwatsuka Y, Law J, Lazarus HM, LeMaistre C, Olsson RF, Pulsipher MA, Savani BN, Schultz KR, Saad AA, Seftel M, Seo S, Shea TC, Steinberg A, Sullivan K, Szwajcer D, Wirk B, Yared J, Yong A, Dalal J, Hahn T, Khera N, Bonfim C, Atsuta Y, Saber W. Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia: A CIBMTR Analysis. Biol Blood Marrow Transplant 2018; 24:1928-1935. [PMID: 29567340 DOI: 10.1016/j.bbmt.2018.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/11/2018] [Indexed: 10/17/2022]
Abstract
For patients with acute lymphoblastic leukemia (ALL), allogeneic hematopoietic cell transplantation (alloHCT) offers a potential cure. Life-threatening complications can arise from alloHCT that require the application of sophisticated health care delivery. The impact of country-level economic conditions on post-transplantation outcomes is not known. Our objective was to assess whether these variables were associated with outcomes for patients transplanted for ALL. Using data from the Center for Blood and Marrow Transplant Research, we included 11,261 patients who received a first alloHCT for ALL from 303 centers across 38 countries between the years of 2005 and 2013. Cox regression models were constructed using the following macroeconomic indicators as main effects: Gross national income per capita, health expenditure per capita, and Human Development Index (HDI). The outcome was overall survival at 100 days following transplantation. In each model, transplants performed within lower resourced environments were associated with inferior overall survival. In the model with the HDI as the main effect, transplants performed in the lowest HDI quartile (n = 697) were associated with increased hazard for mortality (hazard ratio, 2.42; 95% confidence interval, 1.64 to 3.57; P < .001) in comparison with transplants performed in the countries with the highest HDI quartile. This translated into an 11% survival difference at 100 days (77% for lowest HDI quartile versus 88% for all other quartiles). Country-level macroeconomic indices were associated with lower survival at 100 days after alloHCT for ALL. The reasons for this disparity require further investigation.
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Affiliation(s)
- William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Ibrahim A Ahmed
- Department of Hematology, Oncology, and Bone Marrow Transplantation, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Sherif Badawy
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Amer Beitinjaneh
- Department of Hematology/Oncology, University of Miami, Miami, Florida
| | | | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, California
| | - Jan Cerny
- Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Laurence Dedeken
- Department of Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | | | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | | | - Ashish Gupta
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Gregory Hale
- Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Kehinde Adekola
- Division of Hematology/Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | - Jennifer Knight
- Department of Psychology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Yachiyo Kuwatsuka
- Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jason Law
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Charles LeMaistre
- Hematology and Bone Marrow Transplant, Sarah Cannon, Nashville, Tennessee
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ayman A Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - Sachiko Seo
- Department of Hematology and Oncology, National Cancer Research Center East, Chiba, Japan
| | - Thomas C Shea
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Amir Steinberg
- Department of Hematology-Oncology, Mount Sinai Hospital, New York, New York
| | | | - David Szwajcer
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Agnes Yong
- Royal Adelaide Hospital/SA Pathology and School of Medicine, University of Adelaide, Adelaide, Australia
| | - Jignesh Dalal
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Theresa Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Carmem Bonfim
- Hospital de Clinicas-Federal University of Parana, Curitiba, Brazil
| | - Yoshiko Atsuta
- Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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14
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Nam J, Milenkovski R, Yunger S, Geirnaert M, Paulson K, Seftel M. Economic evaluation of rituximab in addition to standard of care chemotherapy for adult patients with acute lymphoblastic leukemia. J Med Econ 2018; 21:47-59. [PMID: 28837377 DOI: 10.1080/13696998.2017.1372230] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIMS Acute lymphoblastic leukemia (ALL) is an aggressive form of leukemia with a poor prognosis in adult patients. The addition of the monoclonal antibody rituximab to standard chemotherapy has been shown to improve survival in adults with ALL. However, it is unknown whether the addition of rituximab is cost-effective. The objective was to determine the economic impact of rituximab in addition to standard of care (SOC) chemotherapy vs SOC alone in newly-diagnosed Philadelphia chromosome-negative, CD20-positive, B-cell precursor ALL. METHODS A decision analytic model was constructed, based upon the Canadian healthcare system. It included the following health states over a lifetime horizon (max ≈60 years): event-free survival (EFS), relapsed/resistant disease, cure, and death. SOC was either hyper-CVAD or the Dana Farber Cancer Institute (DFCI) ALL consortium. EFS, overall survival, and serious adverse event (SAE) rates were derived from a large randomized controlled trial. Costs of the model included: first-line treatment and administration, disease management, second-line and third-line treatment and administration, palliative care, and SAE-related treatments. Inputs were sourced from provincial and national public data, the literature, and cancer agency input. RESULTS Quality-adjusted life-years (QALYs) increased by 2.20 QALYs with rituximab in addition to SOC. The resulting mean Incremental Cost-Effectiveness Ratio (ICER) was C$21,828/QALY. At a willingness-to-pay threshold of C$100,000/QALY, the probability of being cost-effective was 98%. Decision outcomes were robust to the probabilistic and deterministic sensitivity analyses, including the SOC backbone as either hyper-CVAD or DFCI. LIMITATIONS The results of this analysis are limited by generalizability of the chemotherapy backbone to Canadian practice. CONCLUSIONS For adults with ALL, rituximab in addition to SOC was found to be a cost-effective intervention, compared to SOC alone. The addition of rituximab is associated with increased life years and increased QALYs at a reasonable incremental cost.
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Affiliation(s)
- Julian Nam
- a Hoffmann-La Roche Limited , Mississauga , ON , Canada
| | | | - Simon Yunger
- a Hoffmann-La Roche Limited , Mississauga , ON , Canada
| | | | - Kristjan Paulson
- b CancerCare Manitoba , Winnipeg , MB Canada
- c University of Manitoba , Winnipeg , MB Canada
| | - Matthew Seftel
- b CancerCare Manitoba , Winnipeg , MB Canada
- c University of Manitoba , Winnipeg , MB Canada
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15
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Grigor EJM, Fergusson DA, Haggar F, Kekre N, Atkins H, Shorr R, Holt RA, Hutton B, Ramsay T, Seftel M, Jonker D, Daugaard M, Thavorn K, Presseau J, Lalu MM. Efficacy and safety of chimeric antigen receptor T-cell (CAR-T) therapy in patients with haematological and solid malignancies: protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e019321. [PMID: 29288188 PMCID: PMC5988064 DOI: 10.1136/bmjopen-2017-019321] [Citation(s) in RCA: 14] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Patients with relapsed or refractory malignancies have a poor prognosis. Immunotherapy with chimeric antigen receptor T (CAR-T) cells redirects a patient's immune cells against the tumour antigen. CAR-T cell therapy has demonstrated promise in treating patients with several haematological malignancies, including acute B-cell lymphoblastic leukaemia and B-cell lymphomas. CAR-T cell therapy for patients with other solid tumours is also being tested. Safety is an important consideration in CAR-T cell therapy given the potential for serious adverse events, including death. Previous reviews on CAR-T cell therapy have been limited in scope and methodology. Herein, we present a protocol for a systematic review to identify CAR-T cell interventional studies and examine the safety and efficacy of this therapy in patients with haematology malignancies and solid tumours. METHODS AND ANALYSIS We will search MEDLINE, including In-Process and Epub Ahead of Print, EMBASE and the Cochrane Central Register of Controlled Trials from 1946 to 22 February 2017. Studies will be screened by title, abstract and full text independently and in duplicate. Studies that report administering CAR-T cells of any chimeric antigen receptor construct targeting antigens in patients with haematological malignancies and solid tumours will be eligible for inclusion. Outcomes to be extracted will include complete response rate (primary outcome), overall response rate, overall survival, relapse and adverse events. A meta-analysis will be performed to synthesise the prevalence of outcomes reported as proportions with 95% CIs. The potential for bias within included studies will be assessed using a modified Institute of Health Economics tool. Heterogeneity of effect sizes will be determined using the Cochrane I 2 statistic. ETHICS AND DISSEMINATION The review findings will be submitted for peer-reviewed journal publication and presented at relevant conferences and scientific meetings to promote knowledge transfer. PROSPERO REGISTRATION NUMBER CRD42017075331.
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Affiliation(s)
- Emma J M Grigor
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Fatima Haggar
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Natasha Kekre
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Harold Atkins
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Cancer Therapeutic Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Risa Shorr
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert A Holt
- British Columbia Cancer Agency, Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Brian Hutton
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Matthew Seftel
- Department of Hematology, University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Derek Jonker
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mads Daugaard
- Molecular Pathology & Cell Imaging Core Facility, Vancouver Prostate Centre, Vancouver, British Columbia, Canada
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Manoj M Lalu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Regenerative Medicine Program, The Ottawa Health Research Institute, Ottawa, Ontario, Canada
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16
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Hill BT, Ahn KW, Hu ZH, Aljurf M, Beitinjaneh A, Cahn JY, Cerny J, Kharfan-Dabaja MA, Ganguly S, Ghosh N, Grunwald MR, Inamoto Y, Kindwall-Keller T, Nishihori T, Olsson RF, Saad A, Seftel M, Seo S, Szer J, Tallman M, Ustun C, Wiernik PH, Maziarz RT, Kalaycio M, Alyea E, Popat U, Sobecks R, Saber W. Assessment of Impact of HLA Type on Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Lymphocytic Leukemia. Biol Blood Marrow Transplant 2017; 24:581-586. [PMID: 29032274 DOI: 10.1016/j.bbmt.2017.10.015] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/04/2017] [Indexed: 01/24/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy with many highly effective therapies. Chemorefractory disease, often characterized by deletion of chromosome 17p, has historically been associated with very poor outcomes, leading to the application of allogeneic hematopoietic stem cell transplantation (allo-HCT) for medically fit patients. Although the use of allo-HCT has declined since the introduction of novel targeted therapy for the treatment of CLL, there remains significant interest in understanding factors that may influence the efficacy of allo-HCT, the only known curative treatment for CLL. The potential benefit of transplantation is most likely due to the presence of alloreactive donor T cells that mediate the graft-versus-leukemia (GVL) effect. The recognition of potentially tumor-specific antigens in the context of class I and II major histocompatibility complex on malignant B lymphocytes by donor T cells may be influenced by subtle differences in the highly polymorphic HLA locus. Given previous reports of specific HLA alleles impacting the incidence of CLL and the clinical outcomes of allo-HCT for CLL, we sought to study the overall survival and progression-free survival of a large cohort of patients with CLL who underwent allo-HCT from fully HLA-matched related and unrelated donors at Center for International Blood and Marrow Transplant Research transplantation centers. We found no statistically significant association of allo-HCT outcomes in CLL based on previously reported HLA combinations. Additional study is needed to further define the immunologic features that portend a more favorable GVL effect after allo-HCT for CLL.
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Affiliation(s)
- Brian T Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplantation and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- Center for International Blood and Marrow Transplantation and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | | | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Jan Cerny
- UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - Sachiko Seo
- Department of Hematology and Oncology, National Cancer Research Center East, Chiba, Japan
| | - Jeffrey Szer
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia
| | - Martin Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Celalettin Ustun
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | | | - Richard T Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Edwin Alyea
- Center of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Uday Popat
- M.D. Anderson Cancer Center, Houston, Texas
| | | | - Wael Saber
- Center for International Blood and Marrow Transplantation and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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17
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Stroncek DF, Shaw BE, Logan BR, Kiefer DM, Savani BN, Anderlini P, Bredeson CN, Hematti P, Ganguly S, Diaz MA, Abdel-Azim H, Ahmed I, Maharaj D, Seftel M, Beitinjaneh A, Seo S, Yared JA, Halter J, O'Donnell PV, Hale GA, DeFilipp Z, Lazarus H, Liesveld JL, Zhou Z, Munshi P, Olsson RF, Kasow KA, Szer J, Switzer GE, Chitphakdithai P, Shah N, Confer DL, Pulsipher MA. Donor Experiences of Second Marrow or Peripheral Blood Stem Cell Collection Mirror the First, but CD34 + Yields Are Less. Biol Blood Marrow Transplant 2017; 24:175-184. [PMID: 28958894 DOI: 10.1016/j.bbmt.2017.09.013] [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: 07/27/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
Abstract
Little is known about the experiences of individuals donating peripheral blood stem cells (PBSCs) or marrow for a second time. To study this, unrelated donors making a second donation through the National Marrow Donor Program between 2004 and 2013 were evaluated. Experiences of second-time donors giving marrow (n = 118: first donation was PBSC in 76 and marrow in 42) were compared with those making only 1 marrow donation (n = 5829). Experiences of second-time donors giving PBSCs (n = 602) (first donation was PBSCs in 362; marrow in 240) were compared to first-time PBSC donors (n = 16,095). For donors giving a second PBSC or marrow donation there were no significant differences in maximum skeletal pain, maximum symptoms measured by an established modified toxicity criteria, and recovery time compared with those who donated only once. Notably, the yield of marrow nucleated cells and PBSC CD34+ cells with second donations was less. As previously noted with single first-time donations, female (PBSCs and marrow) and obese donors (PBSCs) had higher skeletal pain and/or toxicity with a second donation. PBSC donors who experienced high levels of pain or toxicity with the first donation also experienced high levels of these symptoms with their second donation and slower recovery times. In conclusion, for most donors second donation experiences were similar to first donation experiences, but CD34+ yields were less. Knowledge of the donor's first experience and stem cell yields may help centers decide whether second donations are appropriate and institute measures to improve donor experiences.
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Affiliation(s)
- David F Stroncek
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Bronwen E Shaw
- Center for International Blood and Bone Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Brent R Logan
- Center for International Blood and Bone Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Bipin N Savani
- Hematology & Stem Cell Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paolo Anderlini
- Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Christopher N Bredeson
- The Ottawa Hospital Blood & Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Peiman Hematti
- Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Siddhartha Ganguly
- Hematologic Malignancies and Cellular Therapies, University of Kansas Medical Center, Westwood, Kansas
| | - Miguel Angel Diaz
- Unidad de Trasplante Hematopoyetico, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Hisham Abdel-Azim
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Ibrahim Ahmed
- Children's Mercy Hospital-UMKC, Kansas City, Missouri
| | - Dipnarine Maharaj
- South Florida Bone Marrow Transplant/Stem Cell Transplant Institute, Bethesda Health City, Boynton Beach, Florida
| | - Matthew Seftel
- Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Ontario, Canada
| | - Amer Beitinjaneh
- Stem Cell Transplantation and Cell Therapy Program, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sachiko Seo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jean A Yared
- Department of Medicine, Greenbaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Joerg Halter
- Department of Haematology, University Hospital Basel, Basel, Switzerland
| | - Paul V O'Donnell
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory A Hale
- Cancer and Blood Disorders Institute, All Children's Hospital, St. Petersburg, Florida
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hillard Lazarus
- Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jane L Liesveld
- Hematology-Oncology Unit, Department of Medicine, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Zheng Zhou
- University of Massachusetts, Marlboro, Massachusetts
| | - Pashna Munshi
- Georgetown University Hospital, Washington, District of Columbia
| | - Richard F Olsson
- Karolinska Institutet, Division of Therapeutic Immunology, Stockholm, Sweden
| | - Kimberly Anne Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey Szer
- Department of Hematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia
| | - Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pintip Chitphakdithai
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Nirali Shah
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dennis L Confer
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Michael A Pulsipher
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
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18
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Muffly L, Pasquini MC, Martens M, Brazauskas R, Zhu X, Adekola K, Aljurf M, Ballen KK, Bajel A, Baron F, Battiwalla M, Beitinjaneh A, Cahn JY, Carabasi M, Chen YB, Chhabra S, Ciurea S, Copelan E, D'Souza A, Edwards J, Foran J, Freytes CO, Fung HC, Gale RP, Giralt S, Hashmi SK, Hildebrandt GC, Ho V, Jakubowski A, Lazarus H, Luskin MR, Martino R, Maziarz R, McCarthy P, Nishihori T, Olin R, Olsson RF, Pawarode A, Peres E, Rezvani AR, Rizzieri D, Savani BN, Schouten HC, Sabloff M, Seftel M, Seo S, Sorror ML, Szer J, Wirk BM, Wood WA, Artz A. Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. Blood 2017; 130:1156-1164. [PMID: 28674027 PMCID: PMC5580273 DOI: 10.1182/blood-2017-03-772368] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [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: 03/14/2017] [Accepted: 06/19/2017] [Indexed: 12/20/2022] Open
Abstract
In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS: 26% [95% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.
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Affiliation(s)
- Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA
| | | | - Michael Martens
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research and
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI
| | - Xiaochun Zhu
- Center for International Blood and Marrow Transplant Research and
| | | | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - Karen K Ballen
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Ashish Bajel
- Royal Melbourne Hospital, Victoria, VIC, Australia
| | - Frederic Baron
- Centre Hospitalier Universitaire de Liege, Domaine Universitaire du Sart Tilman, Liege, Belgium
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Amer Beitinjaneh
- Department of Hematology and Oncology, University of Miami, Miami, FL
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Mathew Carabasi
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Saurabh Chhabra
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Stefan Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy and
- Transplant Myeloid Study Group, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research and
| | - John Edwards
- Indiana Blood and Marrow Transplantation, Indianapolis, IN
| | | | | | - Henry C Fung
- Department of Medical Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shahrukh K Hashmi
- Department of Internal Medicine, Mayo Clinic, Minneapolis, MN
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gerhard C Hildebrandt
- Department of Internal Medicine, University of Kentucky Chandler Medical Center, Lexington, KY
| | - Vincent Ho
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Marlise R Luskin
- Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, PA
| | - Rodrigo Martino
- Divison of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Richard Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Philip McCarthy
- Blood and Marrow Transplant Program, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Rebecca Olin
- Department of Medicine, University of California San Francisco Medical Center, San Francisco, CA
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, MI
| | - Edward Peres
- Bone Marrow Transplant Program, Henry Ford Hospital, Detroit, MI
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Blood and Marrow Transplant Clinic, Duke University, Durham, NC
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, The Netherlands
| | - Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Sachiko Seo
- National Cancer Research Center, East Hospital, Kashiwa, Chiba, Japan
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jeff Szer
- Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, VIC, Australia
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Andrew Artz
- Section of Hematology/Oncology, University of Chicago School of Medicine, Chicago, IL
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19
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Skrabek P, Seftel M, Bucher O, Elias B, Turner D. ENGAGING ADMINISTRATIVE DATA TO DETERMINE TIME TO DIAGNOSIS AND TREATMENT OF LYMPHOMA: A POPULATION BASED STUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P. Skrabek
- Department of Medical Oncology & Haematology; CancerCare Manitoba; Winnipeg Canada
| | - M. Seftel
- Department of Medical Oncology & Haematology; CancerCare Manitoba; Winnipeg Canada
| | - O. Bucher
- Epidemiology and Cancer Registry, CancerCare Manitoba; Winnipeg Canada
| | - B. Elias
- Department of Community Health Sciences; University of Manitoba; Winnipeg Canada
| | - D. Turner
- Epidemiology and Cancer Registry, CancerCare Manitoba; Winnipeg Canada
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20
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Rosko AE, Wang H, de Lima M, Sandmaier B, Khoury HJ, Artz A, Brammer J, Bredeson C, Farag S, Kharfan‐Dabaja M, Lazarus HM, Marks DI, Martino Bufarull R, McGuirk J, Mohty M, Nishihori T, Nivison‐Smith I, Rashidi A, Ringden O, Seftel M, Weisdorf D, Bachanova V, Saber W. Reduced intensity conditioned allograft yields favorable survival for older adults with B-cell acute lymphoblastic leukemia. Am J Hematol 2017; 92:42-49. [PMID: 27712033 DOI: 10.1002/ajh.24575] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 01/14/2023]
Abstract
Older adults with B-cell acute lymphoblastic leukemia (B-ALL) have poor survival. We examined the effectiveness of reduced intensity conditioning (RIC) hematopoietic cell transplant (HCT) in adults with B-ALL age 55 years and older and explored prognostic factors associated with long-term outcomes. Using CIBMTR registry data, we evaluated 273 patients (median age 61, range 55-72) with B-ALL with disease status in CR1 (71%), >CR2 (17%) and Primary Induction Failure (PIF)/Relapse (11%), who underwent RIC HCT between 2001 and 2012 using mostly unrelated donor (59%) or HLA-matched sibling (32%). Among patients with available cytogenetic data, the Philadelphia chromosome (Ph+) was present in 50%. The 3-year cumulative incidences of nonrelapse mortality (NRM) and relapse were 25% (95% confidence intervals (CI): 20-31%) and 47% (95% CI: 41-53%), respectively. Three-year overall survival (OS) was 38% (95% CI: 33-44%). Relapse remained the leading cause of death accounting for 49% of all deaths. In univariate analysis, 3 year risk of NRM was significantly higher with reduced Karnofsky performance status (KPS <90: 34% (95% CI: 25-43%) versus KPS ≥90 (18%; 95% CI: 12-24%, P = 0.006). Mortality was increased in older adults (66+ vs. 55-60: Relative Risk [RR] 1.51 95% CI: 1.00-2.29, P = 0.05) and those with advanced disease (RR 2.13; 95% CI: 1.36-3.34, P = 0.001). Survival of patients in CR1 yields 45% (95% CI: 38-52%) at 3 years and no relapse occurred after 2 years. We report promising OS and acceptable NRM using RIC HCT in older patients with B-ALL. Disease status in CR1 and good performance status are associated with improved outcomes. Am. J. Hematol. 92:42-49, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ashley E. Rosko
- Division of Hematology, Department of MedicineOhio State UniversityColumbus Ohio
| | - Hai‐Lin Wang
- Department of Medicine, Medical College of WisconsinCIBMTR, Center for International Blood and Marrow Transplant ResearchMilwaukee Wisconsin
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer CenterUniversity Hospitals Case Medical CenterCleveland Ohio
| | - Brenda Sandmaier
- Division of Medical OncologyUniversity of Washington and Clinical Research Division, Fred Hutchinson Cancer Research CenterSeattle Washington
| | | | - Andrew Artz
- Section of Hematology/OncologyUniversity of Chicago School of MedicineChicago Illinois
| | | | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research InstituteOttawa Ontario Canada
| | - Sherif Farag
- Indiana University Hospital/Riley Hospital for ChildrenIndianapolis Indianapolis
| | - Mohamed Kharfan‐Dabaja
- Department of Blood and Marrow TransplantationH. Lee Moffit Cancer Center and Research InstituteTampa Florida
| | - Hillard M. Lazarus
- Seidman Cancer CenterUniversity Hospitals Case Medical CenterCleveland Ohio
| | - David I. Marks
- Adult Bone Marrow TransplantUniversity Hospitals Bristol NHS TrustBristol United Kingdom
| | | | | | - Mohamed Mohty
- Hopital Saint‐AntoineAPHP, Universite Pierre & Marie Curie, INSERM UMRs U938Paris France
| | - Taiga Nishihori
- Department of Blood and Marrow TransplantationH. Lee Moffit Cancer Center and Research InstituteTampa Florida
| | | | | | - Olle Ringden
- Division of Therapeutic Immunology, Department of Laboratory MedicineKarolinska InstitutetStockholm Sweden
- Centre for Allogeneic Stem Cell TransplantationStockholm Sweden
| | - Matthew Seftel
- Department of Medical Oncology and HematologyPrincess Margaret Cancer CentreToronto Ontario Canada
| | - Daniel Weisdorf
- Divsion of Hematology, Oncology and Transplantation, Department of MedicineUniversity of Minnesota Medical CenterMinneapolis Minnesota
| | - Veronika Bachanova
- Bone and Marrow Transplant ProgramUniversity of Minnesota Medical CenterMinneapolis Minnesota
| | - Wael Saber
- Department of Medicine, Medical College of WisconsinCIBMTR, Center for International Blood and Marrow Transplant ResearchMilwaukee Wisconsin
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Sissolak G, Seftel M, Uldrick TS, Esterhuizen TM, Mohamed N, Kotze D. Burkitt's Lymphoma and B-Cell Lymphoma Unclassifiable With Features Intermediate Between Diffuse Large B-Cell Lymphoma and Burkitt's Lymphoma in Patients With HIV: Outcomes in a South African Public Hospital. J Glob Oncol 2016; 3:218-226. [PMID: 28717763 PMCID: PMC5493215 DOI: 10.1200/jgo.2015.002378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose Burkitt’s lymphoma (BL) is a common HIV-associated lymphoma in South Africa. B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt’s lymphoma (BL/DLBCL) also occurs in HIV infection. Outcomes of HIV-infected patients with BL or BL/DLBCL in a resource-constrained setting are not defined. Methods We performed a retrospective study of HIV-positive patients with BL or BL/DLBCL treated from 2004 to 2012 with curative intent at a publically funded academic medical center in South Africa. Differences between BL and BL/DLBCL, survival outcomes, and factors associated with survival were analyzed. Results There were 35 patients with either HIV-associated BL (24) or BL/DLBCL (11) who met study criteria. Median CD4+ T-lymphocyte count at lymphoma diagnosis was 188 cells/μL (range, 10 to 535 cells/μL). Patients with BL/DLBCL were significantly older and had less bone marrow involvement and lower baseline serum lactase dehydrogenase than patients with BL. Eighty-nine percent of patients presented with advanced disease, and 25% had baseline CNS involvement. Chemotherapy regimens consisted of cytoreduction with low-dose cyclophosphamide, vincristine, and prednisone followed by induction with vincristine, methotrexate, cyclophosphamide, doxorubicin and prednisone (LMB 86; 57%); hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, and cytarabine (hyper-CVAD; 20%); cyclophosphamide, doxorubicin, vincristine, and prednisone and high-dose methotrexate with leucovorin rescue on day 10 with accompanying prophylactic IT chemotherapy (Stanford regimen; 14%); and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP-like; 9%) regimens. Twenty-three patients received CNS treatment or prophylaxis, and 31 received concurrent combination antiretroviral therapy. Two-year overall survival was 38% (95% CI, 22% to 54%) and 2-year event-free survival was 23% (95% CI, 11% to 38%), with no difference between histologic subtypes. Common causes of death were infection (41%) and CNS disease progression or systemic relapse (41%). Conclusion Cure of HIV-associated BL and BL/DLBCL with intensive regimens is possible in resource-limited settings, but lower toxicity regimens, improved CNS prophylaxis, and increased resources for supportive care are required.
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Affiliation(s)
- Gerhard Sissolak
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Matthew Seftel
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Thomas S Uldrick
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Tonya M Esterhuizen
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Nooroudien Mohamed
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Danie Kotze
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
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22
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Carde P, Karrasch M, Fortpied C, Brice P, Khaled H, Casasnovas O, Caillot D, Gaillard I, Bologna S, Ferme C, Lugtenburg PJ, Morschhauser F, Aurer I, Coiffier B, Meyer R, Seftel M, Wolf M, Glimelius B, Sureda A, Mounier N. Eight Cycles of ABVD Versus Four Cycles of BEACOPPescalated Plus Four Cycles of BEACOPPbaseline in Stage III to IV, International Prognostic Score ≥ 3, High-Risk Hodgkin Lymphoma: First Results of the Phase III EORTC 20012 Intergroup Trial. J Clin Oncol 2016; 34:2028-36. [PMID: 27114593 DOI: 10.1200/jco.2015.64.5648] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare patients with high-risk stage III to IV Hodgkin lymphoma (HL) in the phase III European Organisation for Research and Treatment of Cancer 20012 Intergroup trial (Comparison of Two Combination Chemotherapy Regimens in Treating Patients With Stage III or Stage IV Hodgkin's Lymphoma) who were randomly assigned to either doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) or to bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP). PATIENTS AND METHODS Patients with clinical stage III or IV HL, International Prognostic Score of 3 or higher, and age 60 years or younger received ABVD for eight cycles (ABVD8) or escalated-dose BEACOPP (BEACOPPescalated) for four cycles followed by baseline BEACOPP (BEACOPPbaseline) for four cycles (BEACOPP4+4) without radiotherapy. Primary end points were event-free survival (EFS), treatment discontinuation, no complete response (CR) or unconfirmed complete response (CRu) after eight cycles, progression, relapse, or death. Secondary end points were CR rate, overall survival (OS), quality of life, secondary malignancies, and disease-free survival in CR/CRu patients. RESULTS Between 2002 and 2010, 549 patients were randomly assigned to ABVD8 (n = 275) or BEACOPP4+4 (n = 274). Other characteristics included median age, 35 years; male, 75%; stage IV, 74%; "B" symptoms, 81%; and International Prognostic Score ≥ 4, 59%. WHO performance status was 0 (34%), 1 (48%), or 2 (17%). Median follow-up was 3.6 years. CR/CRu was 82.5% in both arms. At 4 years, EFS was 63.7% for ABVD8 versus 69.3% for BEACOPP4+4 (hazard ratio [HR], 0.86; 95% CI, 0.64 to 1.15; P = .312); disease-free survival was 85.8% versus 91.0% (HR, 0.59; 95% CI, 0.33 to 1.06; P = .076), and OS was 86.7% versus 90.3% (HR, 0.71; 95% CI, 0.42 to 1.21; P = .208). Death as a result of toxicity occurred in six and five patients, early discontinuation (before cycle 5) in 12 and 26 patients, treatment crossovers in five and 10 patients, and secondary malignancies in eight and 10 patients in the ABVD8 and BEACOPP4+4 arms, respectively. CONCLUSION ABVD8 and BEACOPP4+4 resulted in similar EFS and OS in patients with high-risk advanced-stage HL. Because BEACOPP4+4 did not demonstrate a favorable effectiveness or toxicity ratio compared with ABVD8, treatment burden, immediate and late toxicities, and associated costs must be considered before selecting one of these regimens on which to build future treatment strategies.
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Affiliation(s)
- Patrice Carde
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Matthias Karrasch
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Catherine Fortpied
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pauline Brice
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Hussein Khaled
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Olivier Casasnovas
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Denis Caillot
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabelle Gaillard
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Serge Bologna
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Christophe Ferme
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pieternella Johanna Lugtenburg
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Frank Morschhauser
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Igor Aurer
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Bertrand Coiffier
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ralph Meyer
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Matthew Seftel
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Max Wolf
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Bengt Glimelius
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anna Sureda
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nicolas Mounier
- Patrice Carde and Christophe Ferme, Gustave Roussy Cancer Campus, Villejuif; Pauline Brice, Hopital St. Louis, Paris; Olivier Casasnovas and Denis Caillot, Centre Hospitalier Universitaire (CHU) de Dijon, Dijon; Isabelle Gaillard, CHU Henri Mondor, Creteil; Serge Bologna, Centre Hospitalier Regional Universitaire (CHR) de Nancy, Nancy; Frank Morschhauser, CHR de Lille, Lille; Bertrand Coiffier, CHU de Lyon, Lyon; Nicolas Mounier, Hopital de L'Archet, Nice, France; Matthias Karrasch and Catherine Fortpied, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium; Hussein Khaled, National Cancer Institute, Cairo, Egypt; Pieternella Johanna Lugtenburg, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands; Igor Aurer, University Hospital Centre Zagreb, Zagreb, Croatia; Ralph Meyer, Juravinski Cancer Centre, Hamilton, Ontario; Matthew Seftel, Cancer Care Manitoba, Winnipeg, Manitoba, Canada; Max Wolf, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia; Bengt Glimelius, Uppsala University, Uppsala, Sweden; and Anna Sureda, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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23
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Deotare U, Yee KW, Le LW, Porwit A, Tierens A, Musani R, Barth D, Torlakovic E, Schimmer A, Schuh AC, Seftel M, Minden MD, Gupta V, Hyjek E. Blastic plasmacytoid dendritic cell neoplasm with leukemic presentation: 10-Color flow cytometry diagnosis and HyperCVAD therapy. Am J Hematol 2016; 91:283-6. [PMID: 26619305 DOI: 10.1002/ajh.24258] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/24/2015] [Indexed: 01/10/2023]
Abstract
Few studies describe the comprehensive immunophenotypic pattern of blastic plasmacytoid dendritic cell neoplasm (BPDCN) in the bone marrow and its treatment. This retrospective analysis evaluates the diagnostic flow cytometry (FCM) pattern and outcome of nine patients diagnosed with BPDCN. A four-tube 10-color FCM panel used for diagnosis of acute leukemia (AL), showed cells in the blast gate (CD45dim/low SSC) and were positive for CD4(bright), CD33(dim), CD56(heterogenous), CD123(bright), CD36, CD38, HLA-DR, CD71. Seven patients received front-line induction therapy with HyperCVAD with an overall response rate of 86%. Five of six responders underwent planned allogeneic hematopoietic cell transplantation (allo-HCT). For a median follow up of 13.3 months, the 1-year disease free survival and overall survival were 56 and 67%, respectively. An accurate diagnosis of BPDCN can be made by 10-color FCM using a four-tube AL panel demonstrating a characteristic pattern of antigen expression. Front-line induction chemotherapy with HyperCVAD can yield high remission rates, but allo-HCT is required for long-term durable remissions.
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Affiliation(s)
- Uday Deotare
- Leukemia Program; Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Karen W.L. Yee
- Leukemia Program; Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Lisa W. Le
- Department of Biostatistics; Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Anna Porwit
- Department of Pathobiology and Laboratory Medicine; University Health Network; Toronto Ontario Canada
| | - Anne Tierens
- Department of Pathobiology and Laboratory Medicine; University Health Network; Toronto Ontario Canada
| | - Rumina Musani
- Department of Pathobiology and Laboratory Medicine; University Health Network; Toronto Ontario Canada
| | - David Barth
- Department of Pathobiology and Laboratory Medicine; University Health Network; Toronto Ontario Canada
| | - Emina Torlakovic
- Department of Pathobiology and Laboratory Medicine; University Health Network; Toronto Ontario Canada
| | - Aaron Schimmer
- Leukemia Program; Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Andre C. Schuh
- Leukemia Program; Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Matthew Seftel
- Leukemia Program; Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
- Department of Medical Oncology and Hematology; Cancer Care Manitoba; Winnipeg Manitoba Canada
| | - Mark D. Minden
- Leukemia Program; Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Vikas Gupta
- Leukemia Program; Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre, University Health Network; Toronto Ontario Canada
| | - Elizabeth Hyjek
- Department of Pathobiology and Laboratory Medicine; University Health Network; Toronto Ontario Canada
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24
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Paulson K, Kuruvilla J, Bredeson CN, Cantin G, Couture F, Crump M, Daly A, Foley R, Gerrie A, Hasegawa W, Lachance S, Seftel M, Popradi G, Wall DA, Stewart D. Carmustine-Free Conditioning Regimens Offer Comparable Efficacy to BEAM: The First Report of the Canadian Blood and Marrow Transplant Group Registry. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.316] [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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25
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Kumar R, Kimura F, Ahn KW, Hu ZH, Kuwatsuka Y, Klein JP, Pasquini M, Miyamura K, Kato K, Yoshimi A, Inamoto Y, Ichinohe T, Wood WA, Wirk B, Seftel M, Rowlings P, Marks DI, Schultz KR, Gupta V, Dedeken L, George B, Cahn JY, Szer J, Lee JW, Ho AYL, Fasth A, Hahn T, Khera N, Dalal J, Bonfim C, Aljurf M, Atsuta Y, Saber W. Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions. Biol Blood Marrow Transplant 2016; 22:932-40. [PMID: 26797402 DOI: 10.1016/j.bbmt.2016.01.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared with mobilized peripheral blood stem cells (PBSCs). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita and region/countries into 4 groups. Groups analyzed were high-income countries (HIC), which were further divided into United States-Canada (n = 486) and other HIC (n = 1264); upper middle income (UMIC) (n = 482); and combined lower-middle, low-income countries (LM-LIC) (n = 142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared with PBSCs in all countries or BM in UMIC or LM-LIC (P < .001). There was no significant difference in OS between BM and PBSCs in UMIC (P = .32) or LM-LIC (P = .23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSCs compared with BM (97% versus 77%, P = .002). Chronic graft-versus-host disease was significantly higher with PBSCs in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSCs may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications.
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Affiliation(s)
- Rajat Kumar
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Fumihiko Kimura
- Division of Hematology, National Defense Medical College, Tokorozawa, Japan
| | - Kwang Woo Ahn
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhen-Huan Hu
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yachiyo Kuwatsuka
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - John P Klein
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcelo Pasquini
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Ayami Yoshimi
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - William Allen Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Philip Rowlings
- Calvary Mater Newcastle, HAPS-Pathology North, University of Newcastle, Callaghan, New South Wales, Australia
| | - David I Marks
- Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Kirk R Schultz
- BC Children's Hospital and Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Vikas Gupta
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Laurence Dedeken
- Department of Hematology-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | | | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Jeff Szer
- Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia
| | - Jong Wook Lee
- BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | | | - Anders Fasth
- Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden
| | - Theresa Hahn
- Roswell Park Cancer Institute, Buffalo, New York
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - Jignesh Dalal
- Rainbow Babies & Children's Hospital/Case Western Reserve University, Cleveland, Ohio
| | - Carmem Bonfim
- Hospital de Clinicas, Federal University of Parana, Curitiba, Brazil
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation and Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wael Saber
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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26
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Deeg HJ, Bredeson C, Farnia S, Ballen K, Gupta V, Mesa RA, Popat U, Hari P, Saber W, Seftel M, Tamari R, Petersdorf EW. Hematopoietic Cell Transplantation as Curative Therapy for Patients with Myelofibrosis: Long-Term Success in all Age Groups. Biol Blood Marrow Transplant 2015; 21:1883-7. [PMID: 26371371 DOI: 10.1016/j.bbmt.2015.09.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 11/20/2022]
Abstract
Myeloproliferative neoplasms (MPN) are chronic marrow disorders with variable prognoses. Most patients with polycythemia vera, essential thrombocythemia, or even primary myelofibrosis (PMF) are successfully treated with conservative strategies for years or even decades, and recent data suggest that even in patients with high-risk disease, in particular those with PMF, life expectancy can be extended by treatment with janus kinase (JAK2) inhibitors. However, none of those modalities are curative, and after marrow failure develops, the disease "accelerates," or transforms to acute leukemia, the only option able to effectively treat and, in fact, cure MPN is allogeneic hematopoietic cell transplantation (HCT). Outcome is superior if HCT is performed before leukemic transformation occurs. Several reports document survival in unmaintained remission beyond 10 years. The most recent analyses show reduced regimen-related mortality (less than 10% or even 5% at day 100) and progressively improved survival with both HLA-identical sibling and unrelated donors. The development of low/reduced-intensity conditioning regimens has contributed to the improved success rate and has allowed successful HCT in patients in their seventh and even eighth decade of life. We propose, therefore, that HCT should be offered to fit patients in these age groups and should be covered by their respective insurance carriers.
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Affiliation(s)
- H Joachim Deeg
- Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, Washington.
| | | | | | - Karen Ballen
- Hematology/Oncology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Vikas Gupta
- Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Ruben A Mesa
- Division of Hematology and Medical Oncology, Mayo Clinic Cancer Center, Scottsdale, Arizona
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Parameswaran Hari
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wael Saber
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew Seftel
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, Canada
| | - Roni Tamari
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Effie W Petersdorf
- Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, Washington
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27
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Alam N, Atenafu EG, Kuruvilla J, Uhm J, Lipton JH, Messner HA, Kim DH, Seftel M, Gupta V. Outcomes of patients with therapy-related AML/myelodysplastic syndrome (t-AML/MDS) following hematopoietic cell transplantation. Bone Marrow Transplant 2015; 50:1180-6. [PMID: 26121109 DOI: 10.1038/bmt.2015.151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/14/2015] [Accepted: 05/13/2015] [Indexed: 11/09/2022]
Abstract
We studied outcomes of 65 consecutive patients with therapy-related AML/myelodyplastic syndrome (t-AML/MDS) who underwent allogeneic hematopoietic cell transplantation (HCT). Previously published scores of HCT-CI, CIBMTR, EBMT and Comorbidity-age index were also evaluated. Median follow-up of survivors was 72 months (range 16-204). At 2 years, overall survival (OS) was 34% (95% confidence interval (CI) 23-45). Nineteen patients (29%) had monosomal karyotype (MK). Patients with MK had an OS of 21% (95% CI 7-41) at 2 years. Abnormal adverse cytogenetics, unrelated donor, bone marrow graft and CIBMTR score were significant risk factors for OS on univariate analysis. On multivariate analysis, abnormal adverse cytogenetics (hazard ratio (HR) 2.7; 95% CI 1.02-7.2; P-value=0.02) and unrelated donor (HR 2.7; 95% CI 1.5-5.0; P-value=0.0013) were independent factors for survival. Non-relapse mortality (NRM) at 2 years was 31% (95% CI 15-47). Donor type was the only factor that was significant for NRM with matched related donors having an NRM of 20% (95% CI 0-42) whereas unrelated donors had NRM of 60% (95% CI 40-80; P-value=0.0007). In conclusion, patients with t-AML/MDS have poor OS. Unrelated donor is a significant risk factor for both higher NRM and decreased OS. Cytogenetics are predictive for OS.
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Affiliation(s)
- N Alam
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - E G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - J Kuruvilla
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - J Uhm
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - J H Lipton
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - H A Messner
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - D H Kim
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - M Seftel
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - V Gupta
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
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28
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Hamad N, Shanavas M, Michelis FV, Uhm J, Gupta V, Seftel M, Kuruvilla J, Lipton JH, Messner HA, Kim DDH. Mycophenolate-based graft versus host disease prophylaxis is not inferior to methotrexate in myeloablative-related donor stem cell transplantation. Am J Hematol 2015; 90:392-9. [PMID: 25615933 DOI: 10.1002/ajh.23955] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 01/08/2023]
Abstract
We retrospectively reviewed 242 patients who received related donor myeloablative peripheral blood hematopoietic cell transplantation. We compared patients who received mycophenolate (MMF)/cyclosporine (CSA) (n = 71), to historical controls who received methotrexate (MTX)/CSA (n = 172). There were no differences in overall survival, nonrelapse mortality, and relapse. The MMF/CSA group had significantly faster neutrophil and platelet engraftment: medians of 13 versus 18 days and 10 versus 14 days, respectively (P = 0.001). The cumulative incidence of acute graft versus host disease (GVHD) (Grades, 2-4) was significantly lower in the MMF/CSA group (45.1 vs. 74.4%, P < 0.001). The MMF/CSA group showed a lower incidence of skin (51.5 vs. 72.1%, P < 0.001) and liver acute GVHD (11.3 vs. 54.2%, P < 0.001) and a higher incidence of lung (42.2 vs. 19.0%, P = 0.045), eye (59.7 vs. 30.1%, P < 0.001), and mouth (72.8 vs. 56.4%, P = 0.001) chronic GVHD but only eye chronic GVHD was confirmed in propensity score matching (PSM) analysis. The incidence of cytomegalovirus (CMV) viremia was higher in the MMF/CSA group (55.8 vs. 39.6%, P < 0.001) but this was not confirmed in PSM analysis. MMF/CSA was identified as an independent favorable factor for acute GVHD (P < 0.001, hazard ratio, 0.41) but as a possible adverse risk factor for CMV viremia as this was not found to be statistically significant in PSM analysis. MMF/CSA in myeloablative matched related donor peripheral blood stem cell transplant is not inferior as GVHD prophylaxis in comparison with MTX/CSA and is associated with faster engraftment but a potentially higher risk of CMV viremia.
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Affiliation(s)
- Nada Hamad
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
| | - Mohamed Shanavas
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
| | - Fotios V. Michelis
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
| | - Jieun Uhm
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
| | - Vikas Gupta
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
| | - Matthew Seftel
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
| | - John Kuruvilla
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
| | - Jeffrey H. Lipton
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
| | - Hans A. Messner
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
| | - Dennis Dong Hwan Kim
- Allogeneic Blood and Marrow Transplant Program; Princess Margaret Cancer Center, University of Toronto; Canada
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29
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Camargo JF, Bhimji A, Kumar D, Kaul R, Pavan R, Schuh A, Seftel M, Lipton JH, Gupta V, Humar A, Husain S. Impaired T cell responsiveness to interleukin-6 in hematological patients with invasive aspergillosis. PLoS One 2015; 10:e0123171. [PMID: 25835547 PMCID: PMC4383538 DOI: 10.1371/journal.pone.0123171] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 02/02/2015] [Indexed: 12/18/2022] Open
Abstract
Invasive mold infections (IMI) are among the most devastating complications following chemotherapy and hematopoietic stem cell transplantation (HSCT), with high mortality rates. Yet, the molecular basis for human susceptibility to invasive aspergillosis (IA) and mucormycosis remain poorly understood. Herein, we aimed to characterize the immune profile of individuals with hematological malignancies (n = 18) who developed IMI during the course of chemotherapy or HSCT, and compared it to that of hematological patients who had no evidence of invasive fungal infection (n = 16). First, we measured the expression of the pattern recognition receptors pentraxin 3, dectin-1, and Toll-like receptors (TLR) 2 and 4 in peripheral blood of chemotherapy and HSCT recipients with IMI. Compared to hematological controls, individuals with IA and mucormycosis had defective expression of dectin-1; in addition, patients with mucormycosis had decreased TLR2 and increased TLR4 expression. Since fungal recognition via dectin-1 favors T helper 17 responses and the latter are highly dependent on activation of the signal transducer and activator of transcription (STAT) 3, we next used phospho-flow cytometry to measure the phosphorylation of the transcription factors STAT1 and STAT3 in response to interferon-gamma (IFN-γ) and interleukin (IL)-6, respectively. While IFN-γ/STAT1 signaling was similar between groups, naïve T cells from patients with IA, but not those with mucormycosis, exhibited reduced responsiveness to IL-6 as measured by STAT3 phosphorylation. Furthermore, IL-6 increased Aspergillus-induced IL-17 production in culture supernatants from healthy and hematological controls but not in patients with IA. Altogether, these observations suggest an important role for dectin-1 and the IL-6/STAT3 pathway in protective immunity against Aspergillus.
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Affiliation(s)
- Jose F. Camargo
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Alyajahan Bhimji
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Deepali Kumar
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Rhea Pavan
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Andre Schuh
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada
| | - Matthew Seftel
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey H. Lipton
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada
| | - Vikas Gupta
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada
| | - Atul Humar
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Shahid Husain
- Transplant Infectious Diseases, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- * E-mail:
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Alam N, Xu W, Atenafu EG, Uhm J, Seftel M, Gupta V, Kuruvilla J, Lipton JH, Messner HA, Kim DDH. Risk model incorporating donor IL6 and IFNG genotype and gastrointestinal GVHD can discriminate patients at high risk of steroid refractory acute GVHD. Bone Marrow Transplant 2015; 50:734-42. [DOI: 10.1038/bmt.2015.19] [Citation(s) in RCA: 13] [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: 09/29/2014] [Revised: 01/08/2015] [Accepted: 01/09/2015] [Indexed: 01/28/2023]
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Mauti E, MacAskill R, Chen C, Seftel M, Kukreti V. Building a Quality Plan for a Blood and Marrow Transplant Program: Quality Framework and Indicator Development. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.151] [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: 10/24/2022]
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Bhella SD, Uhm J, Alam N, Gupta V, Kuruvilla J, Lipton JH, Messner H, Seftel M, Kim D(DH. Moderate/Severe Grade of Chronic Graft Versus Host Disease and Younger Age (Less Than 45 Years Old) Are Risk Factors for Avascular Necrosis in Adult Patients Undergoing Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.021] [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: 11/25/2022]
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Uhm J, Hamad N, Shin EM, Michelis FV, Shanavas M, Gupta V, Kuruvilla J, Lipton JH, Messner HA, Seftel M, Kim D(DH. Incidence, Risk Factors, and Long-Term Outcomes of Sclerotic Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2014; 20:1751-7. [DOI: 10.1016/j.bbmt.2014.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/01/2014] [Indexed: 12/22/2022]
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McClune BL, Ahn KW, Wang HL, Antin JH, Artz AS, Cahn JY, Deol A, Freytes CO, Hamadani M, Holmberg LA, Jagasia MH, Jakubowski AA, Kharfan-Dabaja MA, Lazarus HM, Miller AM, Olsson R, Pedersen TL, Pidala J, Pulsipher MA, Rowe JM, Saber W, van Besien KW, Waller EK, Aljurf MD, Akpek G, Bacher U, Chao NJ, Chen YB, Cooper BW, Dehn J, de Lima MJ, Hsu JW, Lewis ID, Marks DI, McGuirk J, Cairo MS, Schouten HC, Szer J, Ramanathan M, Savani BN, Seftel M, Socie G, Vij R, Warlick ED, Weisdorf DJ. Allotransplantation for patients age ≥40 years with non-Hodgkin lymphoma: encouraging progression-free survival. Biol Blood Marrow Transplant 2014; 20:960-8. [PMID: 24641829 DOI: 10.1016/j.bbmt.2014.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 01/30/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
Non-Hodgkin lymphoma (NHL) disproportionately affects older patients, who do not often undergo allogeneic hematopoietic cell transplantation (HCT). We analyzed Center for International Blood and Marrow Transplant Research data on 1248 patients age ≥40 years receiving reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT for aggressive (n = 668) or indolent (n = 580) NHL. Aggressive lymphoma was more frequent in the oldest cohort 49% for age 40 to 54 versus 57% for age 55 to 64 versus 67% for age ≥65; P = .0008). Fewer patients aged ≥65 had previous autografting (26% versus 24% versus 9%; P = .002). Rates of relapse, acute and chronic GVHD, and nonrelapse mortality (NRM) at 1 year post-HCT were similar in the 3 age cohorts (22% [95% confidence interval (CI), 19% to 26%] for age 40 to 54, 27% [95% CI, 23% to 31%] for age 55 to 64, and 34% [95% CI, 24% to 44%] for age ≥65. Progression-free survival (PFS) and overall survival (OS) at 3 years was slightly lower in the older cohorts (OS: 54% [95% CI, 50% to 58%] for age 40 to 54; 40% [95% CI, 36% to 44%] for age 55 to 64, and 39% [95% CI, 28% to 50%] for age ≥65; P < .0001). Multivariate analysis revealed no significant effect of age on the incidence of acute or chronic GVHD or relapse. Age ≥55 years, Karnofsky Performance Status <80, and HLA mismatch adversely affected NRM, PFS, and OS. Disease status at HCT, but not histological subtype, was associated with worse NRM, relapse, PFS, and OS. Even for patients age ≥55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL.
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Affiliation(s)
- Brian L McClune
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hai-Lin Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joseph H Antin
- Division of Hematologic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrew S Artz
- Section of Hematology/Oncology, University of Chicago School of Medicine, Chicago, Illinois
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Abhinav Deol
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - César O Freytes
- Department of Hematology, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Madan H Jagasia
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Ann A Jakubowski
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Alan M Miller
- Department of Oncology, Baylor University Medical Center, Dallas, TX
| | - Richard Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Tanya L Pedersen
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL
| | - Michael A Pulsipher
- Primary Children's Hospital, Division of Hematology/Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jacob M Rowe
- Department of Hematology, Rambam Medical Center, Haifa, Israel
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Edmund K Waller
- Bone Marrow and Stem Cell Transplant Center, Winship Cancer Institute, Emory University Hospital, Atlanta, Georgia
| | - Mahmoud D Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - Görgun Akpek
- Banner M.D. Anderson Cancer Center, Gilbert, Arizona
| | - Ulrike Bacher
- Department of Stem Cell Transplantation, University of Hamburg, Hamburg, Germany; MLL Munich Leukemia Laboratory, Munich, Germany
| | - Nelson J Chao
- Division of Cell Therapy, Duke University Medical Center, Durham, NC
| | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Brenda W Cooper
- Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH
| | - Jason Dehn
- National Marrow Donor Program, Minneapolis, MN
| | - Marcos J de Lima
- Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH
| | - Jack W Hsu
- Division of Hematology/Oncology, Shands HealthCare, University of Florida, Gainesville, FL
| | - Ian D Lewis
- Haematology Clinical Trial Office, Royal Adelaide Hospital/SA Pathology, Adelaide, Australia
| | - David I Marks
- Avon Haematology Unit and BCH BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom
| | - Joseph McGuirk
- Division of Hematology & Oncology, University of Kansas, Westwood, KS
| | - Mitchell S Cairo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY
| | - Harry C Schouten
- Division of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Jeffrey Szer
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia
| | - Muthalagu Ramanathan
- Department of Hematologic Malignancies Bone Marrow Transplant, UMass Memorial Medical Center, Worcester, MA
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gérard Socie
- Department of Hematology, Hopital Saint Louis, Paris, France
| | - Ravi Vij
- Division of Medical Oncology, Barnes Jewish Hospital, St. Louis Children's Hospital, Washington University, St. Louis, MO
| | - Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Weisdorf
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota.
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Sabloff M, Sobecks RM, Ahn KW, Zhu X, de Lima M, Brown JR, Inamoto Y, Holland HK, Aljurf MD, Laughlin MJ, Kamble RT, Hsu JW, Wirk BM, Seftel M, Lewis ID, Arora M, Alyea EP, Kalaycio ME, Cortes J, Maziarz RT, Gale RP, Saber W. Does total body irradiation conditioning improve outcomes of myeloablative human leukocyte antigen-identical sibling transplantations for chronic lymphocytic leukemia? Biol Blood Marrow Transplant 2014; 20:421-4. [PMID: 24321745 PMCID: PMC4026353 DOI: 10.1016/j.bbmt.2013.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
An allogeneic hematopoietic cell transplantation from an HLA-identical donor after high-dose (myeloablative) pretransplantation conditioning is an effective therapy for some people with chronic lymphocytic leukemia (CLL). Because CLL is a highly radiosensitive cancer, we hypothesized that total body irradiation (TBI) conditioning regimens may be associated with better outcomes than those without TBI. To answer this, we analyzed data from 180 subjects with CLL receiving myeloablative doses of TBI (n = 126) or not (n = 54), who received transplants from an HLA-identical sibling donor between 1995 and 2007 and reported to the Center for International Blood & Marrow Transplant Research. At 5 years, treatment-related mortality was 48% (95% confidence interval [CI], 39% to 57%) versus 50% (95% CI, 36% to 64%); P = NS. Relapse rates were 17% (95% CI, 11% to 25%) versus 22% (95% CI, 11% to 35%); P = NS. Five-year progression-free survival and overall survival were 34% (95% CI, 26% to 43%) versus 28% (95% CI, 15% to 42%); P = NS and 42% (95% CI, 33% to 51%) versus 33% (95% CI, 19% to 48%); P = NS, respectively. The single most common cause of death in both cohorts was recurrent/progressive CLL. No variable tested in the multivariate analysis was found to significantly affect these outcomes, including having failed fludarabine. Within the limitations of this study, we found no difference in HLA-identical sibling transplantation outcomes between myeloablative TBI and chemotherapy pretransplantation conditioning in persons with CLL.
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MESH Headings
- Adult
- Female
- HLA Antigens/immunology
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Middle Aged
- Myeloablative Agonists/therapeutic use
- Recurrence
- Siblings
- Survival Analysis
- Transplantation Conditioning/methods
- Transplantation, Isogeneic
- Treatment Outcome
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
- Whole-Body Irradiation
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Affiliation(s)
- Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Ronald M Sobecks
- Division of Hematologic Oncology and Blood Disorders, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kwang Woo Ahn
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Xiaochun Zhu
- Center for International Blood & Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcos de Lima
- Division of Hematologic Malignancies and Stem Cell Transplantation, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Jennifer R Brown
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Yoshihiro Inamoto
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - H Kent Holland
- Division of Oncology and Hematology, The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Mahmoud D Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Mary J Laughlin
- Hematopoietic Cell Transplantation Program, University Hospitals Case Medical Center, University of Virginia Health System, Charlottesville, Virginia
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas
| | - Jack W Hsu
- Division of Hematology and Oncology, Department of Medicine, Shands Healthcare & University of Florida, Gainesville, Florida
| | - Baldeep M Wirk
- Division of Hematology and Oncology, Stony Brook University Medical Center, Stony Brook, New York
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ian D Lewis
- Haematology and Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Mukta Arora
- Division of Hematology, Oncology and Transplant, University of Minnesota Medical Center, Fairview, Minneapolis, Minneapolis
| | - Edwin P Alyea
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Matt E Kalaycio
- Division of Hematologic Oncology and Blood Disorders, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jorge Cortes
- Department of Leukemia, MD Anderson Cancer Center, Houston, Texas
| | - Richard T Maziarz
- Center for Hematologic Malignancies, OHSU Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Robert Peter Gale
- Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, United Kingdom
| | - Wael Saber
- Center for International Blood & Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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Alam N, Atenafu E, Gupta V, Kuruvilla J, Lipton JH, Messner H, Seftel M, Kim D(DH. Alemtuzumab As Therapy for Steroid Refractory Acute Gvhd: Promising Efficacy but Higher Rate of Infectious Complications Based on Observational Study. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.438] [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: 11/25/2022]
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Warlick ED, Paulson K, Brazauskas R, Zhong X, Miller AM, Camitta BM, George B, Savani BN, Ustun C, Marks DI, Waller EK, Baron F, Freytes CO, Socie G, Akpek G, Schouten HC, Lazarus HM, Horwitz EM, Koreth J, Cahn JY, Bornhauser M, Seftel M, Cairo MS, Laughlin MJ, Sabloff M, Ringdén O, Gale RP, Kamble RT, Vij R, Gergis U, Mathews V, Saber W, Chen YB, Liesveld JL, Cutler CS, Ghobadi A, Uy GL, Eapen M, Weisdorf DJ, Litzow MR. Effect of postremission therapy before reduced-intensity conditioning allogeneic transplantation for acute myeloid leukemia in first complete remission. Biol Blood Marrow Transplant 2014; 20:202-8. [PMID: 24184335 PMCID: PMC3924751 DOI: 10.1016/j.bbmt.2013.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 08/19/2013] [Accepted: 10/28/2013] [Indexed: 11/23/2022]
Abstract
The impact of pretransplant (hematopoietic cell transplantation [HCT]) cytarabine consolidation therapy on post-HCT outcomes has yet to be evaluated after reduced-intensity or nonmyeloablative conditioning. We analyzed 604 adults with acute myeloid leukemia in first complete remission (CR1) reported to the Center for International Blood and Marrow Transplant Research who received a reduced-intensity or nonmyeloablative conditioning HCT from an HLA-identical sibling, HLA-matched unrelated donor, or umbilical cord blood donor from 2000 to 2010. We compared transplant outcomes based on exposure to cytarabine postremission consolidation. Three-year survival rates were 36% (95% confidence interval [CI], 29% to 43%) in the no consolidation arm and 42% (95% CI, 37% to 47%) in the cytarabine consolidation arm (P = .16). Disease-free survival was 34% (95% CI, 27% to 41%) and 41% (95% CI, 35% to 46%; P = .15), respectively. Three-year cumulative incidences of relapse were 37% (95% CI, 30% to 44%) and 38% (95% CI, 33% to 43%), respectively (P = .80). Multivariate regression confirmed no effect of consolidation on relapse, disease-free survival, and survival. Before reduced-intensity or nonmyeloablative conditioning HCT, these data suggest pre-HCT consolidation cytarabine does not significantly alter outcomes and support prompt transition to transplant as soon as morphologic CR1 is attained. If HCT is delayed while identifying a donor, our data suggest that consolidation does not increase transplant treatment-related mortality and is reasonable if required.
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Affiliation(s)
- Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Kristjan Paulson
- Department of Hematology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Xiaobo Zhong
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alan M Miller
- Department of Oncology, Baylor University Medical Center, Dallas, Texas
| | - Bruce M Camitta
- Department of Pediatrics, Midwest Center for Cancer and Blood Disorders, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Biju George
- Department of Hematology, Christian Medical College Hospital, Vellore, India
| | - Bipin N Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Celalettin Ustun
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - David I Marks
- Bristol Adult BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom
| | - Edmund K Waller
- Bone Marrow and Stem Cell Transplant Center, Emory University Hospital, Atlanta, Georgia
| | - Frédéric Baron
- Universitaire de Liege, Centre Hospitalier Universitaire - Sart-Tilman, Liege, Belgium
| | - César O Freytes
- Department of Hematopoietic Stem Cell Transplant Program, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Gérard Socie
- Service d'Hematologie, Hopital Saint Louis, Paris, France
| | - Gorgun Akpek
- SCTCT Program, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Harry C Schouten
- Division of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Edwin M Horwitz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John Koreth
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Martin Bornhauser
- Medizinische Klinik und Poliklinik I, Universitatsklinikum Carl Gustav Carus, Dresden, Germany
| | - Matthew Seftel
- Department of Hematology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mitchell S Cairo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York
| | - Mary J Laughlin
- Hematopoietic Cell Transplantation Program, University of Virginia, Charlottesville, Virginia
| | - Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Olle Ringdén
- Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Peter Gale
- Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, United Kingdom
| | - Rammurti T Kamble
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Ravi Vij
- Washington University School of Medicine, St. Louis, Missouri
| | - Usama Gergis
- Weill Cornell Medical College, New York, New York
| | - Vikram Mathews
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yi-Bin Chen
- Department of BMT, Massachusetts General Hospital, Boston, Massachusetts
| | - Jane L Liesveld
- Department of Hematology/Oncology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Corey S Cutler
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Armin Ghobadi
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Geoffrey L Uy
- Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, United Kingdom
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel J Weisdorf
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mark R Litzow
- Department of Hematology and Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota
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Cudmore J, Seftel M, Sisler J, Zarychanski R. Methotrexate and trimethoprim-sulfamethoxazole: toxicity from this combination continues to occur. Can Fam Physician 2014; 60:53-56. [PMID: 24452563 PMCID: PMC3994806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Jessica Cudmore
- University of Manitoba, Faculty of Medicine, 260-727 McDermot Ave, Winnipeg, MB R3E 3P5.
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Copelan EA, Hamilton BK, Avalos B, Ahn KW, Bolwell BJ, Zhu X, Aljurf M, van Besien K, Bredeson C, Cahn JY, Costa LJ, de Lima M, Gale RP, Hale GA, Halter J, Hamadani M, Inamoto Y, Kamble RT, Litzow MR, Loren AW, Marks DI, Olavarria E, Roy V, Sabloff M, Savani BN, Seftel M, Schouten HC, Ustun C, Waller EK, Weisdorf DJ, Wirk B, Horowitz MM, Arora M, Szer J, Cortes J, Kalaycio ME, Maziarz RT, Saber W. Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI. Blood 2013; 122:3863-70. [PMID: 24065243 PMCID: PMC3854108 DOI: 10.1182/blood-2013-07-514448] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/17/2013] [Indexed: 11/20/2022] Open
Abstract
Cyclophosphamide combined with total body irradiation (Cy/TBI) or busulfan (BuCy) are the most widely used myeloablative conditioning regimens for allotransplants. Recent data regarding their comparative effectiveness are lacking. We analyzed data from the Center for International Blood and Marrow Transplant Research for 1230 subjects receiving a first hematopoietic cell transplant from a human leukocyte antigen-matched sibling or from an unrelated donor during the years 2000 to 2006 for acute myeloid leukemia (AML) in first complete remission (CR) after conditioning with Cy/TBI or oral or intravenous (IV) BuCy. Multivariate analysis showed significantly less nonrelapse mortality (relative risk [RR] = 0.58; 95% confidence interval [CI]: 0.39-0.86; P = .007), and relapse after, but not before, 1 year posttransplant (RR = 0.23; 95% CI: 0.08-0.65; P = .006), and better leukemia-free survival (RR = 0.70; 95% CI: 0.55-0.88; P = .003) and survival (RR = 0.68; 95% CI: 0.52-0.88; P = .003) in persons receiving IV, but not oral, Bu compared with TBI. In combination with Cy, IV Bu is associated with superior outcomes compared with TBI in patients with AML in first CR.
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Affiliation(s)
- Edward A Copelan
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC
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Abstract
Non-Hodgkin Lymphoma (NHL) occurs worldwide although there is notable geographical variation in incidence and subtype distribution. These differences are due to a combination of demographic, environmental and other unidentified factors. A dramatic increase in NHL incidence was seen starting around 1970, with subsequent stabilization 10 years ago. Despite this plateau, the number of new cases in many countries will increase significantly in coming years due primarily to aging populations. In the majority of cases, strong risk factors are not identifiable. There is significant epidemiological heterogeneity between NHL subtypes, yet cancer registries have tended to consider NHL as a single entity. This is one of several epidemiological obstacles discussed.
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Affiliation(s)
- Pamela Skrabek
- Department of Medical Oncology and Haematology, CancerCare Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Canada.
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Kumar R, Skrabek P, Sethukavalar S, Burns P, Lozar B, Bucher O, Lambert P, Bourrier V, Szwajcer D, Seftel M, Houston D, Navaratnam S. P-298 A prospective “real-world” study of the use and effectiveness of azacitidine in a Canadian province with a flexible dosing schedule. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70345-x] [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: 10/26/2022]
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Freytes CO, Zhang MJ, Carreras J, Burns LJ, Gale RP, Isola L, Perales MA, Seftel M, Vose JM, Miller AM, Gibson J, Gross TG, Rowlings PA, Inwards DJ, Pavlovsky S, Martino R, Marks DI, Hale GA, Smith SM, Schouten HC, Slavin S, Klumpp TR, Lazarus HM, van Besien K, Hari PN. Outcome of lower-intensity allogeneic transplantation in non-Hodgkin lymphoma after autologous transplantation failure. Biol Blood Marrow Transplant 2011; 18:1255-64. [PMID: 22198543 DOI: 10.1016/j.bbmt.2011.12.581] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 12/16/2011] [Indexed: 11/27/2022]
Abstract
We studied the outcome of allogeneic hematopoietic stem cell transplantation after lower-intensity conditioning regimens (reduced-intensity conditioning and nonmyeloablative) in patients with non-Hodgkin lymphoma who relapsed after autologous hematopoietic stem cell transplantation. Nonrelapse mortality, lymphoma progression/relapse, progression-free survival (PFS), and overall survival were analyzed in 263 patients with non-Hodgkin lymphoma. All 263 patients had relapsed after a previous autologous hematopoietic stem cell transplantation and then had undergone allogeneic hematopoietic stem cell transplantation from a related (n = 26) or unrelated (n = 237) donor after reduced-intensity conditioning (n = 128) or nonmyeloablative (n = 135) and were reported to the Center for International Blood and Marrow Transplant Research between 1996 and 2006. The median follow-up of survivors was 68 months (range, 3-111 months). Three-year nonrelapse mortality was 44% (95% confidence interval [CI], 37%-50%). Lymphoma progression/relapse at 3 years was 35% (95% CI, 29%-41%). Three-year probabilities of PFS and overall survival were 21% (95% CI, 16%-27%) and 32% (95% CI, 27%-38%), respectively. Superior Karnofsky Performance Score, longer interval between transplantations, total body irradiation-based conditioning regimen, and lymphoma remission at transplantation were correlated with improved PFS. Allogeneic hematopoietic stem cell transplantation after lower-intensity conditioning is associated with significant nonrelapse mortality but can result in long-term PFS. We describe a quantitative risk model based on pretransplantation risk factors to identify those patients likely to benefit from this approach.
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Affiliation(s)
- César O Freytes
- South Texas Veterans Health Care System/University of Texas Health Science Center, San Antonio, TX, USA
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Kumar R, Richardson E, Khair H, Paulson K, Szwajcer D, Seftel M, Rubinger M, Musuka C, Wall D. Allogeneic Hematopoietic Stem Cell Transplantation (alloHSCT) is Underutilized in Myelodysplastic Syndrome (MDS): a Population-Based Canadian Province Experience. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Saeed M, Paulson K, Lambert P, Szwajcer D, Seftel M. Publication bias in blood and marrow transplantation. Biol Blood Marrow Transplant 2010; 17:930-4. [PMID: 21130176 DOI: 10.1016/j.bbmt.2010.11.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
Only a small proportion of abstracts lead to full publication. Abstracts with "positive" results are more likely to be published than other abstracts, leading to publication bias. To date, this issue has not been examined in the blood and marrow transplantation (BMT) literature. We hypothesized that because BMT centers are often based at academic centers, the proportion of abstracts leading to publication will be high. All abstracts presented at the Canadian Blood and Marrow Transplant Group biannual meetings in 2002, 2004, and 2006 were reviewed and categorized by study type, funding source, single-center or multicenter study, form of presentation, and positive or negative results, using the authors' definitions. To determine publication, each reference was searched on multiple databases (MEDLINE, EMBASE, Web of Science, and CINAHL) by first, second, and final author names. Two authors performed abstract categorization and searching, and disagreements were resolved by consensus. Of the 141 abstracts reviewed, only 43 were published (30.4%). Twenty-one studies were published from 2002 (36.8%), compared with 12 from 2004 (24.0%) and 10 from 2006 (29.4%) (P = .35). Neither positive results nor the number of involved centers were associated with the likelihood of publication. Clinical studies (retrospective or prospective) were more likely to be published than nonclinical studies (P = .014). Funded studies and oral presentations were more likely to be published (P = .009 and .004, respectively). A low rate of publication is seen in the field of BMT. Studies with clinical outcomes, externally funded studies, and studies presented orally were more likely to be published. However, there was no publication bias in favor of studies with positive results. Publication bias should be evaluated further at larger BMT meetings, and efforts should be made to encourage full publication of scientific abstracts.
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Affiliation(s)
- Mahwash Saeed
- Section of Hematology/Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba
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Hari PN, Majhail NS, Zhang MJ, Hassebroek A, Siddiqui F, Ballen K, Bashey A, Bird J, Freytes CO, Gibson J, Hale G, Holmberg L, Kamble R, Kyle RA, Lazarus HM, LeMaistre CF, Loberiza F, Maiolino A, McCarthy PL, Milone G, Omondi N, Reece DE, Seftel M, Trigg M, Vesole D, Weiss B, Wiernik P, Lee SJ, Rizzo JD, Mehta P. Race and outcomes of autologous hematopoietic cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 2009; 16:395-402. [PMID: 19922808 DOI: 10.1016/j.bbmt.2009.11.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 11/08/2009] [Indexed: 12/22/2022]
Abstract
Blacks are twice as likely to develop and die from multiple myeloma (MM), and are less likely to receive an autologous hematopoietic-cell transplant (AHCT) for MM compared to Whites. The influence of race on outcomes of AHCT for MM is not well described. We compared the probability of overall survival (OS), progression-free survival (PFS), disease progression, and nonrelapse mortality (NRM) among Black (N=303) and White (N=1892) recipients of AHCT for MM, who were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1995 to 2005. The Black cohort was more likely to be female, and had better Karnofsky performance scores, but lower hemoglobin and albumin levels at diagnosis. Black recipients were younger and more likely to be transplanted later in their disease course. Disease stage and treatment characteristics prior to AHCT were similar between the 2 groups. Black and White recipients had similar probabilities of 5-year OS (52% versus 47%, P=.19) and PFS (19% versus 21%, P=.64) as well as cumulative incidences of disease progression (72% versus 72%, P=.97) and NRM (9% versus 8%, P=.52). In multivariate analyses, race was not associated with any of these endpoints. Black recipients of AHCT for MM have similar outcomes compared to Whites, suggesting that the reasons underlying lower rates of AHCT in Blacks need to be studied further to ensure equal access to effective therapy.
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Affiliation(s)
- Parameswaran N Hari
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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Smith SM, van Besien K, Carreras J, Bashey A, Cairo MS, Freytes CO, Gale RP, Hale GA, Hayes-Lattin B, Holmberg LA, Keating A, Maziarz RT, McCarthy PL, Navarro WH, Pavlovsky S, Schouten HC, Seftel M, Wiernik PH, Vose JM, Lazarus HM, Hari P. Second autologous stem cell transplantation for relapsed lymphoma after a prior autologous transplant. Biol Blood Marrow Transplant 2008; 14:904-12. [PMID: 18640574 DOI: 10.1016/j.bbmt.2008.05.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
Abstract
We determined treatment-related mortality, progression-free survival (PFS), and overall survival (OS) after a second autologous HCT (HCT2) for patients with lymphoma relapse after a prior HCT (HCT1). Outcomes for patients with either Hodgkin lymphoma (HL, n = 21) or non-Hodgkin lymphoma (NHL, n = 19) receiving HCT2 reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) were analyzed. The median age at HCT2 was 38 years (range: 16-61) and 22 (58%) patients had a Karnofsky performance score <90. HCT2 was performed >1 year after HCT1 in 82%. The probability of treatment-related mortality at day 100 was 11% (95% confidence interval [CI], 3%-22%). The 1-, 3-, and 5-year probabilities of PFS were 50% (95% CI, 34%-66%), 36% (95% CI, 21%-52%), and 30% (95% CI, 16%-46%), respectively. Corresponding probabilities of survival were 65% (95% CI, 50%-79%), 36% (95% CI, 22%-52%), and 30% (95% CI, 17%-46%), respectively. At a median follow-up of 72 months (range: 12-124 months) after HCT2, 29 patients (73%) have died, 18 (62%) secondary to relapsed lymphoma. The outcomes of patients with HL and NHL were similar. In summary, this series represents the largest reported group of patients with relapsed lymphomas undergoing SCT2 following failed SCT1, and with long-term follow-up. Our series suggests that SCT2 is feasible in patients relapsing after prior HCT1, with a lower treatment-related mortality than that reported for allogeneic transplant in this setting. HCT2 should be considered for patients with relapsed HL or NHL after HCT1 without alternative allogeneic stem cell transplant options.
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Affiliation(s)
- Sonali M Smith
- Department of Medicine, The University of Chicago, Chicago, Illinois 60637, USA.
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Seftel M, Rubinger M. The role of hematopoietic stem cell transplantation in advanced Hodgkin Lymphoma. Transfus Apher Sci 2007; 37:49-56. [PMID: 17716946 DOI: 10.1016/j.transci.2007.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 04/11/2007] [Accepted: 04/24/2007] [Indexed: 11/17/2022]
Abstract
Primary therapy of Hodgkin Lymphoma is generally successful. However, for the relatively small numbers of patients with relapsed or primary progressive disease, outcomes are not optimal. It is now recognized that high dose chemotherapy and autoSCT may be curative in a proportion of these patients. Nevertheless, survival even following autoSCT remains unsatisfactory, with relapse remaining the major concern. In particular, patients with primary progressive disease, those who fail to respond to salvage therapy, and those who are ineligible for autoSCT carry a relatively poor prognosis. In these groups of patients, clinical trials are examining tandem autologous stem cell transplantation or reduced intensity allogeneic transplantation. The latter procedure is promising in terms of its relatively low toxicities and its possibility of inciting a Graft-versus-Hodgkin Lymphoma effect. Further prospective clinical trials are required to clarify the role of allogeneic transplantation in poor risk Hodgkin Lymphoma.
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Affiliation(s)
- Matthew Seftel
- Department of Internal Medicine, Section of Hematology, University of Manitoba, Canada.
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Doocey R, Seftel M, Barnett M, Bredeson C, Forrest D, Hogge D, Lavoie J, Nantel S, Nevill T, Shepherd J, Sutherland H, Toze C, Smith C, Song K. Autologous stem cell transplantation for poor prognosis germ cell tumors: Long term follow-up of a multi-center experience. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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