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Miller EG, Pietrzak M, Pearson R, Brammer JE, de Lima M, Jaglowski S, Penza S, Vasu S, Wall SA, Lozanski G, Choe H. Evaluating Diversity of Tcrvb Repertoire and Steroid Responsiveness in Acute Graft Versus Host Disease. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Faisal MS, Hanel W, Voorhees T, Li R, Huang Y, Khan A, Bond D, Sawalha Y, Reneau J, Alinari L, Baiocchi R, Christian B, Maddocks K, Efebera Y, Penza S, Saad A, Brammer J, DeLima M, Jaglowski S, Epperla N. Outcomes associated with allogeneic hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma in the era of novel agents. Cancer Med 2023; 12:8228-8237. [PMID: 36653918 PMCID: PMC10134314 DOI: 10.1002/cam4.5631] [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: 08/19/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Relapsed or refractory Hodgkin lymphoma (R/R HL) is a challenging disease with limited treatment options beyond brentuximab vedotin and checkpoint inhibitors. Herein we present the time-trend analysis of R/R HL patients who received allogeneic hematopoietic cell transplantation (allo-HCT) at our center from 2001-2017. METHODS The patients were divided into two distinct treatment cohorts: era1 (2001-2010), and era2 (2011-2017). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), non-relapse mortality (NRM), and cumulative incidence of acute and chronic graft versus host disease (GVHD). RESULTS Among the 51 patients included in the study, 29 were in era1, and 22 were in era2. There was decreased use of myeloablative conditioning in era2 (18% vs. 31%) compared to era1 and 95% of patients in era2 previously received brentuximab Vedotin (BV). Haploidentical donors were seen exclusively in era2 (0% vs. 14%) and more patients received alternative donor transplants (7% vs. 32%) in era2. The 4-year OS (34% vs. 83%, p < 0.001) and 4-year PFS (28% vs. 62%, p = 0.001) were significantly inferior in era1 compared to era2. The incidence of 1-year NRM was lower in era2 compared to era1 (5% vs. 34%, p = 0.06). The cumulative incidence of acute GVHD at day 100 was similar in both eras (p = 0.50), but the incidence of chronic GVHD at 1 year was higher in era2 compared to era1 (55% vs. 21%, p = 0.03). CONCLUSIONS Despite the advent of novel therapies, allo-HCT remains an important therapeutic option for patients with R/R HL.
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Affiliation(s)
- Muhammad Salman Faisal
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology and Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Walter Hanel
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Timothy Voorhees
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Rui Li
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Ying Huang
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Abdullah Khan
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - David Bond
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Yazeed Sawalha
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - John Reneau
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Lapo Alinari
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Robert Baiocchi
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Beth Christian
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Kami Maddocks
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Yvonne Efebera
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology and Oncology, OhioHealth Bing Cancer Center, Columbus, Ohio, USA
| | - Sam Penza
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Ayman Saad
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Brammer
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Marcos DeLima
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Samantha Jaglowski
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Narendranath Epperla
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
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Jiang J, Sigmund AM, Zhao Q, Elder P, Benson DM, Vasu S, Jaglowski S, Mims A, Choe H, Larkin K, Brammer JE, Wall S, Grieselhuber N, Saad A, Penza S, Efebera YA, Sharma N. Longitudinal Survival Outcomes in Allogeneic Stem Cell Transplantation: An Institutional Experience. Cancers (Basel) 2022; 14:cancers14225587. [PMID: 36428678 PMCID: PMC9688916 DOI: 10.3390/cancers14225587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a potentially curative treatment for many hematological disorders, but is often complicated by relapse of the underlying disease, graft-versus-host disease (GVHD), and infectious complications. We conducted a retrospective analysis on patients undergoing allo-SCT from 1984 to 2018 to better understand how survival has changed longitudinally with therapeutic advancements made to mitigate these complications. Method: We analyzed data from 1943 consecutive patients who received allo-SCT. Patients were divided into groups (gps) based on the year (yr) of transplant. Primary endpoints were overall survival (OS), progression free survival (PFS), and GVHD-free relapse-free survival (GRFS). Secondary endpoints were the cumulative incidences of grade II−IV and grade III−IV acute GVHD (aGVHD), chronic GVHD (cGVHD), and non-relapse mortality (NRM). Results: Our study found statistically significant improvements in OS, PFS, and GRFS. Five-year PFS among the groups increased from 24% to 48% over the years. Five-year OS increased from 25% to 53%. Five-year GRFS significantly increased from 6% to 14%, but remained relatively unchanged from 2004 to 2018. Cumulative incidences of grade II−IV aGVHD increased since 2009 (p < 0.001). However, cumulative incidence of NRM decreased since 2004 (p < 0.001). Conclusions: Our data show improved OS, PFS, and GRFS post allo-SCT over decades. This may be attributed to advances in supportive care and treatments focused on mitigation of GVHD and relapse.
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Affiliation(s)
- Justin Jiang
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Audrey M. Sigmund
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Qiuhong Zhao
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Patrick Elder
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Don M. Benson
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Sumithira Vasu
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Samantha Jaglowski
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Alice Mims
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Hannah Choe
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Karilyn Larkin
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Jonathan E. Brammer
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Sarah Wall
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Nicole Grieselhuber
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Ayman Saad
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Sam Penza
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Yvonne A. Efebera
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
- Division of Hematology, Blood and Marrow Transplant, OhioHealth, Columbus, OH 43214, USA
| | - Nidhi Sharma
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
- Correspondence:
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Sigmund AM, Denlinger N, Huang Y, Bond D, Voorhees T, Bajwa A, Elder P, Brammer JE, Saad A, Penza S, Vasu S, de Lima M, Jaglowski S, Kittai AS. Assessment of Salvage Regimens Post CAR-T Cell Therapy for Patients with Diffuse Large B-Cell Lymphoma. Transplant Cell Ther 2022; 28:342.e1-342.e5. [PMID: 35248778 DOI: 10.1016/j.jtct.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anti-CD19 chimeric antigen receptor T-cell therapy (CAR19) represents a critical treatment modality for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). However, the majority of patients will subsequently experience disease progression following CAR19 and there is limited data assessing the best salvage regimen for these patients. OBJECTIVE To evaluate outcomes in DLBCL patients with progressive disease post CAR19 and to assess variables that predict response to salvage therapy. STUDY DESIGN We performed a retrospective analysis of all patients with DLBCL who received CAR19 at our institution from January 2018 to February 2021. Demographics, disease characteristics, best response to CAR19, date of relapse or progression, and first salvage therapy and response to salvage were also collected. We analyzed patients according to whether they responded to CAR19 (responders) or did not (non-responders). Salvage regimens were classified into 6 groups for analysis. Primary endpoints included overall survival (OS) and progression free survival (PFS), calculated using the Kaplan Meier method. Cox models were fit to evaluate the effect of prognostic factors. RESULTS Of the 120 patients who received CAR19 during the analysis period, 69 patients achieved a CR/PR to CAR19 (responders), 44 patients achieved SD/PD to CAR19, and 7 died before assessment (51 non-responders). 30 responders relapsed and 26 received salvage therapy, while 24 non-responders received salvage. The primary salvage regimens that were utilized included lenalidomide-based regimens (n=17, 34%), BTKi (n=10, 20%), checkpoint inhibitor based (n=7, 14%), chemo-immunotherapy (n=5, 10%), allo (n=5, 10%), and other (n=6, 12%). There was no significant difference in OS based on salvage regimen (p=0.4545). Responders who received salvage had significantly longer OS compared to non-responders (median OS not reached vs. 10.9 months; p=0.0187), and response to CAR19 and elevated lactate dehydrogenase (LDH) level at time of salvage treatment were the only two statistically significant prognostic factors after accounting for other variables. CONCLUSION Outcomes for responders to CAR19 are significantly better with salvage therapy as compared to non-responders to CAR19. There was no significant difference in outcomes seen based on salvage regimen in our study. Future research is needed to assess the best salvage regimen post CAR19 failure.
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Affiliation(s)
- Audrey M Sigmund
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Nathan Denlinger
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Ying Huang
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - David Bond
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Timothy Voorhees
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Amneet Bajwa
- Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Jonathan E Brammer
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Ayman Saad
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Sam Penza
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Marcos de Lima
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Samantha Jaglowski
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Adam S Kittai
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
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Vasu S, Kromer M, Zhao Q, Choe H, Larkin K, Wall SA, Jaglowski S, Penza S, Brammer JE, Sharma N, Jacob N, De Lima M, Welliver M. Utilizing Organ-Sparing Marrow Irradiation to Condition Patients Prior to Allogeneic Hematopoietic Cell Transplant with High-Risk Hematologic Malignancies: Results of a Pilot Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00461-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sigmund AM, Jiang J, Zhao Q, Elder P, Rosko A, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, De Lima M, Benson DM, Efebera Y, Sharma N. Allogenic Transplantation in Older Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00303-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sigmund AM, Zhao Q, Jiang J, Elder P, Benson DM, Rosko A, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, Mims A, Choe H, Larkin K, Brammer J, Wall S, Grieselhuber N, Saad A, Penza S, Efebera YA, Sharma N. Impact of Race and Geographic Area of Residence on Outcomes After Allogeneic Stem Cell Transplant. Front Oncol 2022; 12:801879. [PMID: 35280722 PMCID: PMC8913574 DOI: 10.3389/fonc.2022.801879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Allogeneic hematopoietic stem cell transplant (allo-HCT) is a potential curative therapy for a variety of hematologic disorders. However, it requires highly specialized care that is only available at select centers across the country. Thus, minority populations are at risk for healthcare disparities in access to and outcomes of allo-HCT. Our study aimed to assess the impact of race and location of residence on outcomes of allo-HCT. Methods We performed a retrospective analysis of all patients who underwent allo-HCT at the Ohio State University from 1984 to 2018. Patients were divided by race (Caucasian, African American, and other) and grouped by zip code into rural, suburban, and urban groups. Primary endpoints included progression-free survival (PFS) and overall survival (OS). Results Of the 1,943 patients included in the study, 94.3% self-identified as Caucasian, 4.6% African American, and 1.1% other. In total, 63.4% lived in rural areas, 22.9% suburban, and 13.8% urban. There was no significant difference in OS or PFS by race (p = 0.15, 0.21) or place of residence (p = 0.39, 0.17). In addition, no difference in nonrelapse mortality, acute and chronic graft-versus-host disease (GVHD), and GVHD-free relapse-free survival (GRFS) was seen among the race or place of residence. Conclusion Our study suggests that when appropriate access to HCT is given, there is no difference in outcomes based on race, ethnicity or place of primary residence. Further research is needed to further evaluate barriers for these patients to undergo transplant and help mitigate these barriers.
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Affiliation(s)
- Audrey M. Sigmund
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Justin Jiang
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Don M. Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Ashley Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Naresh Bumma
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Abdullah Khan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Srinivas Devarakonda
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Samantha Jaglowski
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Alice Mims
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Hannah Choe
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Karilyn Larkin
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Jonathan Brammer
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Sarah Wall
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Nicole Grieselhuber
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Ayman Saad
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Sam Penza
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Yvonne A. Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Nidhi Sharma
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
- *Correspondence: Nidhi Sharma,
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Bajwa A, Huang Y, Li R, Denlinger N, Brammer J, Penza S, Saad A, Jaglowski S, Kittai AS. Prognostic value of early imaging following CAR-T cell therapy in diffuse large B-cell lymphoma. Leuk Lymphoma 2022; 63:1492-1495. [PMID: 35109749 DOI: 10.1080/10428194.2022.2032039] [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: 10/19/2022]
Affiliation(s)
- Amneet Bajwa
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Rui Li
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Nathan Denlinger
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jonathan Brammer
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Sam Penza
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Ayman Saad
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, OH, USA
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Schaefer A, Huang Y, Kittai A, Maakaron JE, Saygin C, Brammer J, Penza S, Saad A, Jaglowski SM, William BM. Cytopenias After CD19 Chimeric Antigen Receptor T-Cells (CAR-T) Therapy for Diffuse Large B-Cell Lymphomas or Transformed Follicular Lymphoma: A Single Institution Experience. Cancer Manag Res 2021; 13:8901-8906. [PMID: 34876852 PMCID: PMC8643129 DOI: 10.2147/cmar.s321202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) have poor outcomes. Treatment with CD19 chimeric antigen receptor (CAR-T) cells, tisagenlecleucel and axicabtagene ciloleucel, has been associated with improved outcomes. Cytopenias were observed in clinical trials with both products; however, little is known regarding the patterns and outcomes of these cytopenias. SUBJECTS AND METHODS We reviewed DLBCL patients (n=32) receiving either product between January and September 2018 at our institution. RESULTS Median duration of leukopenia, neutropenia, lymphopenia, anemia, and thrombocytopenia was 49, 9, 117.5, 125, and 95.5 days after CAR-T infusion, respectively. Filgrastim was used in 63% of patients, and 50% of patients received red cell or platelet transfusions. With the exception of neutropenia, increase in the duration of cytopenia of any lineage was associated with improvement in progression-free survival, and in overall survival in case of anemia. There was no association between the duration of cytopenias with either cytokine release syndrome or neurotoxicity. DISCUSSION Our data suggest a correlation between cytopenias and survival outcomes after CD19 CAR-T therapy. If validated, cytopenia may be proven useful as a biomarker of response and survival after CAR-T therapy.
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Affiliation(s)
- Andrew Schaefer
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Ying Huang
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Adam Kittai
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Joseph E Maakaron
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Caner Saygin
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Jonathan Brammer
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Sam Penza
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ayman Saad
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Basem M William
- OhioHealth Blood and Marrow Transplant Program, Columbus, OH, USA
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Brammer JE, Braunstein Z, Katapadi A, Porter K, Biersmith M, Guha A, Vasu S, Yildiz VO, Smith SA, Buck B, Haddad D, Gumina R, William BM, Penza S, Saad A, Denlinger N, Vallakati A, Baliga R, Benza R, Binkley P, Wei L, Mocarski M, Devine SM, Jaglowski S, Addison D. Early toxicity and clinical outcomes after chimeric antigen receptor T-cell (CAR-T) therapy for lymphoma. J Immunother Cancer 2021; 9:e002303. [PMID: 34429331 PMCID: PMC8386216 DOI: 10.1136/jitc-2020-002303] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Accepted: 07/09/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Chimeric antigen receptor T-cell (CAR-T) infusion is associated with early toxicity. Yet, whether early toxicity development holds ramifications for long-term outcomes is unknown. METHODS From a large cohort of consecutive adult patients treated with CAR-T therapies for relapsed or refractory lymphomas from 2016 to 2019, we assessed progression-free survival (PFS), by toxicity development (cytokine release syndrome (CRS), neurotoxicity, or cardiotoxicity]. We also assessed the relationship of toxicity development to objective disease response, and overall survival (OS). Multivariable regression was utilized to evaluate relationships between standard clinical and laboratory measures and disease outcomes. Differences in outcomes, by toxicity status, were also assessed via 30-day landmark analysis. Furthermore, we assessed the effects of early anti-CRS toxicity therapy use (at ≤grade 2 toxicity) on maximum toxicity grade observed, and long-term disease outcomes (PFS and OS). RESULTS Overall, from 102 CAR-T-treated patients, 90 were identified as treated with single-agent therapy, of which 88.9% developed toxicity (80 CRS, 41 neurotoxicity, and 17 cardiotoxicity), including 28.9% with high-grade (≥3) events. The most common manifestations were hypotension at 96.6% and fever at 94.8%. Among patients with cardiac events, there was a non-significant trend toward a higher prevalence of concurrent or preceding high-grade (≥3) CRS. 50.0% required tocilizumab or corticosteroids. The median time to toxicity was 3 days; high grade CRS development was associated with cardiac and neurotoxicity. In multivariable regression, accounting for disease severity and traditional predictors of disease response, moderate (maximum grade 2) CRS development was associated with higher complete response at 1 year (HR: 2.34; p=0.07), and longer PFS (HR: 0.41; p=0.02, in landmark analysis), and OS (HR: 0.43; p=0.03). Among those with CRS, relative blood pressure (HR: 2.25; p=0.004), respectively, also associated with improved PFS. There was no difference in disease outcomes, or maximum toxicity grade (CRS, neurotoxicity, or cardiotoxicity) observed, based on the presence or absence of the use of early CRS-directed therapies. CONCLUSIONS Among adult lymphoma patients, moderate toxicity manifest as grade 2 CRS after CAR-T infusion may associate with favorable clinical outcomes. Further studies are needed to confirm these findings.
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Affiliation(s)
- Jonathan E Brammer
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Zachary Braunstein
- Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Aashish Katapadi
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Biersmith
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Cardiology, University Hospitals Harrington Heart & Vascular Institute, Cleveland, Ohio, USA
| | - Sumithira Vasu
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Vedat O Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sakima A Smith
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Benjamin Buck
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Devin Haddad
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard Gumina
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Basem M William
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Sam Penza
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Ayman Saad
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Nathan Denlinger
- Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Ajay Vallakati
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ragavendra Baliga
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Raymond Benza
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Philip Binkley
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mason Mocarski
- Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Samantha Jaglowski
- Bone Marrow Transplantation and Cellular Therapies Program, Division of Hematology, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Division of Cancer Control and Prevention, The Ohio State University James Cancer Hospital, Columbus, Ohio, USA
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11
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Sharma N, Faisal MS, Zhao Q, Jiang J, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, Mims AS, Choe H, Larkin K, Brammer JE, Wall S, Grieselhuber N, Saad A, Penza S, Sigmund AM, Efebera YA. Outcomes of Bone Marrow Compared to Peripheral Blood for Haploidentical Transplantation. J Clin Med 2021; 10:jcm10132843. [PMID: 34199028 PMCID: PMC8268935 DOI: 10.3390/jcm10132843] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) from a haploidentical (haplo) donor has emerged as a suitable alternative in the absence of a matched donor. However, haplo-HCT patients have a higher risk of graft-versus-host disease (GVHD). Hence, bone marrow (BM) stem cell source and post-transplant cyclophosphamide (PTCy) have been routinely used to help mitigate this. Due to ease of collection, peripheral blood (PB) stem cells are increasingly being considered for haplo-HCT. We retrospectively analyzed 74 patients (42 BM and 32 PB) who underwent haplo-HCT at Ohio State University from 2009 to 2018. Median age at transplant was 60 years (yrs) for BM and 54 yrs for PB, (p = 0.45). There was no difference in OS (p = 0.13) and NRM (p = 0.75) as well as PFS (p = 0.10) or GRFS (p = 0.90) between the groups. The BM cohort showed a 3-year OS rate of 63% (95% confidence interval (CI): 46–76), and 3-year PFS of 49% (95% CI: 33–63). For the PB group, 3-year OS and PFS were 78% (95% CI: 59–89) and 68% (95% CI: 49–82), respectively. There were no differences in the incidence of acute GVHD (grade II-IV) (p = 0.31) and chronic GVHD (p = 0.18). Patients receiving BM had a significantly higher risk for relapse with relapse rates by 2 years at 36% (95% CI: 22–50) vs. 16% (95% CI: 6–31) for PB (p = 0.03). The findings from this study suggest that PB is an excellent alternative to BM for haplo-HCT.
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Affiliation(s)
- Nidhi Sharma
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
- Correspondence:
| | - Muhammad Salman Faisal
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Justin Jiang
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Don M. Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Ashley Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Maria Chaudhry
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Naresh Bumma
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Abdullah Khan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Srinivas Devarakonda
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Samantha Jaglowski
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Alice S. Mims
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Hannah Choe
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Karilyn Larkin
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Jonathan E. Brammer
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Sarah Wall
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Nicole Grieselhuber
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Ayman Saad
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Sam Penza
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Audrey M. Sigmund
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
| | - Yvonne A. Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (M.S.F.); (Q.Z.); (P.E.); (D.M.B.); (A.R.); (M.C.); (N.B.); (A.K.); (S.D.); (S.V.); (S.J.); (A.S.M.); (H.C.); (K.L.); (J.E.B.); (S.W.); (N.G.); (A.S.); (S.P.); (A.M.S.); (Y.A.E.)
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Rasor B, Dickerson T, Zhao Q, Elder P, Brammer JE, Larkin K, Jaglowski S, Mims A, Penza S, Vasu S, Wall SA, William B, Saad A, Roddy JVF, Choe H, Puto M. Comparison of fixed dose reduced-intensity conditioning with fludarabine and busulfan to PK-guided busulfan AUC (FluBu4K) in hematopoietic stem cell transplant for AML/MDS. Leuk Lymphoma 2021; 62:944-951. [PMID: 33231122 PMCID: PMC8012251 DOI: 10.1080/10428194.2020.1849677] [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: 08/01/2020] [Revised: 11/01/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
A retrospective cohort study was conducted to assess differences in efficacy and tolerability between a busulfan AUC target of 16.4 mg × Hr/L per day (FluBu4K) and a conventional RIC regimen (FluBu2). Adult patients with a diagnosis of AML or MDS who received fludarabine + busulfan conditioning with or without antithymocyte globulin between 2015 and 2018 were included. The primary outcome was relapse free survival. Overall, 74 patients received conditioning with either FluBu4K or FluBu2. At 18 months, relapse-free survival was not significantly different, at 63.9% with FluBu4k compared to 57.5% with FluBu2 (p = 0.49). There was a statistically significant difference in the cumulative incidence of relapse at 18 months in favor of the FluBu4K regimen, at 12.0% vs 32.5% (p = 0.047). The results of this study indicate that for select patients, there may be benefit in choosing targeted FluBu4K over FluBu2. Adverse effects other than mucositis were not significantly different.
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Affiliation(s)
- Brendan Rasor
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Pharmacy, Kettering Health Network, Kettering, OH, USA
| | - Tyler Dickerson
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jonathan E Brammer
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Karilyn Larkin
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samantha Jaglowski
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alice Mims
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sam Penza
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sarah A Wall
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Basem William
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ayman Saad
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julianna V F Roddy
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hannah Choe
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marcin Puto
- Department of Pharmacy, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Maakaron J, Zhao Q, Balakrishna J, Puto M, Penza S, Brammer JE, Reneau JC, Christian B, Maddocks K, Efebera Y, Rosko A, Saad A, Jaglowski S, William BM. Phase I Dose-Escalation Study of Venetoclax Plus BEAM Followed By Autologous Stem Cell Transplant (ASCT) for Chemoresistant or High-Risk Relapsed/Refractory Non-Hodgkin Lymphoma (NHL): Adding Steam to ASCT. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sigmund AM, Jiang J, Zhao Q, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Efebera YA, Sharma N. Trends in Survival of AML and MDS Patients Following Allogeneic Transplant. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Soror N, Keiter A, Zhao Q, Elder P, Puto M, Penza S, Brammer JE, Efebera YA, Benson DM, Vasu S, Mims A, Blaser B, Choe H, Larkin K, Grieselhuber N, Wall SA, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Saad A, Jaglowski S, William BM. Impact of Opioid Use after Blood and Marrow Transplantation (BMT): A Single-Center Analysis. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00492-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sharma N, Jiang J, Zhao Q, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Sigmund AM, Efebera YA. Impact of Bone Marrow Versus Peripheral Blood on Outcomes in Haploidentical Transplantation. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00308-0] [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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Jiang J, Sigmund AM, Zhao Q, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Efebera YA, Sharma N. Longitudinal Survival Outcomes in Allogeneic Stem Cell Transplantation: An Institutional Experience. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00187-1] [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: 11/26/2022]
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Jiang J, Zhao Q, Sigmund AM, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Efebera YA, Sharma N. Impact of Chronic Graft-Versus-Host Disease on Non-Relapse Mortality and Survival. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wall SA, Huang Y, Keiter A, Kloock C, Yuhasz N, Funderburg A, Presley C, Folefac E, Vasu S, Jaglowski S, Saad A, Larkin K, Penza S, Benson DM, Rosko A. Increasing Number of Geriatric Assessment-Identified Deficits Associated with Non-Receipt of Transplant Among Older Adults. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00565-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Grana A, Gut N, Williams K, Maakaron J, Porter K, William BM, Vasu S, Penza S, Brammer JE, Saad A, Puto M, Jaglowski SM, Roddy J. Safety of Axicabtagene Ciloleucel for the Treatment of Relapsed or Refractory Large B-Cell Lymphoma. Clin Lymphoma Myeloma Leuk 2020; 21:238-245. [PMID: 33132101 DOI: 10.1016/j.clml.2020.10.005] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma. Recent advances in immunotherapy have resulted in the development of chimeric antigen receptor-modified T-cell (CAR-T) therapy, such as axicabtagene ciloleucel (axi-cel). However, axi-cel administration is not without risks of toxicity. PATIENTS AND METHODS This retrospective study of 37 patients with relapsed or refractory diffuse large B-cell lymphoma evaluated the incidence and severity of common and severe safety events after axi-cel treatment in a real-world setting. Ninety percent of patients had received 3 or more prior lines of therapy (median prior therapies 3, range 2-7) before receiving CAR-T therapy, and 32.4% had relapsed after prior stem-cell transplantation. RESULTS All but one patient experienced cytokine release syndrome (CRS) of any grade (97.3%). Of those 36 patients, 83.3% experienced maximum CRS grade of 1 or 2, occurring after a median of 27 hours and persisting for a median of 6 days. Twenty-seven patients (73.0%) experienced neurotoxicity of any grade. Of those 27 patients, 96.3% experienced maximum neurotoxicity grade of 2 or higher, occurring after a median of 145 hours (6 days) and persisting for a median of 7 days. All 10 patients aged 65 or older had neurotoxicity of grade 2 or higher, compared to 59.3% (11/27) under age 65 (P = .02). Patients with baseline Eastern Cooperative Oncology Group performance status score of 2 were significantly more likely to have shorter time to neurotoxicity compared to patients with performance status of 0 (P = .01). CONCLUSION With more real-life experience and data, we will be able to define and refine management of toxicities unique to CAR-T therapy.
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Affiliation(s)
- Allison Grana
- The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Natalia Gut
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Kiersten Williams
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Joseph Maakaron
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Kyle Porter
- Center of Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Basem M William
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Sumithira Vasu
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Sam Penza
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Jonathan E Brammer
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Ayman Saad
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Marcin Puto
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Samantha M Jaglowski
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
| | - Julianna Roddy
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
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21
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Maakaron JE, Liscynesky C, Boghdadly ZE, Huang Y, Agyeman A, Brammer J, Penza S, Efebera Y, Benson D, Rosko A, William B, Jaglowski SM. Fluoroquinolone Prophylaxis in Autologous Stem Cell Transplantation: Worthy of a Second Look. Biol Blood Marrow Transplant 2020; 26:e198-e201. [PMID: 32304873 DOI: 10.1016/j.bbmt.2020.03.027] [Citation(s) in RCA: 7] [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] [Received: 12/31/2019] [Revised: 02/16/2020] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
Abstract
Prophylaxis with fluoroquinolone (FQ) for patients undergoing autologous stem cell transplantation (ASCT) remains controversial. We performed a retrospective review of patients undergoing ASCT with and without bacterial prophylaxis to compare endpoints of interest. In accordance with institutional policy, patients undergoing ASCT for multiple myeloma routinely receive levofloxacin prophylaxis during their period of neutropenia, whereas patients undergoing the ASCT for lymphoma do not. We retrospectively examined patients with multiple myeloma (MM) or lymphoma undergoing ASCT between July 2015 and July 2018 for evidence of positive blood cultures. A total of 172 patients underwent ASCT for lymphoma and 343 underwent ASCT for MM. The 2 cohorts were similar in terms of baseline characteristics. Almost 20% (35 of 172) of the patients with lymphoma and 5.2% (18 of 342) of those with MM had a bloodstream infection (BSI). BSI occurred an average of 2 days earlier in patients with lymphoma compared with patients with MM (day +5 versus day +7; P = .0003). The 2 cohorts recovered absolute neutrophil count at the same time. Hospital length of stay was 2 days shorter for patients with MM (median, 20 days versus 18 days; P = .01). The majority of the organisms were gram-negative in both cohorts. Of the organisms commonly tested for FQ sensitivity, only 1 of 25 was resistant in the lymphoma cohort, compared with 7 of 9 in the MM cohort (P < .0001), with 4 being multidrug resistant. The odds of developing a BSI were 4.6 times greater in the lymphoma cohort compared with the MM cohort (95% confidence interval [CI], 2.52 to 8.40; P < .0001). In total, 23 of 172 patients with lymphoma (13.4%) and 28 of 342 patients with MM (8.2%) developed Clostridium difficile infection (odds ratio, 1.73; 95% CI, .96 to 3.11; P = .066). Two infection-related deaths occurred in the MM cohort. Our data indicate that FQ prophylaxis reduces the risk of BSI in patients undergoing ASCT but increases the incidence of resistant organisms. We recommend routine antimicrobial prophylaxis in patients undergoing ASCT to reduce the risk of BSI, along with a systematic and regular review of outcomes.
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Affiliation(s)
- Joseph E Maakaron
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Christina Liscynesky
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Zeinab El Boghdadly
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Ying Huang
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Akwasi Agyeman
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Jonathan Brammer
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Sam Penza
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Yvonne Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Don Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Ashley Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Basem William
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Samantha M Jaglowski
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
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22
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Rasor B, Dickerson T, Zhao Q, Brammer JE, Larkin K, Jaglowski S, Mims A, Penza S, Vasu S, Wall SA, William BM, Saad A, Roddy J, Choe H, Puto M. Comparison of Fixed Dose, Reduced-Intensity Conditioning with Busulfan and Fludarabine to Reduced PK-Guided Busulfan AUC Conditioning in Patients Undergoing Hematopoietic Stem Cell Transplant for AML/MDS. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.709] [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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23
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Denlinger N, Braunstein Z, Agyeman A, Purdin Z, Neal A, Yucebay F, Roddy J, Brammer JE, Saad A, Penza S, William BM, Vasu S, Huang Y, Jaglowski S. CAR T-Cell Therapy: Clinical Outcomes, Patient Selection and Financial Metrics with Tisagenlecleucel and Axicabtagene Ciloleucel, a Single Center Experience. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.432] [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: 10/25/2022]
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24
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Sharma N, Ni Ni B, Zhao Q, Elder P, Benson DM, Rosko A, Chaudhry M, Bumma N, Khan A, Devarakonda S, Vasu S, Jaglowski S, William BM, Mims A, Choe H, Larkin K, Brammer JE, Wall SA, Grieselhuber N, Saad A, Penza S, Efebera YA. Relationship of Tacrolimus Concentration and Incidence of Acute Graft-Versus-Host Disease after Allogenic Stem Cell Transplantation. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.730] [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: 11/28/2022]
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25
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Ozga MP, Schaefer A, Huang Y, Parekh H, Penza S, Brammer JE, Efebera YA, Benson DM, Vasu S, Mims A, Blaser B, Choe H, Larkin K, Grieselhuber N, Wall SA, Lozanski G, Jaglowski S, Saad A, William BM. Predictors of Relapse after Haploidentical Hematopoietic Progenitor Cell Transplantation (Haplo-HCT); A Single-Institution Experience. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Brammer JE, Braunstein Z, Katapadi A, Porter K, Biersmith M, Guha A, Smith SA, Vasu S, Haddad D, Gumina R, William BM, Penza S, Saad A, Denlinger N, Vallakati A, Baliga R, Binkley P, Jaglowski S, Addison D. Cardiovascular Toxicity and Clinical Outcomes Following Chimeric Antigen Receptor T-Cell Infusion (CART) for Lymphoid Malignancies. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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Maakaron J, Zhao Q, Puto M, Von Derau R, Robinson J, Brammer J, Penza S, Baiocchi R, Christian B, Maddocks K, Saad A, Wall S, Benson D, Efebera Y, Rosko A, Ayyappan S, Grieselhuber N, Vasu S, Larkin K, Epperla N, Devarakonda S, Choe H, Chaudhry M, Blaser B, Blachly J, Bhatnagar B, Alinari L, Mims A, Jaglowski S, William B. PHASE I DOSE-ESCALATION STUDY OF VENETOCLAX PLUS BEAM FOLLOWED BY AUTOLOGOUS STEM CELL TRANSPLANT (ASCT) FOR CHEMORESISTANT, RELAPSED/REFRACTORY, OR HIGH-RISK NON-HODGKIN'S LYMPHOMA (NHL); PRELIMINARY RESULTS. Hematol Oncol 2019. [DOI: 10.1002/hon.213_2631] [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: 11/12/2022]
Affiliation(s)
- J. Maakaron
- Hematology; The Ohio State University; Columbus United States
| | - Q. Zhao
- Hematology; The Ohio State University; Columbus United States
| | - M. Puto
- Hematology; The Ohio State University; Columbus United States
| | - R. Von Derau
- Hematology; The Ohio State University; Columbus United States
| | - J. Robinson
- Hematology; The Ohio State University; Columbus United States
| | - J. Brammer
- Hematology; The Ohio State University; Columbus United States
| | - S. Penza
- Hematology; The Ohio State University; Columbus United States
| | - R. Baiocchi
- Hematology; The Ohio State University; Columbus United States
| | - B. Christian
- Hematology; The Ohio State University; Columbus United States
| | - K. Maddocks
- Hematology; The Ohio State University; Columbus United States
| | - A. Saad
- Hematology; The Ohio State University; Columbus United States
| | - S. Wall
- Hematology; The Ohio State University; Columbus United States
| | - D. Benson
- Hematology; The Ohio State University; Columbus United States
| | - Y. Efebera
- Hematology; The Ohio State University; Columbus United States
| | - A. Rosko
- Hematology; The Ohio State University; Columbus United States
| | - S. Ayyappan
- Hematology; The Ohio State University; Columbus United States
| | - N. Grieselhuber
- Hematology; The Ohio State University; Columbus United States
| | - S. Vasu
- Hematology; The Ohio State University; Columbus United States
| | - K. Larkin
- Hematology; The Ohio State University; Columbus United States
| | - N. Epperla
- Hematology; The Ohio State University; Columbus United States
| | - S. Devarakonda
- Hematology; The Ohio State University; Columbus United States
| | - H. Choe
- Hematology; The Ohio State University; Columbus United States
| | - M. Chaudhry
- Hematology; The Ohio State University; Columbus United States
| | - B. Blaser
- Hematology; The Ohio State University; Columbus United States
| | - J. Blachly
- Hematology; The Ohio State University; Columbus United States
| | - B. Bhatnagar
- Hematology; The Ohio State University; Columbus United States
| | - L. Alinari
- Hematology; The Ohio State University; Columbus United States
| | - A. Mims
- Hematology; The Ohio State University; Columbus United States
| | - S. Jaglowski
- Hematology; The Ohio State University; Columbus United States
| | - B.M. William
- Hematology; The Ohio State University; Columbus United States
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Singer S, Dean R, Zhao Q, Sharma N, Abounader D, Elder P, Hofmeister CC, Benson DM, Rosko A, Penza S, Andritsos L, Vasu S, Jaglowski S, William BM, Bolwell B, Pohlman B, Kalaycio M, Jagadeesh D, Hill B, Sobecks R, Devine SM, Majhail NS, Efebera YA. BEAM versus BUCYVP16 Conditioning before Autologous Hematopoietic Stem Cell Transplant in Patients with Hodgkin Lymphoma. Biol Blood Marrow Transplant 2019; 25:1107-1115. [DOI: 10.1016/j.bbmt.2019.01.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
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29
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Maakaron J, Liscynesky C, Boghdadly ZE, Penza S, Brammer JE, Efebera YA, Benson DM, Vasu S, Mims A, Blaser B, Choe H, Larkin K, Long M, Rosko A, Grieselhuber N, Wall S, William BM, Jaglowski S. Levofloxacin Prophylaxis for Autologous Stem Cell Transplant: A Second Look. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.442] [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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30
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Schaefer A, Saygin C, Maakaron J, Hoelscher T, Purdin Z, Robinson J, Lamprecht M, Penza S, Brammer JE, Efebera YA, Benson DM, Vasu S, Mims A, Blaser B, Choe H, Larkin K, Long M, Rosko A, Grieselhuber N, Wall S, Jaglowski S, William BM. Cytopenias after Chimeric Antigen Receptor T-Cells (CAR-T) Infusion; Patterns and Outcomes. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.311] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Vaughn JL, Zhao Q, Epperla N, Puto M, Roddy J, Elder P, Blum W, Klisovic R, Jaglowski S, Penza S, William B, Andritsos L, Brammer JE, Hofmeister C, Efebera Y, Benson D, Devine S, Cataland S, Vasu S. Transplant-associated thrombotic microangiopathy: is the treatment more expensive than the disease? Bone Marrow Transplant 2018; 54:913-916. [DOI: 10.1038/s41409-018-0390-3] [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] [Received: 07/15/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 01/31/2023]
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32
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Vasu S, Geyer S, Bingman A, Auletta JJ, Jaglowski S, Elder P, O'Donnell LC, Bradbury H, Kitzler R, Andritsos L, Blum W, Klisovic R, Penza S, Efebera Y, Hofmeister C, Benson DM, Muthusamy N, Lozanski G, Devine SM. Erratum to "Granulocyte Colony-Stimulating Factor-Mobilized Allografts Contain Activated Immune Cell Subsets Associated with Risk of Acute and Chronic Graft-versus-Host Disease" [Biol Blood Marrow Transplant 22(2016):658-668]. Biol Blood Marrow Transplant 2016; 22:1341. [PMID: 27291293 DOI: 10.1016/j.bbmt.2016.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Rotta M, Wei L, Kitzler R, Bradbury H, Bingman A, Vasu S, Jaglowski S, Blum W, Klisovic R, Penza S, Andritsos LA, Efebera YA, Lozanski G, Devine SM. Significant Impact of Mobilization Strategy on the Cellular Composition of Donor Allografts. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.847] [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: 11/24/2022]
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34
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Vasu S, Geyer S, Bingman A, Auletta JJ, Jaglowski S, Elder P, O'Donnell LC, Bradbury H, Kitzler R, Andritsos L, Blum W, Klisovic R, Penza S, Efebera Y, Hofmeister C, Benson DM, Muthusamy N, Lozanski G, Devine SM. Granulocyte Colony-Stimulating Factor-Mobilized Allografts Contain Activated Immune Cell Subsets Associated with Risk of Acute and Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2015; 22:658-668. [PMID: 26743340 DOI: 10.1016/j.bbmt.2015.12.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/16/2015] [Indexed: 11/28/2022]
Abstract
We defined associations among immune cell subsets in granulocyte colony-stimulating factor (G-CSF)-mobilized allografts and clinical outcomes after allogeneic hematopoietic cell transplantation (alloHCT). Fresh peripheral blood stem cell (PBSC) aliquots from 238 G-CSF-mobilized allografts were extensively characterized by immunophenotype. Subset-specific transplanted cells were correlated with acute graft-versus-host disease (aGVHD), chronic GVHD (cGVHD), malignant disease relapse, nonrelapse mortality, and overall survival. Of 238 assessable alloHCT recipients, 185 patients (78%) received reduced-intensity conditioning and 152 (64%) antithymocyte globulin-based serotherapy. Incidences of aGVHD and cGVHD were 58% and 48%, respectively. Median follow-up was 21 months (range, 1.4 to 41.1). In multivariable analyses adjusted for relevant clinical factors, allograft activated natural killer (NK) cells (CD56(+)CD16(+)CD69(+)CD158b(+)) were associated with a significantly lower risk of aGVHD (P = .0016; HR, .51; 95% confidence interval, .33 to .78), whereas late-activated HLA-DR(+) CD3(+) cells were associated with significantly higher aGVHD (P < .0005; HR, 2.31; 95% confidence interval, 1.55 to 3.43). In a subgroup of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), receipt of an allograft from an older donor (≥40 years) was associated with a higher incidence of relapse (P = .0042; HR, 2.99); allograft content of early activated CD3(+) cells (CD3(+)CD69(+); P = .0024; HR, .4) and NKT cells (CD3(+)CD56(+); P = .0006; HR, .54) were associated with a lower incidence of relapse. Presence of HLA-Bw4-80Ile(+) genotype was associated with lower relapse incidence. In conclusion, activated NK cells within PBSC allografts associate with lower aGVHD risk, whereas HLA-DR(+) T cells associate with higher aGVHD and cGVHD risk. NKT cells and early activated T cells are associated with lower relapse risk in AML and MDS patients. These findings may have implications in therapeutic targeting of select populations in the allograft to minimize incidence of GVHD.
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Affiliation(s)
- Sumithira Vasu
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Susan Geyer
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, Florida
| | - Anissa Bingman
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Jeffery J Auletta
- Host Defense Program, Nationwide Children's Hospital, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Samantha Jaglowski
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Pat Elder
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Lynn C O'Donnell
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Hillary Bradbury
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Rhonda Kitzler
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Leslie Andritsos
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - William Blum
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Rebecca Klisovic
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Sam Penza
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Yvonne Efebera
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Craig Hofmeister
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Don M Benson
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Natarajan Muthusamy
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio; Department of Epidemiology and Biostatistics, University of South Florida, Tampa, Florida
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Steven M Devine
- Division of Hematology, Department of Medicine, The Ohio State University and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
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35
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Roddy JVF, Haverkos BM, McBride A, Leininger KM, Jaglowski S, Penza S, Klisovic R, Blum W, Vasu S, Hofmeister CC, Benson DM, Andritsos LA, Devine SM, Efebera YA. Tocilizumab for steroid refractory acute graft-versus-host disease. Leuk Lymphoma 2015; 57:81-5. [PMID: 26140610 DOI: 10.3109/10428194.2015.1045896] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute graft-versus-host-disease (aGVHD) is a frequent and often lethal complication of allogeneic hematopoietic stem cell transplant despite prophylaxis. Tocilizumab is a humanized anti-IL-6 receptor monoclonal antibody that has evidence of activity in patients with steroid refractory (SR) GVHD. We retrospectively report on nine patients with grade 3 or 4 SR aGVHD who received tocilizumab. Eight mg/kg of tocilizumab was administered intravenously every 3-4 weeks. aGVHD grading and responses were based on consensus criteria. Median age at transplant was 48 years. Five patients had alternate donor sources. Median time from aGVHD onset to tocilizumab administration was 44 days. Two patients had complete responses and two had partial responses. Median survival from start of tocilizumab was 26 days (range 13-1054). Our limited experience demonstrated an overall response rate of 44% (CR + PR); however, this response was not durable. Further studies are needed to determine the optimal time for tocilizumab initiation.
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Affiliation(s)
- Julianna V F Roddy
- a Department of Pharmacy , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Bradley M Haverkos
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Ali McBride
- c Department of Pharmacy , University of Arizona Cancer Center , Tucson , AZ , USA
| | - Kathryn M Leininger
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Samantha Jaglowski
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Sam Penza
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Rebecca Klisovic
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - William Blum
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Sumithira Vasu
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Craig C Hofmeister
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Don M Benson
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Leslie A Andritsos
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Steven M Devine
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
| | - Yvonne A Efebera
- b Division of Hematology, Department of Internal Medicine , James Cancer Hospital, The Ohio State University Comprehensive Cancer Center , Columbus , Ohio , USA
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36
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Cohen JB, Ruppert AS, Heerema NA, Andritsos LA, Jones JA, Porcu P, Baiocchi R, Christian BA, Byrd JC, Flynn J, Penza S, Devine SM, Blum KA. Complex Karyotype Is Associated With Aggressive Disease and Shortened Progression-Free Survival in Patients With Newly Diagnosed Mantle Cell Lymphoma. Clinical Lymphoma Myeloma and Leukemia 2015; 15:278-285.e1. [DOI: 10.1016/j.clml.2014.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
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37
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Saunders ND, Nichols SD, Antiporda MA, Johnson K, Walker K, Nilsson R, Graham L, Old M, Klisovic RB, Penza S, Schmidt CR. Examination of unplanned 30-day readmissions to a comprehensive cancer hospital. J Oncol Pract 2015; 11:e177-81. [PMID: 25585616 DOI: 10.1200/jop.2014.001546] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The Centers for Medicare and Medicaid Services (CMS), under the Hospitals Readmissions Reductions Program, may withhold regular reimbursements for excessive 30-day readmissions for select diagnoses. Such penalties imply that some readmissions reflect poor clinical decision making or care during the initial hospitalization. We examined factors related to potentially preventable readmissions in CMS patients at a tertiary cancer hospital. METHODS The medical records of all CMS patients with unplanned readmissions within 30 days of index admission were reviewed over 6 months (October 15, 2011-April 15, 2012). Each readmission was classified as not preventable or potentially preventable. Factors associated with potentially preventable readmissions were sought. RESULTS Of 2,531 inpatient admissions in CMS patients over 6 months, 185 patients experienced at least one readmission for 282 total readmissions (11%). Median time to readmission was 9 days (range, 0 to 30 days). The most common causes for first readmission were new diagnoses not present at first admission (n = 43, 23%), new or worsening symptoms due to cancer progression (n = 40, 21%) and complications of procedures (n = 25, 13%). There were 38 (21%) initial readmissions classified as potentially preventable. Use of total parenteral nutrition at the time of discharge was associated with potentially preventable readmission (P = .028). CONCLUSION Most unplanned readmissions to a tertiary cancer hospital are related to progression of disease, new diagnoses, and procedure complications. Minimizing readmissions in complex cancer patients is challenging. Larger multi-institutional datasets are needed to determine a reasonable standard for expected readmission rates.
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Affiliation(s)
| | | | | | - Kristen Johnson
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kerri Walker
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Rhonda Nilsson
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lisa Graham
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Matt Old
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Sam Penza
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carl R Schmidt
- The Ohio State University Wexner Medical Center, Columbus, OH
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38
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Hofmeister CC, Williams N, Geyer S, Hade EM, Bowers MA, Earl CT, Vaughn J, Bingman A, Humphries K, Lozanski G, Baiocchi RA, Jaglowski SM, Blum K, Porcu P, Flynn J, Penza S, Benson DM, Andritsos LA, Devine SM. A phase 1 study of vorinostat maintenance after autologous transplant in high-risk lymphoma. Leuk Lymphoma 2014; 56:1043-9. [PMID: 25213183 DOI: 10.3109/10428194.2014.963073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Only a minority of patients with high risk lymphoma will be cured with autologous transplant, so maintenance with vorinostat, an oral agent with activity in relapsed lymphoma, was studied starting day + 60 for 21 consecutive days followed by a week off for up to 11 cycles. Twenty-three patients with lymphoma were treated. Ten patients completed the full 11-cycle treatment plan per protocol, four patients were removed due to progressive disease and seven withdrew or were removed from the study due to toxicities. Despite Prevnar vaccine administration every 2 months for three injections, the mean antibody concentration never reached protective levels (> 0.35 μg/mL). Fatigue and functional well-being measured by Brief Fatigue Inventory and Functional Assessment of Cancer Therapy-General improved significantly from cycle 1 to cycle 7, but depression scores from the Center for Epidemiologic Studies Depression scale did not change. Given the toxicities observed, this broad-spectrum deacetylase inhibitor at this schedule is not optimal for prolonged maintenance therapy.
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Affiliation(s)
- Craig C Hofmeister
- Division of Hematology, Department of Internal Medicine, The Ohio State University , Columbus, OH , USA
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39
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Salem G, Ruppert AS, Elder P, Hofmeister CC, Benson DM, Penza S, Andritsos L, Klisovic R, Vasu S, Blum W, Devine SM, Jaglowski S, Efebera YA. Lower dose of antithymocyte globulin does not increase graft-versus-host disease in patients undergoing reduced-intensity conditioning allogeneic hematopoietic stem cell transplant. Leuk Lymphoma 2014; 56:1058-65. [PMID: 25166008 DOI: 10.3109/10428194.2014.956314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The appropriate dose of antithymocyte globulin (ATG) to be utilized in reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplant (alloHSCT) is as yet unknown. We retrospectively compared patients who received 7.5 mg/kg (R-ATG, 39 patients) and 6 mg/kg (r-ATG, 97 patients). The cumulative incidences of acute graft-versus-host disease (aGVHD) grade II-IV at 180 days were 46% and 41% and of aGVHD grade III-IV were 11% and 18% in r-ATG and R-ATG, respectively (p > 0.30). The respective estimated cumulative incidences at 24 months of cGVHD were 42% and 44% (p > 0.30). There was no significant difference in non-relapse mortality (p = 0.22), cumulative incidence of relapse (p = 0.53), progression-free survival (p = 0.69) or overall survival (p = 0.95). In conclusion, a decreased ATG dose of 6 mg/kg was associated with a similar proportion of GVHD to 7.5 mg/kg ATG. Given the increasing number of RIC HSCTs performed worldwide, the correct dose and preparation of ATG should be defined by prospective randomized trials.
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Affiliation(s)
- Galena Salem
- Division of Hematology, Department of Internal Medicine, The Ohio State University , Columbus, OH , USA
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40
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Jaglowski SM, Ruppert AS, Hofmeister CC, Elder P, Blum W, Klisovic R, Vasu S, Penza S, Efebera YA, Benson DM, Devine SM, Andritsos LA. The hematopoietic stem cell transplant comorbidity index can predict for 30-day readmission following autologous stem cell transplant for lymphoma and multiple myeloma. Bone Marrow Transplant 2014; 49:1323-9. [PMID: 25068419 PMCID: PMC4192086 DOI: 10.1038/bmt.2014.155] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 11/20/2022]
Abstract
Patients who undergo autologous stem cell transplant (ASCT) for hematologic malignancies frequently have multiple comorbidities. The hematopoietic cell transplantation comorbidity index (HCT-CI), a transplant-specific modification of the Charlson comorbidity index, can predict risk of readmission following allogeneic stem cell transplant. Its utility in the autologous setting is unknown. We evaluated 620 patients who underwent ASCT at the Ohio State University from 2007 to 2012 for lymphoma or multiple myeloma (MM) to identify factors associated with readmission. Univariable and multivariable logistic regression were used to estimate the odds of readmission within 30 days of discharge following ASCT. A Cox proportional hazards model was used to evaluate OS. Sixty-four patients were readmitted within 30 days; the most common indications were fever and prolonged gastrointestinal toxicity. MM compared with lymphoma (odds ratio (OR) 1.89, 95% confidence interval (95% CI): 1.06-3.38, P=0.03), HCT-CI⩾3 (OR 1.74, 95% CI: 1.03-2.96, P=0.04) and length of hospitalization ⩾28 days (OR 3.14, 95% CI: 1.26-7.83, P=0.01) remained significantly associated with 30-day readmission in a multivariable model. While the model had excellent fit (P>0.75), its ability to predict individual patients who would be readmitted was less than acceptable (receiver-operator curve=0.64, 95% CI: 0.57-0.71). In a multivariable proportional hazards model, 30-day readmission (hazards ratio (HR) 1.81, 95% CI: 1.04-3.18, P=0.04), length of hospitalization ⩾28 days (HR 4.93, 95% CI: 2.65-9.18, P<0.001) and chemorefractory disease (HR 3.08, 95% CI: 1.74-5.43, P<0.001) were independently associated with inferior OS, but HCT-CI was not. Evaluation of other assessment tools may allow better prediction of outcomes following ASCT.
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Affiliation(s)
- Samantha M. Jaglowski
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Amy S. Ruppert
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Craig C. Hofmeister
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Patrick Elder
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - William Blum
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Rebecca Klisovic
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Sumithira Vasu
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Sam Penza
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Yvonne A Efebera
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Don M. Benson
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Steven M. Devine
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Leslie A Andritsos
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
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41
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Haverkos BM, McBride A, O'Donnell L, Scholl D, Whittaker B, Vasu S, Penza S, Andritsos LA, Devine SM, Jaglowski SM. An effective mobilization strategy for lymphoma patients after failed upfront mobilization with plerixafor. Bone Marrow Transplant 2014; 49:1052-5. [PMID: 24797182 DOI: 10.1038/bmt.2014.90] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 02/20/2014] [Accepted: 03/16/2014] [Indexed: 11/09/2022]
Abstract
In an otherwise eligible patient, inadequate mobilization of PBSCs is a limiting factor to proceeding with an auto-ASCT. In such situations, plerixafor is commonly added to improve PBSC collection yields along with cytokine (G-CSF alone) or chemomobilization (chemotherapy+G-CSF). Individually, both strategies are proven to be safe and effective. Here we report six patients who underwent successful mobilization with combination chemomobilization plus plerixafor after upfront failure of cytokine mobilization plus plerixafor. The median CD34(+) cell yield after chemomobilization was 2.48 × 10(6)/kg (range 0.99-8.49) after receiving one to two doses of plerixafor. All patients subsequently underwent ASCT without major unforeseen toxicities and engrafted successfully. No significant delays in time to neutrophil recovery were observed. Our experience highlights the safety and effectiveness of chemomobilization with plerixafor after G-CSF plus plerixafor (G+P) failure and suggests this is a viable salvage strategy after initial failed G+P mobilization.
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Affiliation(s)
- B M Haverkos
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - A McBride
- Department of Pharmacy, The University of Arizona Cancer Center, Tuczon, AZ, USA
| | - L O'Donnell
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - D Scholl
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - B Whittaker
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - S Vasu
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - S Penza
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - L A Andritsos
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - S M Devine
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - S M Jaglowski
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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42
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Haverkos BM, Geyer S, McBride A, Penza S, Devine SM, Andritsos LA, Jaglowski S. Mobilization for Autologous Stem Cell Transplantation in Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma: A Single Institution Experience. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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43
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Jones JA, Rupert AS, Poi M, Phelps MA, Andritsos L, Baiocchi R, Benson DM, Blum KA, Christian B, Flynn J, Penza S, Porcu P, Grever MR, Byrd JC. Flavopiridol can be safely administered using a pharmacologically derived schedule and demonstrates activity in relapsed and refractory non-Hodgkin's lymphoma. Am J Hematol 2014; 89:19-24. [PMID: 23959599 DOI: 10.1002/ajh.23568] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 07/07/2013] [Accepted: 08/06/2013] [Indexed: 01/14/2023]
Abstract
Flavopiridol is a broad cyclin-dependent kinase inhibitor (CDKI) that induces apoptosis of malignant lymphocytes in vitro and in murine lymphoma models. We conducted a Phase I dose-escalation study to determine the maximum tolerated dose (MTD) for single-agent flavopiridol administered on a pharmacokinetically derived hybrid dosing schedule to patients with relapsed and refractory non-Hodgkin's lymphoma. Dose was escalated independently in one of four cohorts: indolent B-cell (Cohort 1), mantle cell (Cohort 2), intermediate-grade B-cell including transformed lymphoma (Cohort 3), and T-/NK-cell excluding primary cutaneous disease (Cohort 4). Forty-six patients were accrued. Grade 3 or 4 leukopenia was observed in the majority of patients (60%), but infection was infrequent. Common nonhematologic toxicities included diarrhea and fatigue. Biochemical tumor lysis was observed in only two patients, and no patients required hemodialysis for its management. Dose escalation was completed in two cohorts (indolent and aggressive B-cell). Dose-limiting toxicities were not observed, and the MTD was not reached in either cohort at the highest dose tested (50 mg/m(2) bolus + 50 mg/m(2) continuous infusion weekly for 4 consecutive weeks of a 6-week cycle). Clinical benefit was observed in 26% of 43 patients evaluable for response, including 14% with partial responses (two mantle cells, three indolent B-cells, and one diffuse large B-cell). The single-agent activity of this first-generation CDKI suggests that other agents in this class merit further study in lymphoid malignancies, both alone and in combination.
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Affiliation(s)
- Jeffrey A. Jones
- Division of Hematology; The Ohio State University; Columbus Ohio
| | - Amy S. Rupert
- Division of Hematology; The Ohio State University; Columbus Ohio
| | - Ming Poi
- Division of Pharmaceutics, College of Pharmacy; The Ohio State University; Columbus Ohio
| | - Mitch A. Phelps
- Division of Pharmaceutics, College of Pharmacy; The Ohio State University; Columbus Ohio
| | - Leslie Andritsos
- Division of Hematology; The Ohio State University; Columbus Ohio
| | - Robert Baiocchi
- Division of Hematology; The Ohio State University; Columbus Ohio
| | - Don M. Benson
- Division of Hematology; The Ohio State University; Columbus Ohio
| | - Kristie A. Blum
- Division of Hematology; The Ohio State University; Columbus Ohio
| | - Beth Christian
- Division of Hematology; The Ohio State University; Columbus Ohio
| | - Joseph Flynn
- Division of Hematology; The Ohio State University; Columbus Ohio
| | - Sam Penza
- Division of Hematology; The Ohio State University; Columbus Ohio
| | - Pierluigi Porcu
- Division of Hematology; The Ohio State University; Columbus Ohio
| | | | - John C. Byrd
- Division of Hematology; The Ohio State University; Columbus Ohio
- Division of Medicinal Chemistry, College of Pharmacy; The Ohio State University; Columbus Ohio
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44
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Dunavin NC, Wei L, Elder P, Phillips GS, Benson DM, Hofmeister CC, Penza S, Greenfield C, Rose KS, Rieser G, Merritt L, Ketcham J, Heerema N, Byrd JC, Devine SM, Efebera YA. Early versus delayed autologous stem cell transplant in patients receiving novel therapies for multiple myeloma. Leuk Lymphoma 2013; 54:1658-64. [PMID: 23194056 PMCID: PMC3769940 DOI: 10.3109/10428194.2012.751528] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Autologous stem cell transplant (ASCT) is an effective treatment for multiple myeloma (MM). However, the timing of ASCT in the era of novel agents (lenalidomide, thalidomide, bortezomib) is unknown. We retrospectively reviewed the outcome of patients with MM who received novel agent-based induction treatment and received first ASCT within 12 months of diagnosis (early ASCT, n = 102) or at a later date (late ASCT, n = 65). Median time to ASCT was 7.9 months vs. 17.7 months in early vs. late ASCT. The 3- and 5-year overall survival (OS) from diagnosis was 90 and 63% vs. 82 and 63% in early and late ASCT, respectively (p = 0.45). Forty-one and 36 patients in the early and late ASCT groups have relapsed or progressed, with median time to relapse of 28 and 23 months (p = 0.055). On multivariable analysis, factors predictive of increased risk for progression were International Scoring System (ISS) stage III (p = 0.007), and less than a very good partial response (< VGPR) post-ASCT (p < 0.001). A factor predictive of worst outcome for OS was being on hemodialysis (p = 0.037). No superiority of one agent was seen. In summary, early or late ASCT is a viable option for patients with MM receiving induction treatment with novel targeted therapies.
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Affiliation(s)
- Neil C. Dunavin
- Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Patrick Elder
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Gary S Phillips
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Don M Benson
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Craig C. Hofmeister
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Sam Penza
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Carli Greenfield
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Karen S. Rose
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Gisele Rieser
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Lisa Merritt
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Jill Ketcham
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Nyla Heerema
- Division of Cytogenetics, Department of Pathology and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - John C. Byrd
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Steven M. Devine
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Yvonne A. Efebera
- Division of Hematology, Department of Medicine and The Ohio State University Comprehensive Cancer Center, Columbus, OH
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45
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Cohen JB, Hall NC, Ruppert AS, Jones JA, Porcu P, Baiocchi R, Christian BA, Penza S, Benson DM, Flynn J, Andritsos LA, Devine SM, Blum KA. Association of pre-transplantation positron emission tomography/computed tomography and outcome in mantle cell lymphoma. Bone Marrow Transplant 2013; 48:1212-7. [PMID: 23584442 DOI: 10.1038/bmt.2013.46] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 02/21/2013] [Accepted: 03/04/2013] [Indexed: 11/09/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT)-positive findings before autologous SCT (auto-SCT) are associated with inferior PFS and OS in patients with relapsed Hodgkin's and diffuse large B-cell lymphoma. We classified pre-transplant PET/CT performed before auto-SCT as positive or negative to evaluate the impact of pre-transplant PET/CT in mantle cell lymphoma (MCL). In 29 patients, 17 were PET/CT(-) and 12 were PET/CT(+). PET/CT(+) patients were younger (P=0.04), had lower MCL International Prognostic Index (MIPI, P=0.04) scores, but increased bulky adenopathy >5 cm (45% vs 13%, P=0.09). With a median follow-up of 27 months (range: 5-55 months), 7 patients relapsed (4 in the PET/CT(-) group and 3 in the PET/CT(+) group) with 2 deaths in the PET/CT(+) group without a documented relapse. The estimated 2-year PFS was 64% (95% confidence interval (CI): 0.30-0.85) vs 87% (95% CI: 0.57-0.97) in PET/CT(+) and PET/CT(-) patients, respectively (P=0.054). OS was significantly decreased in PET/CT(+) patients (P=0.007), with 2-year estimates of 60% (95% CI: 0.23-0.84) vs 100% in PET/CT(-) patients. A positive pre-transplant PET/CT is associated with a poor prognosis in patients with MCL. Additional factors may impact the prognostic value of PET/CT, as several PET/CT(+) patients remain in remission.
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Affiliation(s)
- J B Cohen
- Division of Hematology, Arthur G James Comprehensive Cancer Center and Wexner Medical Center at The Ohio State University, Columbus, OH 43210, USA.
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46
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Pandit A, Wei L, Elder P, Falk W, Sell M, Hofmeister CC, Benson DM, Penza S, Andritsos LA, Klisovic R, Vasu S, Blum W, Devine SM, Jaglowski S, Efebera Y. Autologous Hematopoietic Stem Cell Transplant (aHSCT) is a Safe and Reasonable Treatment in Patients with Primary Systemic Amyloidosis (AL amyloidosis). Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Salem G, Ruppert AS, Elder P, Hofmeister CC, Benson DM, Penza S, Andritsos LA, Klisovic R, Vasu S, Blum W, Devine SM, Jaglowski S, Efebera Y. Lower Dose of Antithymocyte Globulin (ATG) Decreases Infection Rate without Increasing Graft-Vs-Host Disease (GVHD) and Relapse in Patients Undergoing Reduced-Intensity (RIC) Allogeneic Hematopoeitic Stem Cell Transplant (HSCT). Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.447] [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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48
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Cohen JB, McBride A, Geyer S, Bingman A, Elder P, Blum W, Klisovic R, Penza S, Andritsos LA, Benson DM, Efebera Y, Hofmeister CC, Garzon R, Marcucci G, Devine SM. Improved Survival of Patients (Pts) with Acute Graft-Versus-Host Disease (aGVHD) During Recent Years: Impact of Donor and Recipient Characteristics. Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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49
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Efebera Y, Geyer S, Bingman A, Kitzler R, Elder P, Hennelly C, Andritsos LA, Jaglowski S, Blum W, Klisovic R, Penza S, Vasu S, Hofmeister CC, Benson DM, Devine SM, Lozanski G. Impact of Atorvastatin On Cellular Immunome of Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation (AHSCT). Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.221] [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: 11/29/2022]
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50
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Salem G, Ruppert A, Efebera Y, Elder P, Bingman A, Penza S, Andritsos L, Devine S. Busulfan, Cyclophosphamide, Etoposide (BUCYVP) or Carmustine, Etoposide, Cytarabine, Melphelan (BEAM) for Conditioning Prior to Autologous Stem Cell Transplantation (ASCT) in Patients with Hodgkin Lymphoma (HL)? Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.127] [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: 10/14/2022]
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