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Wang SY, Scurti GM, Dalheim AV, Quinn S, Stiff PJ, Nishimura MI. Nonactivated and IL-7 cultured CD19-specific CAR T cells are enriched in stem cell phenotypes and functionally superior. Blood Adv 2024; 8:324-335. [PMID: 37967375 PMCID: PMC10788799 DOI: 10.1182/bloodadvances.2023010607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/17/2023] Open
Abstract
ABSTRACT CD19-specific chimeric antigen receptor (CAR) T cells have demonstrated impressive responses in patients with relapsed and refractory B cell malignancies. However, many patients relapse or fail to respond to CD19 CAR T cells, demonstrating the need to improve its efficacy and durability. Current protocols for generating CAR T cells involve T cell activation through CD3 stimulation to facilitate efficient CAR transfer followed by ex vivo expansion with exogenous cytokines to obtain adequate cell numbers for treatment. Both T cell activation and expansion inevitably lead to terminal differentiation and replicative senescence, which are suboptimal for therapy. Interleukin-7 (IL-7) was previously shown to allow for lentiviral transduction of T cells in the absence of activation. In these studies, we used IL-7 to generate CD19 CAR T cells without stimulating CD3. Nonactivated and IL-7 cultured (NICE) CD19 CAR T cells were enriched with the T memory stem cell population, retained novel markers of stemness, had lower expression of exhaustion markers, and increased proliferative potential. Furthermore, our findings are consistent with engraftment of NICE CD19 CAR T cells and demonstrate a superior therapeutic response in both intraperitoneal and subcutaneous in vivo B cell lymphoma models. These results suggest that NICE CD19 CAR T cells may improve outcomes for B cell malignancies and warrant clinical evaluation.
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Affiliation(s)
- Siao-Yi Wang
- Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Gina M. Scurti
- Department of Surgery, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Annika V. Dalheim
- Department of Surgery, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Suzanne Quinn
- Department of Surgery, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Patrick J. Stiff
- Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Michael I. Nishimura
- Department of Surgery, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
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Stiff PJ, Mehrotra S, Potkul RK, Banerjee S, Walker C, Drakes ML. Selinexor in Combination with Decitabine Attenuates Ovarian Cancer in Mice. Cancers (Basel) 2023; 15:4541. [PMID: 37760508 PMCID: PMC10526280 DOI: 10.3390/cancers15184541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND High-grade serous ovarian cancer is a lethal gynecologic disease. Conventional therapies, such as platinum-based chemotherapy, are rendered inadequate for disease management as most advanced disease patients develop resistance to this therapy and soon relapse, leading to poor prognosis. Novel immunotherapy and targeted therapy are currently under investigation as treatment options for ovarian cancer, but so far with little success. Epigenetic changes, such as aberrant DNA methylation, have been reported in resistance to platinum-based therapy. Decitabine is a hypomethylating agent which is effective against platinum-resistant disease and also exhibits several anti-tumor immune functions. Selinexor is a selective inhibitor of nuclear protein export. It restored platinum sensitivity in patient-derived ovarian cancer cell lines and is currently in clinical trials for the treatment of platinum-resistant ovarian cancer. We hypothesized that these two agents used in combination could elicit more potent anti-tumor immune responses in vivo than either agent used alone. METHODS These studies were designed to investigate the efficacy of these two agents used in combination to treat ovarian cancer by assessing murine models for changes in disease pathology and in anti-tumor responses. RESULTS Decitabine priming followed by selinexor treatment significantly limited ascites formation and tumor size. This combination of agents also promoted T cell effector function as measured by granzyme B secretion. Treatment of mice with decitabine and selinexor led to the significant release of a broader range of macrophage and T cell cytokines and chemokines above control PBS and vehicle and above decitabine or selinexor treatment alone. CONCLUSIONS These results reveal crucial information for the design of clinical trials which may advance therapy outcomes in ovarian cancer.
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Affiliation(s)
- Patrick J. Stiff
- Cardinal Bernardin Cancer Center, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | | | - Ronald K. Potkul
- Department of Obstetrics and Gynecology, Loyola University Chicago, Maywood, IL 60153, USA
| | - Swarnali Banerjee
- Department of Mathematics and Statistics, Loyola University Chicago, Chicago, IL 60660, USA
| | | | - Maureen L. Drakes
- Cardinal Bernardin Cancer Center, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
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3
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Shah BD, Cassaday RD, Park JH, Houot R, Oluwole OO, Logan AC, Boissel N, Leguay T, Bishop MR, Topp MS, Tzachanis D, O'Dwyer KM, Arellano ML, Lin Y, Baer MR, Schiller GJ, Subklewe M, Abedi M, Minnema MC, Wierda WG, DeAngelo DJ, Stiff PJ, Jeyakumar D, Mao D, Adhikary S, Zhou L, Schuberth PC, Damico Khalid R, Ghobadia A. Impact of prior therapies and subsequent transplantation on outcomes in adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia treated with brexucabtagene autoleucel in ZUMA-3. J Immunother Cancer 2023; 11:e007118. [PMID: 37648261 PMCID: PMC10471850 DOI: 10.1136/jitc-2023-007118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Brexucabtagene autoleucel (brexu-cel) is an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy approved in the USA for adults with relapsed or refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL) and in the European Union for patients ≥26 years with R/R B-ALL. After 2 years of follow-up in ZUMA-3, the overall complete remission (CR) rate (CR+CR with incomplete hematological recovery (CRi)) was 73%, and the median overall survival (OS) was 25.4 months in 78 Phase 1 and 2 patients with R/R B-ALL who received the pivotal dose of brexu-cel. Outcomes by prior therapies and subsequent allogeneic stem cell transplantation (alloSCT) are reported. METHODS Eligible adults had R/R B-ALL and received one infusion of brexu-cel (1×10⁶ CAR T cells/kg) following conditioning chemotherapy. The primary endpoint was the CR/CRi rate per central review. Post hoc subgroup analyses were exploratory with descriptive statistics provided. RESULTS Phase 1 and 2 patients (N=78) were included with median follow-up of 29.7 months (range, 20.7-58.3). High CR/CRi rates were observed across all prior therapy subgroups examined: 1 prior line of therapy (87%, n=15) and ≥2 prior lines (70%, n=63); prior blinatumomab (63%, n=38) and no prior blinatumomab (83%, n=40); prior inotuzumab (59%, n=17) and no prior inotuzumab (77%, n=61); and prior alloSCT (76%, n=29) and no prior alloSCT (71%, n=49). The frequency of Grade ≥3 cytokine release syndrome, neurological events, and treatment-related Grade 5 adverse events were largely similar among prior therapy subgroups.Median duration of remission (DOR) in responders with (n=14) and without (n=43) subsequent alloSCT was 44.2 (95% CI, 8.1 to not estimable (NE)) and 18.6 months (95% CI, 9.4 to NE); median OS was 47.0 months (95% CI, 10.2 to NE) and not reached (95% CI, 23.2 to NE), respectively. Median DOR and OS were not reached in responders without prior or subsequent alloSCT (n=22). CONCLUSIONS In ZUMA-3, adults with R/R B-ALL benefited from brexu-cel, regardless of prior therapies and subsequent alloSCT status, though survival appeared better in patients without certain prior therapies and in earlier lines of therapy. Additional studies are needed to determine the impact prior therapies and subsequent alloSCT have on outcomes of patients who receive brexu-cel.
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Affiliation(s)
- Bijal D Shah
- Division of Hematology/Oncology, Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Ryan D Cassaday
- Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington, USA
| | - Jae H Park
- Department of Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roch Houot
- Department of Hematology, CHU Rennes, University Hospital Rennes, Inserm & EFS, Rennes, France
| | - Olalekan O Oluwole
- Vanderbilt-Ingram Cancer Center, Division of Hematology and Oncology, Vanderbilt University, Nashville, Tennessee, USA
| | - Aaron C Logan
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Nicolas Boissel
- Département d'Hématologie Clinique, Hôpital Saint-Louis, Paris, France
| | - Thibaut Leguay
- Department of Hematology, Service d'hématologie clinique et thérapie cellulaire Hôpital du Haut-Leveque CHU de Bordeaux, Bordeaux, France
| | - Michael R Bishop
- The David and Etta Jonas Center for Cellular Therapy, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Wurzburg, Germany
| | - Dimitrios Tzachanis
- Moores Cancer Center, University of California San Diego, San Diego, California, USA
| | - Kristen M O'Dwyer
- Wilmot Cancer Institute, University of Rochester, Rochester, New York, USA
| | | | - Yi Lin
- Department of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria R Baer
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland, USA
| | - Gary J Schiller
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Marion Subklewe
- Department of Medicine III, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mehrdad Abedi
- Davis Comprehensive Cancer Center, University of California, Sacramento, California, USA
| | - Monique C Minnema
- Department of Hematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - William G Wierda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Patrick J Stiff
- Department of Hematology/Oncology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Deepa Jeyakumar
- Chao Comprehensive Cancer Center, University of California Irvine Medical Center, Irvine, California, USA
| | - Daqin Mao
- Kite, a Gilead Company, Santa Monica, California, USA
| | | | - Lang Zhou
- Kite, a Gilead Company, Santa Monica, California, USA
| | | | | | - Armin Ghobadia
- Division of Medical Oncology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
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4
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Lin C, Sajeev G, Stiff PJ, Brunstein CG, Cutler C, Sanz G, Lindemans CA, Rezvani AR, Hanna R, Koh LP, Maziarz RT, Hwang WYK, Song Y, Liu Q, Manghani R, Sivaraman S, Signorovitch J, Horwitz ME, Sung AD. Health-Related Quality of Life Following Allogeneic Hematopoietic Cell Transplantation with Omidubicel versus Umbilical Cord Blood. Transplant Cell Ther 2023; 29:52.e1-52.e9. [PMID: 36179986 PMCID: PMC9825638 DOI: 10.1016/j.jtct.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/23/2022] [Indexed: 01/11/2023]
Abstract
Omidubicel is an advanced cell therapy derived from umbilical cord blood (UCB) for use in allogeneic hematopoietic cell transplantation (HCT). A recent randomized phase 3 clinical trial demonstrated faster engraftment, shorter length of hospital stays, and lower rates of infection with omidubicel compared with standard UCB transplantation in patients with high-risk hematologic malignancies. Despite the proven clinical benefits of omidubicel, its impact on health-related quality of life (HRQL) from the patient's perspective has not been described. This study analyzed patient-reported HRQL measures collected prospectively in the randomized phase 3 trial comparing omidubicel to standard UCB transplantation. A total of 108 patients at 33 international stem cell transplantation centers underwent myeloablative allogeneic HCT with either omidubicel or standard UCB. Patients completed serial HRQL questionnaires at screening and on days 42, 100, 180, and 365 post-transplantation. The HRQL surveys included the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), a 50-item cancer-specific questionnaire assessing physical, functional, emotional, social/family, and HCT-specific well-being, and the EuroQol 5-Dimension 3-Level, a 5-item generic HRQL survey. A mixed model with repeated measures was used to compare changes in HRQL from baseline in the 2 treatment arms. The average change in HRQL scores over time was compared by estimating the difference in the area under the curve (AUC) in each treatment group. Seventy-five patients (omidubicel arm, n = 37; standard UCB arm, n = 38) who completed the FACT-BMT at baseline and on 1 or more follow-up visits were included in this study. Baseline characteristics were similar in the 2 treatment arms. Over the first year post-transplantation, the AUCs of mean changes in physical, functional, and total FACT-BMT scores indicated significantly better HRQL with omidubicel (P < .05), with mean differences across time points ranging from 1.4 to 3.1 points, 1.6 to 3.2 points, and 7.2 to 11.0 points, respectively. The minimal clinically important difference was exceeded at 1 or more time points for each of these measures. The HRQL improvements with omidubicel were observed as early as 42 days post-transplantation and persisted at 1 year, indicating the potential long-term benefits of omidubicel on HRQL. Across all patients, adverse clinical outcomes, such as grade 3 viral infections and lower rates of neutrophil engraftment, were associated with worse HRQL scores. The observed improvements in HRQL measures may reflect the known clinical benefits of omidubicel. Compared with standard UCB, allogeneic HCT with omidubicel resulted in significant and clinically meaningful improvements in patient-reported HRQL measures.
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Affiliation(s)
- Chenyu Lin
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | | | - Patrick J Stiff
- Division of Hematology and Oncology, Loyola University Medical Center, Chicago, Illinois
| | - Claudio G Brunstein
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota; Department of Hematology and Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Corey Cutler
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Guillermo Sanz
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CICERONC, Instituto de Salud Carlos III, Madrid, Spain; IIS La Fe, Valencia, Spain
| | - Caroline A Lindemans
- Department of Pediatric Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, California
| | - Rabi Hanna
- Department of Pediatric Hematology Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Liang Piu Koh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Richard T Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - William Y K Hwang
- Department of Haematology, National Cancer Centre Singapore; Department of Haematology, Singapore General Hospital; Cancer and Stem Cell Biology, Duke-NUS Medical School
| | - Yan Song
- Analysis Group, Inc, Boston, Massachusetts
| | - Qing Liu
- Analysis Group, Inc, Boston, Massachusetts
| | | | | | | | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina.
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5
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de Koning C, Tao W, Lacna A, van Veghel K, Horwitz ME, Sanz G, Jagasia MH, Wagner JE, Stiff PJ, Hanna R, Cilloni D, Valcárcel D, Peled T, Galamidi Cohen E, Goshen U, Pandit A, Lindemans CA, Jan Boelens J, Nierkens S. Lymphoid and myeloid immune cell reconstitution after nicotinamide-expanded cord blood transplantation. Bone Marrow Transplant 2021; 56:2826-2833. [PMID: 34312498 PMCID: PMC8563413 DOI: 10.1038/s41409-021-01417-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Omidubicel (nicotinamide-expanded cord blood) is a potential alternative source for allogeneic hematopoietic cell transplantation (HCT) when an HLA-identical donor is lacking. A phase I/II trial with standalone omidubicel HCT showed rapid and robust neutrophil and platelet engraftment. In this study, we evaluated the immune reconstitution (IR) of patients receiving omidubicel grafts during the first 6 months post-transplant, as IR is critical for favorable outcomes of the procedure. Data was collected from the omidubicel phase I-II international, multicenter trial. The primary endpoint was the probability of achieving adequate CD4+ T-cell IR (CD4IR: > 50 × 106/L within 100 days). Secondary endpoints were the recovery of T-cells, natural killer (NK)-cells, B-cells, dendritic cells (DC), and monocytes as determined with multicolor flow cytometry. LOESS-regression curves and cumulative incidence plots were used for data description. Thirty-six omidubicel recipients (median 44; 13-63 years) were included, and IR data was available from 28 recipients. Of these patients, 90% achieved adequate CD4IR. Overall, IR was complete and consisted of T-cell, monocyte, DC, and notably fast NK- and B-cell reconstitution, compared to conventional grafts. Our data show that transplantation of adolescent and adult patients with omidubicel results in full and broad IR, which is comparable with IR after HCT with conventional graft sources.
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Affiliation(s)
- Coco de Koning
- University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Weiyang Tao
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amelia Lacna
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Guillermo Sanz
- Hospital Universitario y Politécnico la Fe, València, Spain
- Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Caroline A Lindemans
- University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jaap Jan Boelens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefan Nierkens
- University Medical Center Utrecht, Utrecht, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
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Riedell PA, Hamadani M, Ahn KW, Litovich C, Murthy GSG, Locke FL, Brunstein CG, Merryman RW, Stiff PJ, Pawarode A, Nishihori T, Kharfan-Dabaja MA, Herrera AF, Sauter CS, Smith SM. Outcomes and Utilization Trends of Front-Line Autologous Hematopoietic Cell Transplantation for Mantle Cell Lymphoma. Transplant Cell Ther 2021; 27:911.e1-911.e7. [PMID: 34450333 PMCID: PMC8556305 DOI: 10.1016/j.jtct.2021.08.014] [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: 07/02/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Although autologous hematopoietic cell transplantation (auto-HCT) has become a common practice for eligible patients in the front-line setting with mantle cell lymphoma (MCL), there are limited data regarding trends in auto-HCT utilization and associated outcomes. This study used the Center for International Blood and Marrow Transplant Research (CIBMTR) database to evaluate survival outcomes and auto-HCT utilization in adults age ≥18 years who underwent auto-HCT within 12 months of diagnosis of MCL between January 2000 and December 2018. The 19-year period from 2000 to 2018 was divided into 4 separate intervals-2000 to 2004, 2005 to 2009, 2010 to 2014, and 2015 to 2018-and encompassed 5082 patients. To evaluate transplantation utilization patterns, we combined MCL incidence derived from the SEER 21 database with CIBMTR- reported auto-HCT activity within 12 months of diagnosis of MCL. Primary outcomes included overall survival (OS) along with the auto-HCT utilization rate. The cumulative incidence of nonrelapse mortality at 1 year decreased from 7% in the earliest cohort (2000 to 2004) to 2% in the latest cohort (2015 to 2018). Mirroring this trend, OS outcomes improved continually with time, with a 3-year OS of 72% in the earliest cohort improving to 86% in the latest cohort. In addition, we noted an increase in auto-HCT utilization from 2001 to 2018, particularly in patients age ≤65 years. This large retrospective analysis highlights trends in auto-HCT utilization and outcomes in patients with MCL and emphasizes the need to optimize pretransplantation and post-transplantation treatment strategies to enhance survival outcomes.
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Affiliation(s)
- Peter A Riedell
- Division of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Kwang W Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carlos Litovich
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Claudio G Brunstein
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Reid W Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Masachusetts
| | - Patrick J Stiff
- Division of Hematology-Oncology, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sonali M Smith
- Division of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois
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7
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Riedell PA, Hamadani M, Ahn KW, Litovich C, Brunstein CG, Cashen AF, Cohen JB, Epperla N, Hill BT, Im A, Inwards DJ, Lister J, McCarty JM, Ravi Kiran Pingali S, Shadman M, Shaughnessy P, Solh M, Stiff PJ, Vose JM, Kharfan-Dabaja MA, Herrera AF, Sauter CS, Smith SM. Effect of time to relapse on overall survival in patients with mantle cell lymphoma following autologous haematopoietic cell transplantation. Br J Haematol 2021; 195:757-763. [PMID: 34581433 DOI: 10.1111/bjh.17865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
In young and fit patients with mantle cell lymphoma (MCL), intensive induction therapy followed by a consolidative autologous haematopoietic cell transplant (autoHCT) is the standard of care in the front-line setting. Recently, time-to-event analysis has emerged as an important risk assessment tool in lymphoma, though its impact in MCL is not well defined. We utilized the Center for International Blood and Marrow Transplant Research database to evaluate the effect of post-autoHCT time to relapse on overall survival (OS) over time in 461 patients who underwent autoHCT within 12 months of MCL diagnosis. On multivariate analysis, the impact of relapse on OS was greatest at the six-month [hazard ratio (HR) = 7·68], 12-month (HR = 6·68), and 18-month (HR = 5·81) landmark timepoints. Using a dynamic landmark model we demonstrate that adjusted OS at five years following each landmark timepoint improved with time for relapsing and non-relapsing patients. Furthermore, early relapse (<18 months) following autoHCT defines a high-risk group with inferior post-relapse OS. This retrospective analysis highlights the impact of time to relapse on OS in MCL patients undergoing up-front autoHCT and emphasizes the need to consider novel therapeutic approaches for patients suffering early relapse.
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Affiliation(s)
- Peter A Riedell
- Division of Hematology and Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Mehdi Hamadani
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.,BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kwang W Ahn
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carlos Litovich
- Department of Medicine, CIBMTR® (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Claudio G Brunstein
- Department of Medicine, Adult Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - Amanda F Cashen
- Division of Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Annie Im
- Division of Hematology/Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - John Lister
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - John M McCarty
- Bone Marrow Transplant Program, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Medical Oncology Division, University of Washington, Seattle, WA, USA
| | - Paul Shaughnessy
- Sarah Cannon Transplant and Cellular Therapy Program Methodist Hospital, San Antonio, TX, USA
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA
| | - Patrick J Stiff
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Julie M Vose
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Craig S Sauter
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA
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8
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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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9
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Desai PM, Brown J, Gill S, Solh MM, Akard LP, Hsu JW, Ustun C, Andreadis C, Frankfurt O, Foran JM, Lister J, Schiller GJ, Wieduwilt MJ, Pagel JM, Stiff PJ, Liu D, Khan I, Stock W, Kambhampati S, Tallman MS, Morris L, Edwards J, Pusic I, Kantarjian HM, Mamelok R, Wong A, Van Syoc R, Kellerman L, Panuganti S, Mandalam R, Abboud CN, Ravandi F. Open-Label Phase II Prospective, Randomized, Controlled Study of Romyelocel-L Myeloid Progenitor Cells to Reduce Infection During Induction Chemotherapy for Acute Myeloid Leukemia. J Clin Oncol 2021; 39:3261-3272. [PMID: 34156898 PMCID: PMC8500663 DOI: 10.1200/jco.20.01739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Standard cytotoxic induction chemotherapy for acute myeloid leukemia (AML) results in prolonged neutropenia and risk of infection. Romyelocel-L is a universal, allogeneic myeloid progenitor cell product being studied to reduce infection during induction chemotherapy. PATIENTS AND METHODS One hundred sixty-three patients with de novo AML (age ≥ 55 years) receiving induction chemotherapy were randomly assigned on day 0 (d0), of whom 120 were evaluable. Subjects received either romyelocel-L infusion on d9 with granulocyte colony-stimulating factor (G-CSF) starting daily d14 (treatment group) or G-CSF daily alone on d14 (control) until absolute neutrophil count recovery to 500/µL. End points included days in febrile episode, microbiologically defined infections, clinically diagnosed infection, and days in hospital. RESULTS Mean days in febrile episode was shorter in the treatment arm from d15 through d28 (2.36 v 3.90; P = .02). Similarly, a trend toward decreased microbiologically defined infections and clinically diagnosed infection in the treatment arm was observed from d9 to d28 (35.6% v 47.5%; P = .09), reaching a statistically significant difference from d15 to d28 (6.8% v 27.9%; P = .002). Because of this, antibacterial or antifungal use for treatment of an infection was significantly less in the treatment group (d9-d28: 44.1% v 63.9%; P = .01). Significantly fewer patients in the treatment arm received empiric antifungals from d9 tod28 (42.4% v 63.9%; P = .02) and d15-d28 (42.4% v 62.3%; P = .02). Patients in the treatment arm also had 3.2 fewer hospital days compared with control (25.5 v 28.7; P = .001). Remission rates and days to absolute neutrophil count recovery were similar in the two groups. No patients in the romyelocel-L plus G-CSF group died because of infection compared with two patients in the control arm. No graft-versus-host disease was observed. CONCLUSION Subjects receiving romyelocel-L showed a decreased incidence of infections, antimicrobial use, and hospitalization, suggesting that romyelocel-L may provide a new option to reduce infections in patients with AML undergoing induction therapy.
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Affiliation(s)
| | - Janice Brown
- Stanford University Medical Center, Stanford, CA
| | - Saar Gill
- University of Pennsylvania, Philadelphia, PA
| | | | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, IN
| | | | | | | | | | | | | | | | | | | | | | | | - Irum Khan
- University of Illinois Cancer Center, Chicago, IL
| | | | | | | | | | - John Edwards
- Indiana Blood and Marrow Transplantation, Indianapolis, IN
| | | | | | | | | | | | | | | | | | | | - Farhad Ravandi
- The University of Texas MD Anderson Cancer Center, Houston, TX
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10
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Hossain NM, Stiff PJ. Expanding the Toolbox of Adoptive Cell Immunotherapy. J Clin Oncol 2021; 39:1479-1482. [PMID: 33764792 DOI: 10.1200/jco.21.00295] [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: 11/20/2022] Open
Affiliation(s)
- Nasheed M Hossain
- Division of Hematology-Oncology, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, IL
| | - Patrick J Stiff
- Division of Hematology-Oncology, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, IL
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11
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Chemaly RF, Dadwal SS, Bergeron A, Ljungman P, Kim YJ, Cheng GS, Pipavath SN, Limaye AP, Blanchard E, Winston DJ, Stiff PJ, Zuckerman T, Lachance S, Rahav G, Small CB, Mullane KM, Patron RL, Lee DG, Hirsch HH, Waghmare A, McKevitt M, Jordan R, Guo Y, German P, Porter DP, Gossage DL, Watkins TR, Marty FM, Chien JW, Boeckh M. A Phase 2, Randomized, Double-blind, Placebo-Controlled Trial of Presatovir for the Treatment of Respiratory Syncytial Virus Upper Respiratory Tract Infection in Hematopoietic-Cell Transplant Recipients. Clin Infect Dis 2021; 71:2777-2786. [PMID: 31793991 PMCID: PMC7108134 DOI: 10.1093/cid/ciz1166] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background Hematopoietic-cell transplant (HCT) recipients are at risk for severe respiratory syncytial virus (RSV) infection. We evaluated the RSV fusion inhibitor presatovir in a randomized, double-blind, Phase II trial in HCT recipients with RSV upper respiratory tract infections. Methods Patients were stratified by lymphopenia (<200/µL) and ribavirin use; were randomized, stratified by lymphopenia (<200/μL) and ribavirin use, to receive oral presatovir at 200 mg or a placebo on Days 1, 5, 9, 13, and 17, and were followed through Day 28. The coprimary efficacy endpoints were the time-weighted average change in the nasal RSV viral load between Days 1 and 9 and the proportion of patients developing lower respiratory tract complications (LRTCs) through Day 28. Results From 23 January 2015 to 16 June 2017, 189 patients were randomly assigned to treatment (96 to presatovir and 93 to the placebo). Presatovir treatment, compared with the placebo treatment, did not significantly affect (prespecified α = 0.01) a time-weighted average decline in the RSV viral load from Day 1 to 9 (treatment difference, −0.33 log10 copies/mL; 95% confidence interval [CI] −.64 to −.02 log10 copies/mL; P = .040) or the progression to LRTC (11.2% vs 19.5%, respectively; odds ratio, 0.50; 95% CI, .22–1.18; P = .11). In a post hoc analysis among patients with lymphopenia, presatovir decreased LRTC development by Day 28 (2/15 [13.3%] vs 9/14 [64.3%], respectively; P = .008), compared with the placebo. Adverse events were similar for patients receiving presatovir and the placebo. Conclusions Presatovir had a favorable safety profile in adult HCT recipients with RSV but did not achieve the coprimary endpoints. Exploratory analyses suggest an antiviral effect among patients with lymphopenia. Clinical Trials Registration NCT02254408; EUDRA-CT#2014-002474-36.
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Affiliation(s)
- Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjeet S Dadwal
- Division of Infectious Disease, City of Hope National Medical Center, Duarte, California, USA
| | - Anne Bergeron
- Service de Pneumologie, Université Paris Diderot, Hôpital Saint Louis, Paris, France
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Guang-Shing Cheng
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sudhakar N Pipavath
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ajit P Limaye
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elodie Blanchard
- Department of Respiratory Diseases, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Drew J Winston
- Department of Medicine, University of California Los Angeles Ronald Reagan Medical Center, Los Angeles, California, USA
| | - Patrick J Stiff
- Department of Hematology/Oncology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Tsila Zuckerman
- Hematology Institute, Rambam Medical Health Care Campus, Haifa, Israel
| | - Silvy Lachance
- Hematology-Oncology Department, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Galia Rahav
- Infectious Diseases Unit, Chaim Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Catherine B Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Kathleen M Mullane
- Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Roberto L Patron
- Department of Infectious Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Dong-Gun Lee
- Department of Infectious Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hans H Hirsch
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Alpana Waghmare
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Ying Guo
- Gilead Sciences Inc., Foster City, California, USA
| | | | | | | | | | - Francisco M Marty
- Department of Infectious Disease, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
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12
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Uy GL, Aldoss I, Foster MC, Sayre PH, Wieduwilt MJ, Advani AS, Godwin JE, Arellano ML, Sweet KL, Emadi A, Ravandi F, Erba HP, Byrne M, Michaelis L, Topp MS, Vey N, Ciceri F, Carrabba MG, Paolini S, Huls GA, Jongen-Lavrencic M, Wermke M, Chevallier P, Gyan E, Récher C, Stiff PJ, Pettit KM, Löwenberg B, Church SE, Anderson E, Vadakekolathu J, Santaguida M, Rettig MP, Muth J, Curtis T, Fehr E, Guo K, Zhao J, Bakkacha O, Jacobs K, Tran K, Kaminker P, Kostova M, Bonvini E, Walter RB, Davidson-Moncada JK, Rutella S, DiPersio JF. Flotetuzumab as salvage immunotherapy for refractory acute myeloid leukemia. Blood 2021; 137:751-762. [PMID: 32929488 PMCID: PMC7885824 DOI: 10.1182/blood.2020007732] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
Approximately 50% of acute myeloid leukemia (AML) patients do not respond to induction therapy (primary induction failure [PIF]) or relapse after <6 months (early relapse [ER]). We have recently shown an association between an immune-infiltrated tumor microenvironment (TME) and resistance to cytarabine-based chemotherapy but responsiveness to flotetuzumab, a bispecific DART antibody-based molecule to CD3ε and CD123. This paper reports the results of a multicenter, open-label, phase 1/2 study of flotetuzumab in 88 adults with relapsed/refractory AML: 42 in a dose-finding segment and 46 at the recommended phase 2 dose (RP2D) of 500 ng/kg per day. The most frequent adverse events were infusion-related reactions (IRRs)/cytokine release syndrome (CRS), largely grade 1-2. Stepwise dosing during week 1, pretreatment dexamethasone, prompt use of tocilizumab, and temporary dose reductions/interruptions successfully prevented severe IRR/CRS. Clinical benefit accrued to PIF/ER patients showing an immune-infiltrated TME. Among 30 PIF/ER patients treated at the RP2D, the complete remission (CR)/CR with partial hematological recovery (CRh) rate was 26.7%, with an overall response rate (CR/CRh/CR with incomplete hematological recovery) of 30.0%. In PIF/ER patients who achieved CR/CRh, median overall survival was 10.2 months (range, 1.87-27.27), with 6- and 12-month survival rates of 75% (95% confidence interval [CI], 0.450-1.05) and 50% (95% CI, 0.154-0.846). Bone marrow transcriptomic analysis showed that a parsimonious 10-gene signature predicted CRs to flotetuzumab (area under the receiver operating characteristic curve = 0.904 vs 0.672 for the European LeukemiaNet classifier). Flotetuzumab represents an innovative experimental approach associated with acceptable safety and encouraging evidence of activity in PIF/ER patients. This trial was registered at www.clinicaltrials.gov as #NCT02152956.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cytokine Release Syndrome/chemically induced
- Cytokine Release Syndrome/drug therapy
- Dose-Response Relationship, Immunologic
- Drug Administration Schedule
- Drug Resistance, Neoplasm
- Female
- Follow-Up Studies
- Hematopoiesis/drug effects
- Humans
- Immunotherapy
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Male
- Maximum Tolerated Dose
- Middle Aged
- Nausea/chemically induced
- Protein Interaction Maps
- Salvage Therapy
- Survival Rate
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Affiliation(s)
- Geoffrey L Uy
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Ibrahim Aldoss
- Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Peter H Sayre
- Division of Hematology and Blood and Marrow Transplantation, University of California San Francisco, San Francisco, CA
| | | | - Anjali S Advani
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Kendra L Sweet
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Ashkan Emadi
- Marlene & Stewart Greenebaum Cancer, School of Medicine, University of Maryland, Baltimore, MD
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Harry P Erba
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Centre, Durham, NC
| | - Michael Byrne
- Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Laura Michaelis
- Division of Hematology/Oncology, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI
| | - Max S Topp
- Medizinische Klinik Und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Norbert Vey
- Hematologie Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan, Italy
| | - Matteo Giovanni Carrabba
- Hematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milan, Italy
| | - Stefania Paolini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology L. and A. Seràgnoli, University of Bologna, Bologna, Italy
| | - Gerwin A Huls
- Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Martin Wermke
- Universitätsklinikum Carl Gustav Carus an der Technische Universität, Dresden, Germany
| | - Patrice Chevallier
- Institut Universitaire du Cancer Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuel Gyan
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Christian Récher
- Hôpital Bretonneau, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, France
| | | | - Kristen M Pettit
- Michigan Medicine Bone Marrow Transplant and Leukemia, C. S. Mott Children's Hospital, Ann Arbor, MI
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Jayakumar Vadakekolathu
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | | | - Michael P Rettig
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | | | | | | | - Kuo Guo
- MacroGenics Inc, Rockville, MD
| | | | | | | | | | | | | | | | | | | | - Sergio Rutella
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
- Centre for Health, Ageing and Understanding Disease (CHAUD), School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - John F DiPersio
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO
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13
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Abstract
Ovarian cancer generally escapes diagnosis until the advanced stages. High-grade serous ovarian cancer (HGSOC) is the most frequently occurring form of this malaise and is a disease which has the highest mortality rate of gynecologic cancers. Over recent years it has been revealed that the course of such cancers can be significantly influenced by the nature of immune cells in tumors at the time of diagnosis and by immune cells induced by therapy. Numerous investigators have since focused on disease biology to identify biomarkers or therapeutic targets. Yet, while over the past decade there have been significant improvements in state-of-the-art surgery for ovarian cancer as frontline therapy, there have been limited advancements in the development of novel curative or management drugs for this disease. This chapter discusses the major elements of immune suppression in HGSOC from a biological viewpoint, mechanisms of overcoming resistance to therapies, and recent therapy aimed at improving patient care and survival.
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Affiliation(s)
- Maureen L Drakes
- Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL, USA.
| | - Patrick J Stiff
- Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL, USA
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Drakes ML, Czerlanis CM, Stiff PJ. Immune Checkpoint Blockade in Gynecologic Cancers: State of Affairs. Cancers (Basel) 2020; 12:cancers12113301. [PMID: 33182298 PMCID: PMC7695253 DOI: 10.3390/cancers12113301] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Most endometrial cancer patients are diagnosed at an early stage, receive standard treatment, and survive well. Ovarian cancer has no specific symptoms and usually escapes diagnosis until the patient has advanced disease. This disease results in the highest number of deaths of gynecologic cancers. Current treatments for gynecologic cancers in the advanced stage are not sufficiently effective for good outcome in most patients. This review discusses two novel treatments, which are immune checkpoint inhibitor antibodies that block immune checkpoint molecules cytotoxic T lymphocyte associated protein-4 (CTLA-4) and programmed death-1 (PD-1) in patients. The antibody blocking of CTLA-4 or PD-1 alone is promising treatment for some categories of advanced disease endometrial cancer, but it has little effect against ovarian cancer. Our study primarily discusses the status of clinical trials for these two diseases and the biological parameters governing the different outcomes to these therapies. We also propose mechanisms whereby blocking CTLA-4 and PD-1 may be used in combination with other agents to give much better survival in advanced disease ovarian cancer patients. Abstract This review provides an update on the current use of immune checkpoint inhibitors (ICI) in female gynecologic cancers, and it addresses the potential of these agents to provide therapy options for disease management and long-term remission in advanced disease patients, where surgery, chemotherapy, and/or radiation fail to meet this goal. The topic of immune checkpoint inhibitors (ICI) blocking cytotoxic T lymphocyte associated protein-4 (CTLA-4) and the programmed death-1 (PD-1) axis has come to the forefront of translational medicine over the last decade for several malignancies. The text will focus primarily on a discussion of ovarian cancer, which is the most frequent cause of death of gynecologic cancers; endometrial cancer, which is the most often diagnosed gynecologic cancer; and cervical cancer, which is the third most common female gynecologic malignancy, all of which unfavorably alter the lives of many women. We will address the critical factors that regulate the outcome of these cancer types to ICI therapy, the ongoing clinical trials in this area, as well as the adverse immune responses that impact the outcome of patients given ICI regimens.
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Hagen P, D'Souza A, Hari P, Davila O, Zhang MJ, Vesole DH, Smith SE, Rodriguez TE, Stiff PJ. Busulfan, melphalan, and bortezomib compared to melphalan as a high dose regimen for autologous hematopoietic stem cell transplantation in multiple myeloma: long term follow up of a novel high dose regimen. Leuk Lymphoma 2020; 61:3484-3492. [PMID: 32865474 DOI: 10.1080/10428194.2020.1811275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Melphalan at a dose of 200 mg/m2 (MEL200) remains the standard high dose therapy before autologous stem cell transplantation (ASCT) for multiple myeloma (MM). Intensifying the high dose regimen has shown promising results. We report here 7-year follow up of our novel high dose regimen of busulfan and melphalan followed by bortezomib (BuMelVel). Forty-three MM patients received BuMelVel high dose therapy with pharmacokinetic adjusted busulfan. Outcomes were compared to a matched control cohort from the CIBMTR database (n = 162) receiving MEL200. The primary endpoint was progression free survival. Five year PFS was 47% v 30% (95% CI; 32-62) in favor or the BuMelVel group (95% CI; 23-37) (p = 0.05). In multivariate analysis for PFS, BuMelVel (HR 0.65; 95% CI 0.44-0.97)(p = 0.036) was predictive. Similar to recent reports of double alkylator therapy, although depth of response was similar between the BuMelVel group and MEL200, the BUMELVEL group experienced an improved PFS.
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Affiliation(s)
- Patrick Hagen
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Anita D'Souza
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Parameswaran Hari
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omar Davila
- CIBMTR, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mei-Jie Zhang
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David H Vesole
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Scott E Smith
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Tulio E Rodriguez
- Department of Hematology Oncology, Advocate Lutheran General Hospital, Chicago, IL, USA
| | - Patrick J Stiff
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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Torgerson N, Odetola O, Hagen P, Hossain N, Tsai S, Smith SE, Stiff PJ. Impact of immunoparesis on clinical outcomes following bone marrow transplantation. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20505 Background: Immunoparesis (hypogammaglobinemia) has been shown to impact outcomes in patients with newly diagnosed multiple myeloma (MM). Its impact in the post-transplant setting and potential risk of both infections and immune dysregulation impacting relapse is less clear. We sought to assess the role of immunoparesis both pre and post autologous stem cell transplant (ASCT) in newly diagnosed MM patients. Our primary outcome was the impact of immunoparesis on progression free survival (PFS) post-ASCT controlling for maintenance therapy. Methods: We evaluated all MM patients between 2008 and 2017 at Loyola University who underwent ASCT. Inclusion criteria included first ASCT and age > 18 years. We evaluated both the presence of and number of impacted immunoglobulin (Ig) classes pre-transplant and day 100, 6-months, and 12 months post-ASCT. Results: The most common MM isotype was IgG Kappa (41.01%). Immunoparesis pre-ASCT and post-ASCT at day 100, 6 months, and 12 months was seen in 75%, 89.5%, 80%, and 58.5% respectively. Median time from diagnosis to transplant was 7.75 months (5.98 – 13.73). When adjusting for pre-transplant response, conditioning regimen, and post-transplant maintenance, neither the absolute presence of or number of Ig-classes impacting was predictive of hazard of disease progression or death (OS) while ISS-stage, best response post ASCT, and time from diagnosis to transplant were (table). Conclusions: Contrary to studies in the pre-transplant setting, our analysis indicates that immunoparesis is not predictive of relapse or survival in the post-transplant setting, suggesting modification of disease process with treatment and ASCT. When controlled for maintenance therapy, immunoparesis does not increase risk of progression or decrease overall survival alleviating the concern for increased morbidity/mortality secondary to infections in the face of immunoparesis in the era of maintenance therapy. [Table: see text]
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Gyurkocza B, Nath R, Stiff PJ, Agura E, Litzow MR, Tomlinson B, Choe H, Abhyankar S, Seropian SE, Chen GL, Hari P, Al-Kadhimi Z, Foran J, Orozco JJ, van Besien K, Sabloff M, Kebriaei P, Abboud C, Levy MY, Lazarus HM, Giralt SA, Berger MS, Reddy V, Pagel JM. Targeted Conditioning with Anti-CD45 Iodine (131I) Apamistamab [Iomab-B] Leads to High Rates of Allogeneic Transplantation and Successful Engraftment in Older Patients with Active, Relapsed or Refractory (rel/ref) AML after Failure of Chemotherapy and Targeted Agents: Preliminary Midpoint Results from the Prospective, Randomized Phase 3 Sierra Trial. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Berg S, Thomas C, Joyce C, Hossain N, Ismail Z, Patel S, Smith SE, Stiff PJ, Tsai SB, Hagen PA. A Single-Center, Retrospective Study, of Risk Factors for Clostridium Difficile Infection Among Allogeneic Hematopoietic Stem Cell Transplant Recipients. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.384] [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: 11/16/2022]
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Singh D, Hagen PA, Hossain N, Smith SE, Stiff PJ, Tsai SB. Liposomal Daunorubicin/Cytarabine As a Bridge to Second Allogeneic Transplant for Early Relapses after First Allograft for Acute Myelogenous Leukemia/Myelodysplastic Syndrome. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.633] [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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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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de Koning C, Horwitz ME, Sanz G, Jagasia M, Wagner JE, Stiff PJ, Hanna R, Cilloni D, Nierkens S, Boelens JJ. Rapid and Robust CD4+ and CD8+ T-, NK-, B-Cell, Dendritic Cell, and Monocyte Reconstitution after Nicotinamide-Expanded Cord Blood Transplantation. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Al-Mansour Z, Li H, Cook JR, Constine LS, Couban S, Stewart DA, Shea TC, Porcu P, Winter JN, Kahl BS, Smith SM, Marcellus DC, Barton KP, Mills GM, LeBlanc M, Rimsza LM, Forman SJ, Leonard JP, Fisher RI, Friedberg JW, Stiff PJ. Autologous transplantation as consolidation for high risk aggressive T-cell non-Hodgkin lymphoma: a SWOG 9704 intergroup trial subgroup analysis. Leuk Lymphoma 2019; 60:1934-1941. [PMID: 30628511 DOI: 10.1080/10428194.2018.1563691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Phase II data suggest a benefit to autotransplantation for aggressive T-cell non-Hodgkin lymphoma (T-NHL) in first remission; randomized trials have yet to validate this. We performed a retrospective analysis of aggressive T-NHL patients in the intergroup randomized consolidative autotransplant trial (SWOG 9704). Of the 370 enrolled, 40 had T-NHL: 12 were not randomized due to ineligibility (n = 1), choice (n = 2), or progression (n = 9), leaving 13 randomized to control and 15 to autologous stem cell transplantation (ASCT). Two ASCT patients refused transplant and one failed mobilization. The 5-year landmark PFS/OS estimates for ASCT vs. control groups were 40% vs. 38% (p = .56), and 40% vs. 45% (p = .98), respectively. No difference was seen based on IPI, or histologic subtype. Only 1/7 receiving BCNU-based therapy survived vs. 4/5 receiving TBI. Aggressive T-NHL autotransplanted in first remission did not appear to benefit from consolidative ASCT. This and the 30% who dropped out pre-randomization mostly to progression, suggests that improved induction regimens be developed.
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Affiliation(s)
- Zeina Al-Mansour
- a Cardinal Bernardin Cancer Center, Loyola University Medical Center , Maywood , IL , USA
| | - Hongli Li
- b SWOG Statistical Center , Seattle , WA , USA
| | | | | | - Stephen Couban
- e Queen Elizabeth II Health Sciences Centre and Dalhousie University , Halifax , Canada
| | | | - Thomas C Shea
- g University of North Carolina , Chapel Hill , NC , USA
| | - Pierluigi Porcu
- h Sidney Kimmel Cancer Center, Thomas Jefferson University , Philadelphia , PA , USA
| | | | - Brad S Kahl
- j University of Wisconsin , Madison , WI , USA
| | | | | | - Kevin P Barton
- a Cardinal Bernardin Cancer Center, Loyola University Medical Center , Maywood , IL , USA
| | - Glenn M Mills
- m Louisiana State University Health Sciences Center , Shreveport , LA , USA
| | | | | | | | | | - Richard I Fisher
- q q Temple University School of Medicine, Fox Chase Cancer Center - Temple Health , Philadelphia , PA , USA
| | | | - Patrick J Stiff
- a Cardinal Bernardin Cancer Center, Loyola University Medical Center , Maywood , IL , USA
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Horwitz ME, Wease S, Blackwell B, Valcarcel D, Frassoni F, Boelens JJ, Nierkens S, Jagasia M, Wagner JE, Kuball J, Koh LP, Majhail NS, Stiff PJ, Hanna R, Hwang WYK, Kurtzberg J, Cilloni D, Freedman LS, Montesinos P, Sanz G. Phase I/II Study of Stem-Cell Transplantation Using a Single Cord Blood Unit Expanded Ex Vivo With Nicotinamide. J Clin Oncol 2018; 37:367-374. [PMID: 30523748 PMCID: PMC6368416 DOI: 10.1200/jco.18.00053] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [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: 12/13/2022] Open
Abstract
PURPOSE Increasing the number of hematopoietic stem and progenitor cells within an umbilical cord blood (UCB) graft shortens the time to hematopoietic recovery after UCB transplantation. In this study, we assessed the safety and efficacy of a UCB graft that was expanded ex vivo in the presence of nicotinamide and transplanted after myeloablative conditioning as a stand-alone hematopoietic stem-cell graft. METHODS Thirty-six patients with hematologic malignancies underwent transplantation at 11 sites. RESULTS The cumulative incidence of neutrophil engraftment at day 42 was 94%. Two patients experienced secondary graft failure attributable to viral infections. Hematopoietic recovery was compared with that observed in recipients of standard UCB transplantation as reported to the Center for International Blood and Marrow Transplant Research (n = 146). The median time to neutrophil recovery was 11.5 days (95% CI, 9 to 14 days) for recipients of nicotinamide-expanded UCB and 21 days (95% CI, 20 to 23 days) for the comparator ( P < .001). The median time to platelet recovery was 34 days (95% CI, 32 to 42 days) and 46 days (95% CI, 42 to 50 days) for the expanded and the comparator cohorts, respectively ( P < .001). The cumulative incidence of grade 2 to 4 acute graft-versus-host disease (GVHD) at day 100 was 44%, and grade 3 and 4 acute GVHD at day 100 was 11%. The cumulative incidence at 2 years of all chronic GVHD was 40%, and moderate/severe chronic GVHD was 10%. The 2-year cumulative incidences of nonrelapse mortality and relapse were 24% and 33%, respectively. The 2-year probabilities of overall and disease-free survival were 51% and 43%, respectively. CONCLUSION UCB expanded ex vivo with nicotinamide shortens median neutrophil recovery by 9.5 days (95% CI, 7 to 12 days) and median platelet recovery by 12 days (95% CI, 3 to 16.5 days). This trial establishes feasibility, safety, and efficacy of an ex vivo expanded UCB unit as a stand-alone graft.
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Affiliation(s)
| | | | | | | | | | | | - Stefan Nierkens
- 5 University Medical Center Utrecht, Utrecht, the Netherlands
| | - Madan Jagasia
- 6 Vanderbilt University Medical Center, Nashville, TN
| | | | - Jurgen Kuball
- 5 University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | - Pau Montesinos
- 14 Hospital Universitario y Politécnic de La Fe, Valencia, Spain
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Drakes ML, Stiff PJ. Regulation of Ovarian Cancer Prognosis by Immune Cells in the Tumor Microenvironment. Cancers (Basel) 2018; 10:E302. [PMID: 30200478 PMCID: PMC6162424 DOI: 10.3390/cancers10090302] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022] Open
Abstract
It is estimated that in the United States in 2018 there will be 22,240 new cases of ovarian cancer and 14,070 deaths due to this malignancy. The most common subgroup of this disease is high-grade serous ovarian cancer (HGSOC), which is known for its aggressiveness, high recurrence rate, metastasis to other sites, and the development of resistance to conventional therapy. It is important to understand the ovarian cancer tumor microenvironment (TME) from the viewpoint of the function of pre-existing immune cells, as immunocompetent cells are crucial to mounting robust antitumor responses to prevent visible tumor lesions, disease progression, or recurrence. Networks consisting of innate and adaptive immune cells, metabolic pathways, intracellular signaling molecules, and a vast array of soluble factors, shape the pathogenic nature of the TME and are useful prognostic indicators of responses to conventional therapy and immunotherapy, and subsequent survival rates. This review highlights key immune cells and soluble molecules in the TME of ovarian cancer, which are important in the development of effective antitumor immunity, as well as those that impair effector T cell activity. A more insightful knowledge of the HGSOC TME will reveal potential immune biomarkers to aid in the early detection of this disease, as well as biomarkers that may be targeted to advance the design of novel therapies that induce potent antitumor immunity and survival benefit.
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Affiliation(s)
- Maureen L Drakes
- Cardinal Bernardin Cancer Center, Department of Medicine, Loyola University Chicago, Building 112, 2160 South First Avenue, Maywood, IL 60153, USA.
| | - Patrick J Stiff
- Cardinal Bernardin Cancer Center, Department of Medicine, Loyola University Chicago, Building 112, 2160 South First Avenue, Maywood, IL 60153, USA.
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Abstract
It is estimated that in the United States in 2018 there will be 22,240 new cases of ovarian cancer and 14,070 deaths due to this malignancy. The most common subgroup of this disease is high-grade serous ovarian cancer (HGSOC), which is known for its aggressiveness, high recurrence rate, metastasis to other sites, and the development of resistance to conventional therapy. It is important to understand the ovarian cancer tumor microenvironment (TME) from the viewpoint of the function of pre-existing immune cells, as immunocompetent cells are crucial to mounting robust antitumor responses to prevent visible tumor lesions, disease progression, or recurrence. Networks consisting of innate and adaptive immune cells, metabolic pathways, intracellular signaling molecules, and a vast array of soluble factors, shape the pathogenic nature of the TME and are useful prognostic indicators of responses to conventional therapy and immunotherapy, and subsequent survival rates. This review highlights key immune cells and soluble molecules in the TME of ovarian cancer, which are important in the development of effective antitumor immunity, as well as those that impair effector T cell activity. A more insightful knowledge of the HGSOC TME will reveal potential immune biomarkers to aid in the early detection of this disease, as well as biomarkers that may be targeted to advance the design of novel therapies that induce potent antitumor immunity and survival benefit.
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Affiliation(s)
- Maureen L Drakes
- Cardinal Bernardin Cancer Center, Department of Medicine, Loyola University Chicago, Building 112, 2160 South First Avenue, Maywood, IL 60153, USA.
| | - Patrick J Stiff
- Cardinal Bernardin Cancer Center, Department of Medicine, Loyola University Chicago, Building 112, 2160 South First Avenue, Maywood, IL 60153, USA.
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Drakes ML, Mehrotra S, Aldulescu M, Potkul RK, Liu Y, Grisoli A, Joyce C, O'Brien TE, Stack MS, Stiff PJ. Stratification of ovarian tumor pathology by expression of programmed cell death-1 (PD-1) and PD-ligand- 1 (PD-L1) in ovarian cancer. J Ovarian Res 2018. [PMID: 29843813 DOI: 10.1186/s13048-018-0414-z] [] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ovarian cancer is the major cause of death among gynecologic cancers with 75% of patients diagnosed with advanced disease, and only 20% of these patients having a survival duration of five years. Treatments blocking immune checkpoint molecules, programmed cell death (PD-1) or its ligand PD-ligand- I (PD-L1) have produced a beneficial and prolonged effect in a subgroup of these patients. However, there is debate in the literature concerning the prognostic value of the expression of these molecules in tumors, with immunotherapy responsiveness, and survival. We evaluated the immune landscape of the ovarian tumor microenvironment of patients, by measuring the impact of the expression of tumor PD-1, PD-L1 and infiltrating lymphocytes on stage and grade of tumors and survival, in a cohort of 55 patients with gynecologic malignancies. Most patients under study were diagnosed with advanced disease ovarian cancer. RESULTS Our studies revealed that a low density of PD-1 and of PD-L1 expressing cells in tumor tissue were significantly associated with advanced disease (P = 0.028 and P = 0.033, respectively). Moreover, PD-L1 was expressed significantly more often in high grade tumors (41.5%) than in low grade tumors of patients (7.7%) (P = 0.040). The presence of CD3 or of FoxP3 infiltrating cells with PD-L1 in patient tumors did not impact the significance of the association of PD-L1 with high grade tumors (P = 0.040), and our analyses did not show an association between the presence of PD-1 or PD-L1 and survival. CONCLUSIONS We conclude that a subgroup of advanced disease ovarian cancer patients with high grade tumors, expressing PD-L1, may be prime candidates for immunotherapy targeting PD-1 signaling.
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Affiliation(s)
- Maureen L Drakes
- Cardinal Bernardin Cancer Center, Oncology Research Institute, Department of Medicine, Loyola University Chicago, Bldg. 112, Room 232, 2160 South First Avenue, Maywood, IL, 60153, USA.
| | - Swati Mehrotra
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Monica Aldulescu
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Ronald K Potkul
- Department of Obstetrics and Gynecology, Loyola University Chicago, Maywood, IL, USA
| | - Yueying Liu
- Department of Chemistry & Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Anne Grisoli
- Department of Chemistry & Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA
| | - Timothy E O'Brien
- Department of Mathematics & Statistics, and Institute of Environmental Sustainability, Loyola University Chicago, Chicago, IL, USA
| | - M Sharon Stack
- Department of Chemistry & Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Patrick J Stiff
- Cardinal Bernardin Cancer Center, Oncology Research Institute, Department of Medicine, Loyola University Chicago, Bldg. 112, Room 232, 2160 South First Avenue, Maywood, IL, 60153, USA
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Drakes ML, Mehrotra S, Aldulescu M, Potkul RK, Liu Y, Grisoli A, Joyce C, O'Brien TE, Stack MS, Stiff PJ. Stratification of ovarian tumor pathology by expression of programmed cell death-1 (PD-1) and PD-ligand- 1 (PD-L1) in ovarian cancer. J Ovarian Res 2018; 11:43. [PMID: 29843813 PMCID: PMC5975524 DOI: 10.1186/s13048-018-0414-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/09/2018] [Indexed: 01/06/2023] Open
Abstract
Background Ovarian cancer is the major cause of death among gynecologic cancers with 75% of patients diagnosed with advanced disease, and only 20% of these patients having a survival duration of five years. Treatments blocking immune checkpoint molecules, programmed cell death (PD-1) or its ligand PD-ligand- I (PD-L1) have produced a beneficial and prolonged effect in a subgroup of these patients. However, there is debate in the literature concerning the prognostic value of the expression of these molecules in tumors, with immunotherapy responsiveness, and survival. We evaluated the immune landscape of the ovarian tumor microenvironment of patients, by measuring the impact of the expression of tumor PD-1, PD-L1 and infiltrating lymphocytes on stage and grade of tumors and survival, in a cohort of 55 patients with gynecologic malignancies. Most patients under study were diagnosed with advanced disease ovarian cancer. Results Our studies revealed that a low density of PD-1 and of PD-L1 expressing cells in tumor tissue were significantly associated with advanced disease (P = 0.028 and P = 0.033, respectively). Moreover, PD-L1 was expressed significantly more often in high grade tumors (41.5%) than in low grade tumors of patients (7.7%) (P = 0.040). The presence of CD3 or of FoxP3 infiltrating cells with PD-L1 in patient tumors did not impact the significance of the association of PD-L1 with high grade tumors (P = 0.040), and our analyses did not show an association between the presence of PD-1 or PD-L1 and survival. Conclusions We conclude that a subgroup of advanced disease ovarian cancer patients with high grade tumors, expressing PD-L1, may be prime candidates for immunotherapy targeting PD-1 signaling. Electronic supplementary material The online version of this article (10.1186/s13048-018-0414-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maureen L Drakes
- Cardinal Bernardin Cancer Center, Oncology Research Institute, Department of Medicine, Loyola University Chicago, Bldg. 112, Room 232, 2160 South First Avenue, Maywood, IL, 60153, USA.
| | - Swati Mehrotra
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Monica Aldulescu
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Ronald K Potkul
- Department of Obstetrics and Gynecology, Loyola University Chicago, Maywood, IL, USA
| | - Yueying Liu
- Department of Chemistry & Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Anne Grisoli
- Department of Chemistry & Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA
| | - Timothy E O'Brien
- Department of Mathematics & Statistics, and Institute of Environmental Sustainability, Loyola University Chicago, Chicago, IL, USA
| | - M Sharon Stack
- Department of Chemistry & Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Patrick J Stiff
- Cardinal Bernardin Cancer Center, Oncology Research Institute, Department of Medicine, Loyola University Chicago, Bldg. 112, Room 232, 2160 South First Avenue, Maywood, IL, 60153, USA
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Drakes ML, Mehrotra S, Aldulescu M, Potkul RK, Liu Y, Grisoli A, Joyce C, O'Brien TE, Stack MS, Stiff PJ. Stratification of ovarian tumor pathology by expression of programmed cell death-1 (PD-1) and PD-ligand- 1 (PD-L1) in ovarian cancer. J Ovarian Res 2018. [PMID: 29843813 DOI: 10.1186/s13048-018-0414-z]+[] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian cancer is the major cause of death among gynecologic cancers with 75% of patients diagnosed with advanced disease, and only 20% of these patients having a survival duration of five years. Treatments blocking immune checkpoint molecules, programmed cell death (PD-1) or its ligand PD-ligand- I (PD-L1) have produced a beneficial and prolonged effect in a subgroup of these patients. However, there is debate in the literature concerning the prognostic value of the expression of these molecules in tumors, with immunotherapy responsiveness, and survival. We evaluated the immune landscape of the ovarian tumor microenvironment of patients, by measuring the impact of the expression of tumor PD-1, PD-L1 and infiltrating lymphocytes on stage and grade of tumors and survival, in a cohort of 55 patients with gynecologic malignancies. Most patients under study were diagnosed with advanced disease ovarian cancer. RESULTS Our studies revealed that a low density of PD-1 and of PD-L1 expressing cells in tumor tissue were significantly associated with advanced disease (P = 0.028 and P = 0.033, respectively). Moreover, PD-L1 was expressed significantly more often in high grade tumors (41.5%) than in low grade tumors of patients (7.7%) (P = 0.040). The presence of CD3 or of FoxP3 infiltrating cells with PD-L1 in patient tumors did not impact the significance of the association of PD-L1 with high grade tumors (P = 0.040), and our analyses did not show an association between the presence of PD-1 or PD-L1 and survival. CONCLUSIONS We conclude that a subgroup of advanced disease ovarian cancer patients with high grade tumors, expressing PD-L1, may be prime candidates for immunotherapy targeting PD-1 signaling.
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Affiliation(s)
- Maureen L Drakes
- Cardinal Bernardin Cancer Center, Oncology Research Institute, Department of Medicine, Loyola University Chicago, Bldg. 112, Room 232, 2160 South First Avenue, Maywood, IL, 60153, USA.
| | - Swati Mehrotra
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Monica Aldulescu
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Ronald K Potkul
- Department of Obstetrics and Gynecology, Loyola University Chicago, Maywood, IL, USA
| | - Yueying Liu
- Department of Chemistry & Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Anne Grisoli
- Department of Chemistry & Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA
| | - Timothy E O'Brien
- Department of Mathematics & Statistics, and Institute of Environmental Sustainability, Loyola University Chicago, Chicago, IL, USA
| | - M Sharon Stack
- Department of Chemistry & Biochemistry, Harper Cancer Research Institute, University of Notre Dame, South Bend, IN, USA
| | - Patrick J Stiff
- Cardinal Bernardin Cancer Center, Oncology Research Institute, Department of Medicine, Loyola University Chicago, Bldg. 112, Room 232, 2160 South First Avenue, Maywood, IL, 60153, USA
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Hagen PA, Adams W, Tsai SB, Smith SE, Simms PP, Stiff PJ. Relationship between disease activity and circulating endothelial and endothelial progenitor cells in multiple myeloma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e20004] [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: 11/20/2022] Open
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Micallef IN, Stiff PJ, Nademanee AP, Maziarz RT, Horwitz ME, Stadtmauer EA, Kaufman JL, McCarty JM, Vargo R, Cheverton PD, Struijs M, Bolwell B, DiPersio JF. Plerixafor Plus Granulocyte Colony-Stimulating Factor for Patients with Non-Hodgkin Lymphoma and Multiple Myeloma: Long-Term Follow-Up Report. Biol Blood Marrow Transplant 2018; 24:1187-1195. [PMID: 29410180 DOI: 10.1016/j.bbmt.2018.01.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/26/2018] [Indexed: 12/22/2022]
Abstract
The purpose of this report is to analyze long-term clinical outcomes of patients exposed to plerixafor plus granulocyte colony-stimulating factor (G-CSF) for stem cell mobilization. This was a study of patients with non-Hodgkin lymphoma (NHL; n = 167) and multiple myeloma (MM; n = 163) who were enrolled in the long-term follow-up of 2 pivotal phase III studies (NCT00741325 and NCT00741780) of 240 µg/kg plerixafor plus 10 µg/kg G-CSF, or placebo plus 10 µg/kg G-CSF to mobilize and collect CD34+ cells for autologous hematopoietic stem cell transplantation. Overall survival (OS) and progression-free survival (PFS) were evaluated over a 5-year period following the first dose of plerixafor or placebo. The probability of OS was not significantly different in patients with NHL or MM treated with plerixafor or placebo (NHL: 64%; 95% confidence interval [CI], 56% to 71% versus 56%; 95% CI, 44% to 67%, respectively; MM: 64%; 95% CI, 54% to 72% versus 64%; 95% CI, 53% to 73%, respectively). In addition, there was no statistically significant difference in the probability of PFS over 5 years between treatment groups in patients with NHL (50%; 95% CI, 44% to 67% for plerixafor versus 43%; 95% CI, 31% to 54% for placebo) or those with MM (17%; 95% CI, 10% to 24% for plerixafor versus 30%; 95% CI, 21% to 40% for placebo). In this long-term follow-up study, the addition of plerixafor to G-CSF for stem cell mobilization did not affect 5-year survival in patients with NHL or patients with MM.
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Affiliation(s)
| | - Patrick J Stiff
- Division of Hematology/Oncology, Loyola University, Chicago, Illinois
| | | | - Richard T Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, North Carolina
| | - Edward A Stadtmauer
- Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan L Kaufman
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - John M McCarty
- Department of Internal Medicine, Virginia Commonwealth University Massey Cancer Center, Richmond, Virginia
| | | | | | | | - Brian Bolwell
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - John F DiPersio
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.
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Neelapu SS, Locke FL, Bartlett NL, Lekakis LJ, Miklos DB, Jacobson CA, Braunschweig I, Oluwole OO, Siddiqi T, Lin Y, Timmerman JM, Stiff PJ, Friedberg JW, Flinn IW, Goy A, Hill BT, Smith MR, Deol A, Farooq U, McSweeney P, Munoz J, Avivi I, Castro JE, Westin JR, Chavez JC, Ghobadi A, Komanduri KV, Levy R, Jacobsen ED, Witzig TE, Reagan P, Bot A, Rossi J, Navale L, Jiang Y, Aycock J, Elias M, Chang D, Wiezorek J, Go WY. Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma. N Engl J Med 2017; 377:2531-2544. [PMID: 29226797 PMCID: PMC5882485 DOI: 10.1056/nejmoa1707447] [Citation(s) in RCA: 3454] [Impact Index Per Article: 493.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In a phase 1 trial, axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, showed efficacy in patients with refractory large B-cell lymphoma after the failure of conventional therapy. METHODS In this multicenter, phase 2 trial, we enrolled 111 patients with diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, or transformed follicular lymphoma who had refractory disease despite undergoing recommended prior therapy. Patients received a target dose of 2×106 anti-CD19 CAR T cells per kilogram of body weight after receiving a conditioning regimen of low-dose cyclophosphamide and fludarabine. The primary end point was the rate of objective response (calculated as the combined rates of complete response and partial response). Secondary end points included overall survival, safety, and biomarker assessments. RESULTS Among the 111 patients who were enrolled, axi-cel was successfully manufactured for 110 (99%) and administered to 101 (91%). The objective response rate was 82%, and the complete response rate was 54%.With a median follow-up of 15.4 months, 42% of the patients continued to have a response, with 40% continuing to have a complete response. The overall rate of survival at 18 months was 52%. The most common adverse events of grade 3 or higher during treatment were neutropenia (in 78% of the patients), anemia (in 43%), and thrombocytopenia (in 38%). Grade 3 or higher cytokine release syndrome and neurologic events occurred in 13% and 28% of the patients, respectively. Three of the patients died during treatment. Higher CAR T-cell levels in blood were associated with response. CONCLUSIONS In this multicenter study, patients with refractory large B-cell lymphoma who received CAR T-cell therapy with axi-cel had high levels of durable response, with a safety profile that included myelosuppression, the cytokine release syndrome, and neurologic events. (Funded by Kite Pharma and the Leukemia and Lymphoma Society Therapy Acceleration Program; ZUMA-1 ClinicalTrials.gov number, NCT02348216 .).
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MESH Headings
- Adult
- Aged
- Antigens, CD19
- Biomarkers/blood
- Disease-Free Survival
- Female
- Humans
- Immunotherapy, Adoptive
- Interleukins/blood
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Nervous System Diseases/chemically induced
- Neutropenia/chemically induced
- Receptors, Antigen, T-Cell/blood
- Receptors, Antigen, T-Cell/therapeutic use
- Survival Rate
- T-Lymphocytes/immunology
- T-Lymphocytes/transplantation
- Young Adult
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Affiliation(s)
- Sattva S Neelapu
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Frederick L Locke
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Nancy L Bartlett
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Lazaros J Lekakis
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - David B Miklos
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Caron A Jacobson
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Ira Braunschweig
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Olalekan O Oluwole
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Tanya Siddiqi
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Yi Lin
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - John M Timmerman
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Patrick J Stiff
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Jonathan W Friedberg
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Ian W Flinn
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Andre Goy
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Brian T Hill
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Mitchell R Smith
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Abhinav Deol
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Umar Farooq
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Peter McSweeney
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Javier Munoz
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Irit Avivi
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Januario E Castro
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Jason R Westin
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Julio C Chavez
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Armin Ghobadi
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Krishna V Komanduri
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Ronald Levy
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Eric D Jacobsen
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Thomas E Witzig
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Patrick Reagan
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Adrian Bot
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - John Rossi
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Lynn Navale
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Yizhou Jiang
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Jeff Aycock
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Meg Elias
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - David Chang
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - Jeff Wiezorek
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
| | - William Y Go
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.S.N., J.R.W.); H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (F.L.L., J.C.C.); Washington University and Siteman Cancer Center, St. Louis (N.L.B., A. Ghobadi); University of Miami, Miami (L.J.L., K.V.K.); Stanford University, Stanford (D.B.M., R.L.), City of Hope National Medical Center, Duarte (T.S.), University of California at Los Angeles, Los Angeles (J.M.T.), University of California at San Diego, San Diego (J.E.C.), and Kite Pharma, Santa Monica (A.B., J.R., L.N., Y.J., J.A., M.E., D.C., J.W., W.Y.G.) - all in California; Dana-Farber Cancer Institute, Boston (C.A.J., E.D.J.); Montefiore Medical Center, Bronx (I.B.), and the University of Rochester School of Medicine, Rochester (J.W.F., P.R.) - both in New York; Vanderbilt University Medical Center (O.O.O.) and the Sarah Cannon Research Institute and Tennessee Oncology (I.W.F.), Nashville; Mayo Clinic, Rochester, MN (Y.L., T.E.W.); Loyola University Medical Center, Maywood, IL (P.J.S.); John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ (A. Goy); Cleveland Clinic, Cleveland (B.T.H., M.R.S.); Karmanos Cancer Center, Wayne State University, Detroit (A.D.); University of Iowa Carver College of Medicine, Iowa City (U.F.); Colorado Blood Cancer Institute, Denver (P.M.S.); Banner M.D. Anderson Cancer Center, Gilbert, AZ (J.M.); and Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (I.A.)
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Moore T, Wagner CR, Scurti GM, Hutchens KA, Godellas C, Clark AL, Kolawole EM, Hellman LM, Singh NK, Huyke FA, Wang SY, Calabrese KM, Embree HD, Orentas R, Shirai K, Dellacecca E, Garrett-Mayer E, Li M, Eby JM, Stiff PJ, Evavold BD, Baker BM, Le Poole IC, Dropulic B, Clark JI, Nishimura MI. Clinical and immunologic evaluation of three metastatic melanoma patients treated with autologous melanoma-reactive TCR-transduced T cells. Cancer Immunol Immunother 2017; 67:311-325. [PMID: 29052782 DOI: 10.1007/s00262-017-2073-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 03/04/2017] [Accepted: 10/03/2017] [Indexed: 11/24/2022]
Abstract
Malignant melanoma incidence has been increasing for over 30 years, and despite promising new therapies, metastatic disease remains difficult to treat. We describe preliminary results from a Phase I clinical trial (NCT01586403) of adoptive cell therapy in which three patients received autologous CD4+ and CD8+ T cells transduced with a lentivirus carrying a tyrosinase-specific TCR and a marker protein, truncated CD34 (CD34t). This unusual MHC Class I-restricted TCR produces functional responses in both CD4+ and CD8+ T cells. Parameters monitored on transduced T cells included activation (CD25, CD69), inhibitory (PD-1, TIM-3, CTLA-4), costimulatory (OX40), and memory (CCR7) markers. For the clinical trial, T cells were activated, transduced, selected for CD34t+ cells, then re-activated, and expanded in IL-2 and IL-15. After lymphodepleting chemotherapy, patients were given transduced T cells and IL-2, and were followed for clinical and biological responses. Transduced T cells were detected in the circulation of three treated patients for the duration of observation (42, 523, and 255 days). Patient 1 tolerated the infusion well but died from progressive disease after 6 weeks. Patient 2 had a partial response by RECIST criteria then progressed. After progressing, Patient 2 was given high-dose IL-2 and subsequently achieved complete remission, coinciding with the development of vitiligo. Patient 3 had a mixed response that did not meet RECIST criteria for a clinical response and developed vitiligo. In two of these three patients, adoptive transfer of tyrosinase-reactive TCR-transduced T cells into metastatic melanoma patients had clinical and/or biological activity without serious adverse events.
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Affiliation(s)
- Tamson Moore
- Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA.
| | - Courtney Regan Wagner
- Department of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Gina M Scurti
- Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Kelli A Hutchens
- Department of Pathology, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
- Forefront Dermatology, 801 York St, Manitowoc, WI, 54220, USA
| | - Constantine Godellas
- Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Ann Lau Clark
- Department of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | | | - Lance M Hellman
- Department of Chemistry & Biochemistry and the Harper Cancer Research Institute, University of Notre Dame, 251 Nieuwland Science Hall, Notre Dame, IN, 46656, USA
| | - Nishant K Singh
- Department of Chemistry & Biochemistry and the Harper Cancer Research Institute, University of Notre Dame, 251 Nieuwland Science Hall, Notre Dame, IN, 46656, USA
| | - Fernando A Huyke
- Department of Chemistry & Biochemistry and the Harper Cancer Research Institute, University of Notre Dame, 251 Nieuwland Science Hall, Notre Dame, IN, 46656, USA
| | - Siao-Yi Wang
- Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Kelly M Calabrese
- Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
- Abbvie, 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Heather D Embree
- Lentigen Technology Inc, A Miltenyi Biotec Company, 910 Clopper Road Suite 200S, Gaithersburg, MD, 20878, USA
| | - Rimas Orentas
- Lentigen Technology Inc, A Miltenyi Biotec Company, 910 Clopper Road Suite 200S, Gaithersburg, MD, 20878, USA
| | - Keisuke Shirai
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St, Charleston, SC, 29425, USA
- Dartmouth-Hitchcock, Norris Cotton Cancer Center, One Medical Center Dr, Lebanon, NH, 03756, USA
| | - Emilia Dellacecca
- Department of Pathology, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
- Department of Microbiology, and Immunology, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, USA
| | - Elizabeth Garrett-Mayer
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St, Charleston, SC, 29425, USA
| | - Mingli Li
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St, Charleston, SC, 29425, USA
- Bluebird Biology, 60 Binney St., Cambridge, MA, 02142, USA
| | - Jonathan M Eby
- Department of Pathology, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
- Department of Microbiology, and Immunology, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, USA
| | - Patrick J Stiff
- Department of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Brian D Evavold
- O. Wayne Rollins Research Center, Emory University, Room 3127, 1510 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Brian M Baker
- Department of Chemistry & Biochemistry and the Harper Cancer Research Institute, University of Notre Dame, 251 Nieuwland Science Hall, Notre Dame, IN, 46656, USA
| | - I Caroline Le Poole
- Department of Pathology, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
- Department of Microbiology, and Immunology, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, USA
- Lurie Comprehensive Cancer Center, Department of Dermatology, Northwestern University at Chicago, Room 5-113, 303 East Superior Street, Chicago, IL, 60611, USA
| | - Boro Dropulic
- Lentigen Technology Inc, A Miltenyi Biotec Company, 910 Clopper Road Suite 200S, Gaithersburg, MD, 20878, USA
| | - Joseph I Clark
- Department of Medicine, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Michael I Nishimura
- Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
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33
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Soiffer RJ, Kim HT, McGuirk J, Horwitz ME, Johnston L, Patnaik MM, Rybka W, Artz A, Porter DL, Shea TC, Boyer MW, Maziarz RT, Shaughnessy PJ, Gergis U, Safah H, Reshef R, DiPersio JF, Stiff PJ, Vusirikala M, Szer J, Holter J, Levine JD, Martin PJ, Pidala JA, Lewis ID, Ho VT, Alyea EP, Ritz J, Glavin F, Westervelt P, Jagasia MH, Chen YB. Prospective, Randomized, Double-Blind, Phase III Clinical Trial of Anti-T-Lymphocyte Globulin to Assess Impact on Chronic Graft-Versus-Host Disease-Free Survival in Patients Undergoing HLA-Matched Unrelated Myeloablative Hematopoietic Cell Transplantation. J Clin Oncol 2017; 35:4003-4011. [PMID: 29040031 DOI: 10.1200/jco.2017.75.8177] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Several open-label randomized studies have suggested that in vivo T-cell depletion with anti-T-lymphocyte globulin (ATLG; formerly antithymocyte globulin-Fresenius) reduces chronic graft-versus-host disease (cGVHD) without compromising survival. We report a prospective, double-blind phase III trial to investigate the effect of ATLG (Neovii Biotech, Lexington, MA) on cGVHD-free survival. Patients and Methods Two hundred fifty-four patients 18 to 65 years of age with acute leukemia or myelodysplastic syndrome who underwent myeloablative HLA-matched unrelated hematopoietic cell transplantation (HCT) were randomly assigned one to one to placebo (n =128 placebo) or ATLG (n = 126) treatment at 27 sites. Patients received either ATLG or placebo 20 mg/kg per day on days -3, -2, -1 in addition to tacrolimus and methotrexate as GVHD prophylaxis. The primary study end point was moderate-severe cGVHD-free survival. Results Despite a reduction in grade 2 to 4 acute GVHD (23% v 40%; P = .004) and moderate-severe cGVHD (12% v 33%; P < .001) in ATLG recipients, no difference in moderate-severe cGVHD-free survival between ATLG and placebo was found (2-year estimate: 48% v 44%, respectively; P = .47). Both progression-free survival (PFS) and overall survival (OS) were lower with ATLG (2-year estimate: 47% v 65% [ P = .04] and 59% v 74% [ P = .034], respectively). Multivariable analysis confirmed that ATLG was associated with inferior PFS (hazard ratio, 1.55; 95% CI, 1.05 to 2.28; P = .026) and OS (hazard ratio, 1.74; 95% CI, 1.12 to 2.71; P = .01). Conclusion In this prospective, randomized, double-blind trial of ATLG in unrelated myeloablative HCT, the incorporation of ATLG did not improve moderate-severe cGVHD-free survival. Moderate-severe cGVHD was significantly lower with ATLG, but PFS and OS also were lower. Additional analyses are needed to understand the appropriate role for ATLG in HCT.
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Affiliation(s)
- Robert J Soiffer
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Haesook T Kim
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph McGuirk
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Mitchell E Horwitz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Laura Johnston
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Mrinal M Patnaik
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Witold Rybka
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew Artz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - David L Porter
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas C Shea
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Michael W Boyer
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Richard T Maziarz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Paul J Shaughnessy
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Usama Gergis
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Hana Safah
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Ran Reshef
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - John F DiPersio
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Patrick J Stiff
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Madhuri Vusirikala
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Jeff Szer
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer Holter
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - James D Levine
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Paul J Martin
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Joseph A Pidala
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Ian D Lewis
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Vincent T Ho
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Edwin P Alyea
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Jerome Ritz
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Frank Glavin
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Peter Westervelt
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Madan H Jagasia
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
| | - Yi-Bin Chen
- Robert J. Soiffer, Haesook T. Kim, Vincent T. Ho, Edwin P. Alyea, and Jerome Ritz, Dana-Farber Cancer Institute; James D. Levine, Beth Israel Deaconess Medical Center and Harvard Medical School; Yi-Bin Chen, Massachusetts General Hospital, Boston; Frank Glavin, Neovii Biotech, Lexington, MA; Joseph McGuirk, University of Kansas Medical Center, Kansas City, KS; Mitchell E. Horwitz, Duke University Medical Center, Durham; Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, NC; Laura Johnston, Stanford University, Stanford, CA; Mrinal M. Patnaik, Mayo Clinic, Rochester, MN; Witold Rybka, Penn State College of Medicine, Hershey; David L. Porter, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Andrew Artz, University of Chicago, Chicago; Patrick J. Stiff, Loyola University Medical Center, Maywood, IL; Michael W. Boyer, University of Utah, Salt Lake City, UT; Richard T. Maziarz, Oregon Health & Science University, Portland, OR; Paul J. Shaughnessy, Texas Transplant Institute, San Antonio; Madhuri Vusirikala, University of Texas Southwestern Medical Center, Dallas, TX; Usama Gergis, Weill Cornell Medical College; Ran Reshef, Columbia University Medical Center, New York, NY; Hana Safah, Tulane University, New Orleans, LA; John F. DiPersio and Peter Westervelt, Washington University School of Medicine, St Louis, MO; Jeff Szer, Royal Melbourne Hospital, Parkville, Victoria; Ian D. Lewis, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Jennifer Holter, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Paul J. Martin, Fred Hutchinson Cancer Research Center, Seattle, WA; Joseph A. Pidala, H. Lee Moffitt Cancer Center, Tampa, FL; and Madan H. Jagasia, Vanderbilt University Medical Center, Nashville, TN
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Andreadis C, Fenske TS, Hill BT, Stiff PJ, Grinblatt DL, Hsi ED, Kelley T, Richards KL, Kostakoglu L, Schöder H, Jung SH, Pitcher B, Pike K, Plona T, Baugher R, Mellott S, Bartlett NL, Leonard J, Shea TC, Devine SM. Ironclad: A randomized phase III study of ibrutinib (Ibr) or no consolidation following autologous hematopoietic stem cell transplantation (AutoHCT) for relapsed/refractory activated-B-cell (ABC) subtype diffuse large B-cell lymphoma (DLBCL). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps7566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS7566 Background: Relapsed DLBCL in the rituximab era portends a poor prognosis with only about 25% of patients achieving long-term disease control following 2ndline therapy and AutoHCT. Patients with the ABC subtype have an inferior prognosis at diagnosis than those with GC and are overrepresented at relapse. In order to improve outcomes in ABC-DLBCL, we designed a study targeting disease pathobiology at the time of AutoHCT. Ibr has a safety profile allowing combination with cytotoxic chemotherapy and has single-agent activity with a 37% response rate in patients with relapsed/refractory ABC-DLBCL. Methods: This is an intergroup, randomized, placebo-controlled phase III study combining Ibr or placebo with high-dose chemotherapy during conditioning with AutoHCT and for 12 months following AutoHCT. Pts with relapsed or refractory DLBCL have tissue submitted centrally for real-time review and subtype assignment by GEP (Frederick Laboratory). Key eligibility criteria include no more than 3 prior regimens, no active CNS involvement, no need for long-term anticoagulation, and no progression on prior Ibr. Pts with chemosensitive ABC-DLBCL are randomized to Ibr 560 mg or placebo with BEAM or CBV chemotherapy until day 0. After engraftment, pts receive Ibr 560 mg daily or placebo for 12 additional cycles. Pts with progressive disease on placebo can cross over to Ibr monotherapy. An initial safety cohort of 6 pts is being enrolled to evaluate the tolerability of Ibr with concurrent BEAM and CBV therapy. The primary endpoint is superior 2-year PFS (Ha/H0: 67% vs 50%). Secondary endpoints include time to count recovery, post-transplant response rates, OS, PFS, and incidence of 2arymalignancies. In correlative studies, we will assess the prognostic and predictive role of pre-transplant FDG-PET in the setting of Ibr or placebo therapy, the role of emergent BCR pathway mutations, double hit genetics, and pharmacogenetic determinants on treatment outcome and toxicities. We expect to accrue 296 patients over 4 years. An Alliance/BMT-CTN study: NCT02443077 Clinical trial information: NCT02443077.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Heiko Schöder
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Sin-Ho Jung
- Duke University School of Medicine, Durham, NC
| | | | - Kristen Pike
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Teri Plona
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Ryan Baugher
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Nancy L. Bartlett
- Washington University School of Medicine in St. Louis and Siteman Cancer Center, St. Louis, MO
| | - John Leonard
- Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
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Kobrinski DA, Smith SE, Al-Mansour Z, Tsai SB, Martin B, Stiff PJ. Allogeneic hematopoietic stem cell transplantation for mantle cell lymphoma in a heavily pretreated patient population. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7558 Background: Allogeneic hematopoietic stem cell transplantation (allo-SCT) is the only potential curative treatment option for patients with MCL due to its potent graft-versus-lymphoma (GVL) effect. Survival following allo-SCT for MCL is variable due to high rates of non-relapse mortality (NRM). Methods: We retrospectively identified all patients who were treated with an allo-SCT for MCL at Loyola University Medical Center between January 1, 1999 and January 1, 2016. Probability estimates for overall survival (OS) and non-relapse mortality (NRM) at 5 years were calculated from the date of allo-SCT to the date of patient death or last known follow-up. Significance was determined using a cox proportional hazard (CPH) model. Rates of acute graft-versus-host disease (aGVHD) and relapse were also reported. Results: Patient characteristics (n = 29) are listed in Table. Median follow-up in surviving patients is 10 years (range 5-14 years). A majority of patients (n = 23, 79%) had 3 or more lines of treatment prior to allo-SCT. The 5 year rates of OS and NRM for all patients are 42% and 53%, respectively. Univariate analysis showed a lower risk of death in patients who received TBI-based conditioning (HR: 0.19, 95 CI: 0.04 – 0.81, p = 0.03), and those who had HLA-matched related donor (MRD) transplants (HR: 0.29, 95 CI: 0.11 – 0.79, p = 0.02). Patients who received more than 3 lines of prior treatment had a higher risk of death (HR: 2.77, 95% CI: 1.05-7.34, p = 0.04). Low rates of grade III/IV aGVHD (n = 4) and relapse (n = 4) occurred in our patient population. Two patient deaths were attributable to aGVHD, and the majority of other deaths were due to treatment-related toxicities. Conclusions: In an era of numerous effective non-curative salvage therapies, the optimal timing of allo-SCT for MCL needs further clarification. Our data supports early opposed to delayed allo-SCT for select high-risk patients with MCL who have a MRD. [Table: see text]
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Affiliation(s)
| | | | | | | | - Brendan Martin
- Clinical Research Office, Health Sciences Division, Loyola University Chicago, Maywood, IL
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Mumby PB, Doyle T, Adams W, Hicks EB, Thilges S, Mai HP, Smith SE, Rodriguez T, Go A, Marinier D, Stiff PJ. Utility of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in hematopoietic stem cell transplantation (HSCT). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10046 Background: The SIPAT is used to assess psychosocial risk in solid organ transplants but data in HSCT is lacking. We examined if pre-HSCT SIPAT scores predict mortality, morbidity, length of stay (LOS) and number of hospitalizations over a 1 year period. Methods: 89 adult HSCT (59% autologous, 38% allogeneic) pts from an academic medical center underwent the SIPAT pre-HSCT. Additional data were obtained on Day 0, and 3-, 6-, and 12-months. Univariable Cox proportional hazards models assessed the instantaneous risk of mortality at any given time after Day 0 as a function of baseline pt characteristics and the SIPAT score. Results: TheSIPAT categorized 28%, 66% and 5.7% respectively of the pts as excellent (E), good (G), and high risk (HR) candidates. One year post HSCT, 76% of E, 72% of G, and 40% of HR candidates were alive. Higher SIPAT scores were a significant predictor of mortality. Compared to E candidates, the HR candidates were 5.94 (95% CI: 1.31-26.81) times more likely to die any time after Day 0 – even after controlling for pts’ comorbidity index ( p = .02). Similarly, compared to G candidates, HR pts were 4.81 (95% CI: 1.33-17.47) times more likely to die even after controlling for pts’ comorbidity index ( p = .01). There was no difference between the G and E candidates on univariable ( p = .75) or multivariable analysis controlling for comorbidity index score ( p = .72). For every 1 point increase in pts’ adherence score, the risk of death was expected to decline by approximately 14% ( HR = 0.86, 95% CI: 0.78 – 0.96; p = .01). SIPAT items that predicted mortality were depression ( p = .02), deceptive behavior ( p < .001) and moderate alcohol abuse ( p < .001). In linear regression analysis, higher SIPAT score was associated with longer LOS ( p = .04) but not infection ( p = .23), GVHD ( p = .40), or number of hospitalizations ( p = .73). Because there were only 18 mortality events, multivariable analyses were limited. Future research will examine the effect of SIPAT on time to death controlling for other pt comorbidities. Conclusions: We found the SIPAT was able to predict mortality and LOS in HSCT pts. This finding if validated in a multi-center manner could be an important tool for HSCT pt selection.
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Affiliation(s)
| | - Todd Doyle
- Loyola University Medical Center, Maywood, IL
| | | | | | | | - Hanh P. Mai
- Loyola University Medical Center, Chicago, IL
| | | | | | - Aileen Go
- Cancer Transplant Institute, Scottsdale, AZ
| | - David Marinier
- Gundersen Health System, Center for Cancer and Blood Disorders, La Crosse, WI
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Stiff PJ. Allografts for Follicular Non-Hodgkin Lymphoma: Why Never Is No Longer an Acceptable Answer. Biol Blood Marrow Transplant 2016; 22:1346-1347. [PMID: 27264634 DOI: 10.1016/j.bbmt.2016.05.025] [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] [Received: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Patrick J Stiff
- Division of Hematology-Oncology, Loyola University Medical Center, Loyola University Stritch School of Medicine, Maywood, Illinois.
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Rodriguez TE, Hari P, Stiff PJ, Smith SE, Sterrenberg D, Vesole DH. Busulfan, Melphalan, and Bortezomib versus High-Dose Melphalan as a Conditioning Regimen for Autologous Hematopoietic Stem Cell Transplantation in Multiple Myeloma. Biol Blood Marrow Transplant 2016; 22:1391-1396. [PMID: 27164062 PMCID: PMC5075527 DOI: 10.1016/j.bbmt.2016.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Abstract
High-dose melphalan 200 mg/m2 (MEL 200) is the standard of care as a conditioning regimen for autologous hematopoietic stem cell transplantation (AHSCT) for multiple myeloma (MM). We compared a novel conditioning combination incorporating busulfan, melphalan, and bortezomib (BUMELVEL) versus standard MEL 200 in newly diagnosed patients undergoing AHSCT for MM. Between July 2009 and May 2012, 43 eligible patients received BUMELVEL conditioning followed by AHSCT. BU was administered i.v. daily for 4 days to achieve a target area under the concentration-time curve total of 20,000 mM·min based on pharmacokinetic analysis after the first dose. MEL 140 mg/m2 (MEL 140) and VEL 1.6 mg/m2 were administered i.v. on days −2 and −1, respectively. Outcomes were compared with a contemporaneous North American cohort (n = 162) receiving MEL 200 matched for age, sex, performance status, stage, interval from diagnosis to AHSCT, and disease status before AHSCT. Multivariate analysis of relapse, progression-free survival (PFS), and overall survival (OS) was performed. The median follow-up was 25 months. No transplant-related mortality was observed in the study cohort at 1 year. PFS at 1 year was superior in the BUMELVEL cohort (90%) in comparison with 77% in MEL 200 historical control subjects (P = .02). Cumulative incidence of relapse was lower in the BUMELVEL group versus the MEL 200 group (10% at 1 year versus 21%; P = .047). OS at 1 year was similar between cohorts (93% versus 93%; P =.89). BU can be safely combined with MEL 140 and VEL without an increase in toxicities or transplant-related mortality. We observed a superior PFS in the BUMELVEL cohort without maintenance therapy, warranting further trials.
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Affiliation(s)
- Tulio E Rodriguez
- Division of Hematology and Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
| | - Parameswaran Hari
- Department of Medicine and Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Patrick J Stiff
- Division of Hematology and Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Scott E Smith
- Division of Hematology and Oncology, Department of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Danielle Sterrenberg
- Division of Hematology and Oncology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - David H Vesole
- Multiple Myeloma Division, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey; Multiple Myeloma Program, MedStar Georgetown University Hospital, Washington, DC
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40
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Puvvada SD, Stiff PJ, Leblanc M, Cook JR, Couban S, Leonard JP, Kahl B, Marcellus D, Shea TC, Winter JN, Li H, Rimsza LM, Friedberg JW, Smith SM. Outcomes of MYC-associated lymphomas after R-CHOP with and without consolidative autologous stem cell transplant: subset analysis of randomized trial intergroup SWOG S9704. Br J Haematol 2016; 174:686-91. [PMID: 27072903 DOI: 10.1111/bjh.14100] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/22/2016] [Indexed: 01/19/2023]
Abstract
Double hit lymphoma (DHL) and double protein-expressing (MYC, BCL2) lymphomas (DPL) fare poorly with R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, prednisolone); consolidative autologous stem cell transplant (ASCT) may improve outcomes. S9704, a phase III randomized study of CHOP +/-R with or without ASCT enabled evaluation of intensive consolidation. Immunohistochemistry (IHC) identified 27 of 198 patients (13·6%) with MYC overexpression; 20 (74%) harboured concurrent BCL2 overexpression. Four had DHL and 16 had DPL only. With median 127 months follow-up, there is a trend favouring outcomes after ASCT in DPL and MYC protein overexpressing patients, whereas all DHL patients have died irrespective of ASCT.
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Affiliation(s)
- Soham D Puvvada
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Michael Leblanc
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - James R Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stephen Couban
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - John P Leonard
- Weill Medical College of Cornell University, New york, NY, USA
| | - Brad Kahl
- University of Wisconsin, Madison, WI, USA
| | - Deborah Marcellus
- McMaster University, Margaret and Charles Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Thomas C Shea
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Hongli Li
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa M Rimsza
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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41
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Diefenbach CS, Li H, Hong F, Gordon LI, Fisher RI, Bartlett NL, Crump M, Gascoyne RD, Wagner H, Stiff PJ, Cheson BD, Stewart DA, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ, Advani RH. Evaluation of the International Prognostic Score (IPS-7) and a Simpler Prognostic Score (IPS-3) for advanced Hodgkin lymphoma in the modern era. Br J Haematol 2015; 171:530-8. [PMID: 26343802 DOI: 10.1111/bjh.13634] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
The International Prognostic Score (IPS-7) is the most commonly used risk stratification tool for advanced Hodgkin lymphoma (HL), however recent studies suggest the IPS-7 is less discriminating due to improved outcomes with contemporary therapy. We evaluated the seven variables for IPS-7 recorded at study entry for 854 patients enrolled on Eastern Cooperative Oncology Group 2496 trial. Univariate and multivariate Cox models were used to assess their prognostic ability for freedom from progression (FFP) and overall survival (OS). The IPS-7 remained prognostic however its prognostic range has narrowed. On multivariate analysis, two factors (age, stage) remained significant for FFP and three factors (age, stage, haemoglobin level) for OS. An alternative prognostic index, the IPS-3, was constructed using age, stage and haemoglobin level, which provided four distinct risk groups [FFP (P = 0·0001) and OS (P < 0·0001)]. IPS-3 outperformed the IPS-7 on risk prediction for both FFP and OS by model fit and discrimination criteria. Using reclassification calibration, 18% of IPS-7 low risk patients were re-classified as intermediate risk and 13% of IPS-7 intermediate risk patients as low risk. For patients with advanced HL, the IPS-3 may provide a simpler and more accurate framework for risk assessment in the modern era. Validation of these findings in other large data sets is planned.
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Affiliation(s)
| | - Hailun Li
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | | | | | - Michael Crump
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | - Joseph M Tuscano
- Davis Cancer Center, University of California, Sacramento, CA, USA
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42
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Czerlanis CM, Drakes M, Elmishad A, Liotta M, Parthasarathy M, Pease L, Pilman K, Potkul R, Yu Z, Stiff PJ. A study of mature alpha-DC-1 vaccine to induce immune responses in ovarian cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14033] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Lori Pease
- Loyola University Medical Center, Maywood, IL
| | | | | | - Zheng Yu
- Loyola University Medical Center, Maywood, IL
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43
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Khoury HJ, Collins R, Blum WG, Stiff PJ, Lebkowski J, Wirth E, Nishimoto K, DiPersio JF. Long-term follow-up of patients with acute myelogenous leukemia receiving an autologous telomerase-based dendritic cell vaccine. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.7007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Robert Collins
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - William G. Blum
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | - John F. DiPersio
- Washington University School of Medicine in St. Louis, St. Louis, MO
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44
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Walewski JA, Nademanee A, Masszi T, Holowiecki J, Abidi M, Chen AI, Stiff PJ, Viviani S, Bachanova V, Sweetenham JW, Lee SY, Huebner D, Larsen EK, Hunder NNH, Moskowitz CH. Multivariate analysis of PFS from the AETHERA trial: A phase III study of brentuximab vedotin consolidation after autologous stem cell transplant for HL. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jan Andrzej Walewski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | - Tamás Masszi
- Szent Istvan & Szent Laszlo Corporate Hospital Hematology & Stem Cell Dept., Budapest, Hungary
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation & Oncohematology, Maria Sklodowska-Curie Institute of Oncology, Gliwice, Poland
| | | | - Andy I. Chen
- Oregon Health and Science University, Portland, OR
| | | | | | | | | | - Shih-Yuan Lee
- Takeda Pharmaceuticals International Company, Cambridge, MA
| | - Dirk Huebner
- Takeda Pharmaceuticals International Company, Cambridge, MA
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45
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Ramsey SD, Nademanee A, Masszi T, Holowiecki J, Abidi M, Chen AI, Stiff PJ, Viviani S, Zhu Y, Bonthapally V, Thomas E, Hunder NNH, Walewski JA. Quality of life EQ-5D results from the AETHERA trial: A phase III study of brentuximab vedotin consolidation following autologous stem cell transplant for HL. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.6568] [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: 11/20/2022] Open
Affiliation(s)
- Scott David Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Tamás Masszi
- Szent Istvan & Szent Laszlo Corporate Hospital Hematology & Stem Cell Dept., Budapest, Hungary
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation & Oncohematology, Maria Sklodowska-Curie Institute of Oncology, Gliwice, Poland
| | | | - Andy I. Chen
- Oregon Health and Science University, Portland, OR
| | | | | | - Yanyan Zhu
- Takeda Pharmaceuticals International Company, Cambrid, MA
| | | | | | | | - Jan Andrzej Walewski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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Bachanova V, Burns LJ, Ahn KW, Laport GG, Akpek G, Kharfan-Dabaja MA, Nishihori T, Agura E, Armand P, Jaglowski SM, Cairo MS, Cashen AF, Cohen JB, D'Souza A, Freytes CO, Gale RP, Ganguly S, Ghosh N, Holmberg LA, Inwards DJ, Kanate AS, Lazarus HM, Malone AK, Munker R, Mussetti A, Norkin M, Prestidge TD, Rowe JM, Satwani P, Siddiqi T, Stiff PJ, William BM, Wirk B, Maloney DG, Smith SM, Sureda AM, Carreras J, Hamadani M. Impact of Pretransplantation (18)F-fluorodeoxy Glucose-Positron Emission Tomography Status on Outcomes after Allogeneic Hematopoietic Cell Transplantation for Non-Hodgkin Lymphoma. Biol Blood Marrow Transplant 2015; 21:1605-11. [PMID: 25983043 DOI: 10.1016/j.bbmt.2015.05.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
Abstract
Assessment with (18)F-fluorodeoxy glucose (FDG)-positron emission tomography (PET) before hematopoietic cell transplantation (HCT) for lymphoma may be prognostic for outcomes. Patients with chemotherapy-sensitive non-Hodgkin lymphoma (NHL) undergoing allogeneic HCT reported to the Center of International Blood and Marrow Transplantation Registry between 2007 and 2012 were included. Pre-HCT PET status (positive versus negative) was determined by the reporting transplantation centers. We analyzed 336 patients; median age was 55 years and 60% were males. Follicular lymphoma (n = 104) was more common than large cell (n = 85), mantle cell (n = 69), and mature natural killer or T cell lymphoma (n = 78); two thirds of the cohort received reduced-intensity conditioning; one half had unrelated donor grafts. Patients underwent PET scanning a median of 1 month (range, .07 to 2.83 months) before HCT; 159 were PET positive and 177 were PET negative. At 3 years, relapse/progression, progression-free survival (PFS), and overall survival (OS) in PET-positive versus PET-negative groups were 40% versus 26%; P = .007; 43% versus 47%; P = .47; and 58% versus 60%; P = .73, respectively. On multivariate analysis, a positive pretransplantation PET was associated with an increased risk of relapse/progression (risk ratio [RR], 1.86; P = .001) but was not associated with increased mortality (RR, 1.29, 95% confidence interval [CI], .96 to 1.7; P = .08), therapy failure (RR, 1.32; 95% CI, .95 to 1.84; P = .10), or nonrelapse mortality (RR, .75; 95% CI, .48 to 1.18; P = .22). PET status conferred no influence on graft-versus-host disease. A positive PET scan before HCT is associated with increased relapse risk but should not be interpreted as a barrier to a successful allograft. PET status does not appear to predict survival after allogeneic HCT for NHL.
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Affiliation(s)
- Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, Minnesota.
| | - Linda J Burns
- Health Services Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ginna G Laport
- Division of Bone Marrow Transplant, Stanford Hospital and Clinics, Stanford, California
| | - Görgün Akpek
- Stem Cell Transplantation and Cellular Therapy Program, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Edward Agura
- Blood and Marrow Transplant Services, Baylor University Medical Center, Dallas, Texas
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Samantha M Jaglowski
- Division of Hematology, The Ohio State University Medical Center, Columbus, Ohio
| | - Mitchell S Cairo
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Amanda F Cashen
- Department of BMT/Oncology, Barnes Jewish Hospital, St. Louis, Missouri
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - César O Freytes
- South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - 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
| | - Leona A Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Abraham S Kanate
- Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Adriana K Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Reinhold Munker
- Section of Hematology/Oncology, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - Alberto Mussetti
- S.C. Ematologia e Trapianto Midollo Osseo, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Maxim Norkin
- Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, Florida
| | - Tim D Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Jacob M Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Prakash Satwani
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Tanya Siddiqi
- Department of Hematology Oncology, City of Hope National Medical Center, Duarte, California
| | - Patrick J Stiff
- Department of Hematology/Oncology, Loyola University Medical Center, Chicago, Illinois
| | - Basem M William
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Anna M Sureda
- Servei d'Hematologia, Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain; Secretary, European Group for Blood and Marrow Transplantation
| | - Jeanette Carreras
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Advani RH, Hong F, Fisher RI, Bartlett NL, Robinson KS, Gascoyne RD, Wagner H, Stiff PJ, Cheson BD, Stewart DA, Gordon LI, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized Phase III Trial Comparing ABVD Plus Radiotherapy With the Stanford V Regimen in Patients With Stages I or II Locally Extensive, Bulky Mediastinal Hodgkin Lymphoma: A Subset Analysis of the North American Intergroup E2496 Trial. J Clin Oncol 2015; 33:1936-42. [PMID: 25897153 DOI: 10.1200/jco.2014.57.8138] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The phase III North American Intergroup E2496 Trial (Combination Chemotherapy With or Without Radiation Therapy in Treating Patients With Hodgkin's Lymphoma) compared doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) with mechlorethamine, doxorubicin, vincristine, bleomycin, vinblastine, etoposide, and prednisone (Stanford V). We report results of a planned subgroup analysis in patients with stage I or II bulky mediastinal Hodgkin lymphoma (HL). PATIENTS AND METHODS Patients were randomly assigned to six to eight cycles of ABVD every 28 days or Stanford V once per week for 12 weeks. Two to 3 weeks after completion of chemotherapy, all patients received 36 Gy of modified involved field radiotherapy (IFRT) to the mediastinum, hila, and supraclavicular regions. Patients on the Stanford V arm received IFRT to additional sites ≥ 5 cm at diagnosis. Primary end points were failure-free survival (FFS) and overall survival (OS). RESULTS Of 794 eligible patients, 264 had stage I or II bulky disease, 135 received ABVD, and 129 received Stanford V. Patient characteristics were matched. The overall response rate was 83% with ABVD and 88% with Stanford V. At a median follow-up of 6.5 years, the study excluded a difference of more than 21% in 5-year FFS and more than 16% in 5-year OS between ABVD and Stanford V (5-year FFS: 85% v 79%; HR, 0.68; 95% CI, 0.37 to 1.25; P = .22; 5-year OS: 96% v 92%; HR, 0.49; 95% CI, 0.16 to 1.47; P = .19). In-field relapses occurred in < 10% of the patients in each arm. CONCLUSION For patients with stage I or II bulky mediastinal HL, no substantial statistically significant differences were detected between the two regimens, although power was limited. To the best of our knowledge, this is the first prospective trial reporting outcomes specific to this subgroup, and it sets a benchmark for comparison of ongoing and future studies.
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Affiliation(s)
- Ranjana H Advani
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN.
| | - Fangxin Hong
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Richard I Fisher
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Nancy L Bartlett
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - K Sue Robinson
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Randy D Gascoyne
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Henry Wagner
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Patrick J Stiff
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Bruce D Cheson
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Douglas A Stewart
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Leo I Gordon
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Brad S Kahl
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Jonathan W Friedberg
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Kristie A Blum
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Thomas M Habermann
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Joseph M Tuscano
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Richard T Hoppe
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
| | - Sandra J Horning
- Ranjana H. Advani, Richard T. Hoppe, and Sandra J. Horning, Stanford University, Stanford; Joseph M. Tuscano, University of California, Davis Cancer Center, Sacramento, CA; Fangxin Hong, Dana-Farber Cancer Institute, Boston, MA; Richard I. Fisher and Jonathan W. Friedberg, University of Rochester, Rochester, NY; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; K. Sue Robinson, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia; Douglas A. Stewart, Tim Baker Cancer Institute, Calgary, Alberta, Canada; Henry Wagner Jr, Penn State Cancer Institute, Hershey, PA; Patrick J. Stiff, Loyola University Medical Center, Maywood; Leo I. Gordon, Northwestern University, Chicago, IL; Bruce D. Cheson, Georgetown University Hospital, Washington, DC; Brad S. Kahl, University of Wisconsin, Madison, WI; Kristie A. Blum, Ohio State University, Columbus, OH; and Thomas M. Habermann, Mayo Clinic, Rochester, MN
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48
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Othus M, Appelbaum FR, Petersdorf SH, Kopecky KJ, Slovak M, Nevill T, Brandwein J, Larson RA, Stiff PJ, Walter RB, Tallman MS, Stenke L, Erba HP. Fate of patients with newly diagnosed acute myeloid leukemia who fail primary induction therapy. Biol Blood Marrow Transplant 2014; 21:559-64. [PMID: 25536215 DOI: 10.1016/j.bbmt.2014.10.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 10/03/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study was to describe the fate of patients with newly diagnosed acute myeloid leukemia (AML) who did not achieve an initial remission while being treated on a contemporary cooperative group trial. We analyzed the outcome of patients entered into S0106, a recently reported cooperative group trial for patients with newly diagnosed AML. A total of 589 eligible patients was treated, of whom 150 (25%) did not achieve a remission while on study and were available for further analysis. The 4-year survival rate for the entire cohort of 150 patients was 23%. Among the 64 patients who received an allogeneic hematopoietic cell transplant, the 4-year survival rate was 48% compared with 4% for the 86 patients who did not undergo transplantation. Among those transplanted, we could not detect a difference in outcome according to remission status, donor source, type of preparative regimen, or cytogenetic risk category. More than 20% of patients with newly diagnosed AML who fail induction therapy can still be cured, particularly if they are able to receive an allogeneic hematopoietic cell transplant. These results suggest that early HLA typing and donor identification are important components of the initial therapy of AML.
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Affiliation(s)
- Megan Othus
- Public Health Sciences, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Frederick R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | | | - Kenneth J Kopecky
- Public Health Sciences, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Public Health Sciences, SWOG Statistical Center, Seattle, Washington
| | | | - Thomas Nevill
- Haematology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Richard A Larson
- Hematologic Malignancies, University of Chicago, Chicago, Illinois
| | - Patrick J Stiff
- Hematology/Oncology, Loyola University Medical Center, Maywood, Illinois
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Leif Stenke
- Karolinska University Hospital, Stockholm, Sweden
| | - Harry P Erba
- University of Alabama at Birmingham, Birmingham, Alabama
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49
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Abstract
Despite improved methods of cancer detection and disease management over the last few decades, cancer remains a major public health problem in many societies. Conventional therapies, such as chemotherapy, radiation, and surgery, are not usually sufficient to prevent disease recurrence. Therefore, efforts have been focused on developing novel therapies to manage metastatic disease and to prolong disease-free and overall survival, by modulating the immune system to alleviate immunosuppression, and to enhance antitumor immunity. This review discusses protumor mechanisms in patients that circumvent host immunosurveillance, and addresses current immunotherapy modalities designed to target these mechanisms. Given the complexity of cancer immunosuppressive mechanisms, we propose that identification of novel disease biomarkers will drive the development of more targeted immunotherapy. Finally, administration of different classes of immunotherapy in combination regimens, will be the ultimate route to impact low survival rates in advanced cancer patients.
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Affiliation(s)
- Maureen L Drakes
- Department of Medicine, Division of Hematology and Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Patrick J Stiff
- Department of Medicine, Division of Hematology and Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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50
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Hamadani M, Hari PN, Zhang Y, Carreras J, Akpek G, Aljurf MD, Ayala E, Bachanova V, Chen AI, Chen YB, Costa LJ, Fenske TS, Freytes CO, Ganguly S, Hertzberg MS, Holmberg LA, Inwards DJ, Kamble RT, Kanfer EJ, Lazarus HM, Marks DI, Nishihori T, Olsson R, Reddy NM, Rizzieri DA, Savani BN, Solh M, Vose JM, Wirk B, Maloney DG, Smith SM, Montoto S, Saber W, Alpdogan O, Cashen A, Dandoy C, Finke R, Gale R, Gibson J, Hsu JW, Janakiraman N, Laughlin MJ, Lill M, Cairo MS, Munker R, Rowlings PA, Schouten HC, Shea TC, Stiff PJ, Waller EK. Early failure of frontline rituximab-containing chemo-immunotherapy in diffuse large B cell lymphoma does not predict futility of autologous hematopoietic cell transplantation. Biol Blood Marrow Transplant 2014; 20:1729-36. [PMID: 25008330 DOI: 10.1016/j.bbmt.2014.06.036] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/30/2014] [Indexed: 12/21/2022]
Abstract
The poor prognosis for patients with diffuse large B cell lymphoma (DLBCL) who relapse within 1 year of initial diagnosis after first-line rituximab-based chemo-immunotherapy has created controversy about the role of autologous transplantation (HCT) in this setting. We compared autologous HCT outcomes for chemosensitive DLBCL patients between 2000 and 2011 in 2 cohorts based on time to relapse from diagnosis. The early rituximab failure (ERF) cohort consisted of patients with primary refractory disease or those with first relapse within 1 year of initial diagnosis. The ERF cohort was compared with those relapsing >1 year after initial diagnosis (late rituximab failure [LRF] cohort). ERF and LRF cohorts included 300 and 216 patients, respectively. Nonrelapse mortality (NRM), progression/relapse, progression-free survival (PFS), and overall survival (OS) of ERF versus LRF cohorts at 3 years were 9% (95% confidence interval [CI], 6% to 13%) versus 9% (95% CI, 5% to 13%), 47% (95% CI, 41% to 52%) versus 39% (95% CI, 33% to 46%), 44% (95% CI, 38% to 50%) versus 52% (95% CI, 45% to 59%), and 50% (95% CI, 44% to 56%) versus 67% (95% CI, 60% to 74%), respectively. On multivariate analysis, ERF was not associated with higher NRM (relative risk [RR], 1.31; P = .34). The ERF cohort had a higher risk of treatment failure (progression/relapse or death) (RR, 2.08; P < .001) and overall mortality (RR, 3.75; P <.001) within the first 9 months after autologous HCT. Beyond this period, PFS and OS were not significantly different between the ERF and LRF cohorts. Autologous HCT provides durable disease control to a sizeable subset of DLBCL despite ERF (3-year PFS, 44%) and remains the standard-of-care in chemosensitive DLBCL regardless of the timing of disease relapse.
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Affiliation(s)
- Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ying Zhang
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeanette Carreras
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Görgün Akpek
- Section of Hematology Oncology at Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Mahmoud D Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - Ernesto Ayala
- Blood and Marrow Transplantation Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Andy I Chen
- Blood and Marrow Transplant Program, Oregon Health and Science University, Portland, Oregon
| | - Yi-Bin Chen
- Department of BMT, Massachusetts General Hospital, Boston, Massachusetts
| | - Luciano J Costa
- Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, South Carolina
| | - Timothy S Fenske
- Division of Hematology and Oncology, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - César O Freytes
- Blood and Marrow Transplant Program, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Siddhartha Ganguly
- BMT Program, Saint Luke's Blood & Marrow Transplant Program, Westwood, Kansas
| | - Mark S Hertzberg
- Department of Haematology, Westmead Hospital, Westmead, NSW, Australia
| | - Leona A Holmberg
- Department of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Rammurti T Kamble
- Department of Hematology/Oncology, Baylor College of Medicine and the Center for Cell and Gene Therapy, Houston, Texas
| | - Edward J Kanfer
- Department of Hematology, Imperial College NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Hillard M Lazarus
- Blood and Marrow Transplant Program, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - David I Marks
- Adult BMT Unit, University Hospitals Britol NHS Trust, Bristol, United Kingdom
| | - Taiga Nishihori
- Blood and Marrow Transplantation Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Richard Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Nishitha M Reddy
- Blood and Marrow Transplant Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina
| | - Bipin N Savani
- Blood and Marrow Transplant Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melhem Solh
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Julie M Vose
- Department of Internal Medicine, The Nebraska Medical Center, Omaha, Nebraska
| | - Baldeep Wirk
- BMT Program, Stony Brook University Medical Center, Stony Brook, New York
| | - David G Maloney
- Department of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Silvia Montoto
- Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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